This material reproduced with the permission of the Land Transport Safety Authority (LTSA)
If you’ve got diabetes, you need to be aware of the risks involved when you’re driving. If you know the risks, you can take steps to manage them.
If your diabetes has just been diagnosed and treatment is still being adjusted, you may not be fit to drive just yet. Check with your doctor.
Low blood glucose levels are dangerous for drivers with diabetes. If you’re taking insulin or tablets for diabetes (except Metformin), it’s very important that you avoid low blood glucose levels, which can greatly impair your driving and cause crashes.
High blood glucose levels could leave you feeling unwell or tired, and may affect your ability to drive safely. You should avoid driving while you’re hyperglycaemic.
People with insulin-dependent diabetes are not normally allowed to drive taxis, heavy trade and passenger service vehicles. If a diabetes specialist wrote on your behalf to the Chief Medical Advisor of the Land Transport Safety Authority (LTSA), we might make an exception. Strict conditions would apply.
If your diabetes is well controlled you can drive a private car safely. However, there are times when you need to take precautions.
In some situations you may need to refrain from driving. If you have a mild hypoglycaemic episode we recommend that you don’t drive for at least an hour, to give your brain time to recover.
If you have a severe hypoglycaemic episode (eg when you need someone else’s help to deal with it), you shouldn’t drive for 24 hours. If you have several hypoglycaemic episodes you should talk to your doctor before you return to driving.
If you have a severe hypoglycaemic episode while you’re driving, whether you’re involved in a crash or not, you shouldn’t drive for at least a month. It’s likely you’ll need to be reviewed by a specialist before you can safely return to driving, and you need to talk to your doctor.
Your driving ability could be affected by long-term complications of diabetes, such as eyesight deterioration and the loss of normal sensation in your feet. Check with your doctor.
Some drivers with diabetes may be issued with a licence that has certain conditions attached. The conditions will depend on the type of licence (classes and endorsements), how the diabetes is controlled, any history of hypoglycaemic attacks, compliance with medications and an assessment of any medical complications that are commonly associated with the diabetes. The LTSA’s Director decides the type of conditions to impose, having regard to the Medical Aspects of Fitness to Drive booklet and in consultation with the LTSA’s Chief Medical Adviser.
Insulin and tablets for the control of diabetes are classified as drugs under the Land Transport Act 1998. You may be prosecuted under this Act if you’ve been misusing or abusing diabetes medications and your driving results in crashes or injuries. For a case to proceed, however, there would need to be proof that the way you’d used the drugs was contrary to medical advice.
Don’t hesitate to see your doctor or your diabetes educators if you have any questions. A handbook that includes a chapter on diabetes, Medical Aspects of Fitness to Drive, has been issued to all doctors.
For more information contact the Land Transport Safety Authority:
PO Box 2840
Alternatively, visit the LTSA website or freephone 0800 699 000.
You can usually do all you want to do when travelling with Type 2 diabetes. But it helps if you plan ahead.
How you prepare depends on where you’re going and for how long. Two weeks backpacking through Europe takes different planning than a week at the beach. Will you be crossing time zones? What kind of food will you eat and when? Will you be more active or less active than usual?
Consider telling your travel agent that you have diabetes and explain some of the particular needs that travelling with diabetes entails. That way, a suitable itinerary can be planned to meet your needs.
It’s a good idea to visit your doctor for a check-up several weeks before you leave. Show your itinerary to your health care team and work out plans for your food and medication, especially if you are travelling through different time zones.
Get immunisation shots (if you need them) at least one month before you leave. If the shots make you unwell, you’ll have time to recover before your trip.
Health insurance for your trip is an absolute must. All travellers are prone to infectious illnesses as they travel through new countries. Having Type 2 diabetes puts you at higher risk. An infection or injury can also be harder to manage when you have Type 2 diabetes. It is important for you to be able to access good quality healthcare if you need it.
Before any trip, get three papers from your doctor:
The letter for customs:
The letter for a doctor should:
Supplies of diabetes medications
Make sure you have a full supply of all your diabetes medications before you leave. Your prescription should enable you to get ample supplies of your medication and test strips. Enough to get you through to the next time that you will be settled in a country where you are certain you can get supplies (try not to run low on medication or test strips while you are travelling).
Other medicine supplies
If you are going into remote or isolated areas is often sensible to get a prescription from your doctor for anti nausea and vomiting medication, anti diarrhoea medication, and some basic anti fungal and antibiotic medication. Doing this will mean you’ll have the medications you need should you become sick overseas and are unable to get medical help quickly. Discuss your needs with your doctor and remember to get he/she to give you instructions on when and how to use the medication. Get the prescription filled before you leave and carry these medications with you.
It is best to wear a medical ID bracelet or necklace that shows you have diabetes. It is also wise to carry a card in your wallet or amongst your travelling papers that states you have Type 2 diabetes and what medication you take.
Visit the MedicAlert Foundation of New Zealand website for more information about obtaining a medical ID bracelet.
Managing low blood glucose levels
If you take sulphonylurea tablets or insulin for your diabetes carry a source of simple carbohydrate on you, e.g., orange juice, glucose tablets, jelly beans. It also pays to carry a small complex carbohydrate snack on you (e.g., muesli bar).
People on holiday often drink more alcohol than usual. Try to drink only moderately, and be aware of the safety guidelines for drinking alcohol if you are on sulphonylurea tablets or insulin.
Managing sickness and high blood glucose levels.
If you get sick overseas you may not have access to the same level of health care that you have in most parts of New Zealand. You may be on a camel trip across the Sahara!
It is important for you to be clear about how to go about managing sickness and high blood glucose levels for people with Type 2 diabetes. If possible go over the guidelines for managing illness with Type 2 diabetes with a diabetes nurse educator before going away.
Remember, stop taking metformin (metomin, glucophage) if you develop vomiting or diarrhoea. You can start back on it when you are well again.
If you are in remote areas take:
Pack more medication and blood-testing supplies than you think you will need. Pack all of these in your personal carry bag so that your medication and testing supplies are always with you. This way you are less likely to get separated from your essential supplies if your luggage goes astray. Also the temperature in the baggage compartments of some planes can be very low. This can damage your testing strips or meter or insulin (if you take insulin).
Your carry bag should contain:
Keep these things in mind when you travel with insulin:
Insulin doses when travelling
Managing your insulin doses while travelling is complex, especially if you are crossing time zones rapidly (by air). Crossing time zones, effectively, makes your day either longer or shorter, so you’ll need to adjust your insulin doses (and food) to compensate for this.
The safest way to plan your insulin management when travelling is to work it through with your specialist diabetes team before you leave. Give yourself plenty of time to plan by making this appointment well in advance of your departure date.
Take your full travel itinerary when you see the team. Make sure you come away with a plan you are happy with and that you understand. This plan should be written down. See more on managing your insulin across time zones in the “Tips for Travel by Air” section.
Some people have found that if they request special diabetes meals on airlines that they get served meals that are very low in carbohydrate. It is often best to order standard meals and to make healthy choices within that.
If you are on medications that can cause your blood glucose levels to go low let the cabin staff know. This way they will be alert if you need any help. Also carry glucose and a carbohydrate snack on you.
If you are on insulin
The security scanners used at check-in will not damage insulin or blood glucose meters.
Wait until you see your food coming down the aisle before you take your injection. Otherwise, a delay in the meal could lead to a low blood glucose level.
If you are on insulin you may need to make changes to the dose or timing of your injection when moving across time zones. Having two watches often helps you keep track of these changes. Keep one watch on the time of the country you have just left. This will enable you to remain very clear on when your next insulin would have been due. You can also accurately judge how much time has passed since you had your last insulin if you record your insulin doses against this time.
Have a plan worked out in conjunction with your specialist diabetes team in advance as to how you will manage your insulin doses if you are crossing time zones.
Avoid risks of blood clots in your legs
Keep up a good level of activity during your journey. Walk around in the terminal before boarding.
When you are booking your seat try to get an aisle seat. Because you have diabetes you are more likely to develop blood clots in your legs. To prevent this happening it is essential that you get up and walk around in flight for a few minutes every hour while you are awake. Doing simple stretching exercises when seated also helps. Move your ankles in circles and point and release your toes often. This encourages good blood flow in your legs.
Blood glucose testing
You may find it helpful to test your blood glucose levels more frequently while travelling. The timing and content of your food will change. It is also easy to mix up the effects of jet lag with either high or low blood glucose levels, so it pays to know what your glucose levels are doing. Remember when you are tired it is easy to neglect your diabetes. But it is at these times that you need to know more about what is happening.
With the wide array of mouth-watering foods available on cruise holidays, it’s easy for your diabetes management to get out of kilter. Talk to your diabetes educator or dietitian before you leave about how you plan to deal with the food aspect of the trip. It’s often helpful to get a sample menu from the cruise line so you can get an idea of the types of foods that will be served.
Cruise ships offer some great activities to help you stay active. These range from aerobics classes, swimming, gym workouts, dancing, or strolling the deck at sunset.
It’s a good idea to make the cruise staff aware of your diabetes in case any problems arise. Keep a card or I.D. on you that states you have Type 2 diabetes.
Our “Diabetes & Driving” section contains practical information about what you need to look out for when you are driving, as well as some of the legal aspects of driving in NZ with diabetes. Your travel agent can often find out in advance the rules covering driving in the countries you will be visiting. If you are on diabetes medication that can cause low blood sugar levels test your blood sugar before and during driving and treat any low blood sugar levels promptly.
A holiday in the great outdoors can be a wonderful retreat from the pressures of everyday life. But there are a few things to consider before you go. Here are some tips:
The key to enjoying a trip of this kind is to try to avoid things that may significantly alter your blood glucose levels. Be aware of safety and try to avoid sunburn, injuries and contaminated food or water. Make sure your foot wear is sturdy and also fits you well. Don’t use brand new shoes to hike in, try them out before the trip.
Eat and drink enough to meet your needs. Take extra food, water and medication. If you are on medication that can cause your blood glucose to go low take supplies of simple carbohydrate (e.g., glucose, sugar).
Hiking, cycling or kayaking nearly always means you are a lot more physically active than usual. If you are on sulphonylurea tablets or insulin you may find your blood sugar levels begin to go low. If this happens it is often best to reduce the dose of these medications while you are having the extra activity. Talk to your specialist diabetes team before you go if you are planning a very active holiday. Ask them to help you plan for dose reduction if need be.