As long as your diabetes is well-controlled, there’s no reason it should stop you from driving. However, the process of obtaining a license is a lot more arduous for people with diabetes, and chronic medical conditions in general.

This page provides an overview of the laws regarding driving and driving licenses in the US. Please use this only as a general guide; the specifics of driving laws vary from state to state.

Applying for a license

Each state has its own laws about driver’s licenses. The process varies depending on where you live. In most states, you will have to provide some information about your condition. Sometimes this refers specifically to diabetes, and sometimes you will only be asked if you have a medical condition that could impact your ability to drive.

In many states, people with diabetes will then be given a form, which is filled in by a physician. Typically, it includes questions about hospitalisation, medication, and fasting blood glucose test results. The form will be used to decide whether or not you should be given a driving license.

Maintaining your license, and suspension

Once you’ve received your driver’s license, you have to maintain good blood glucose control at the wheel in order to keep it. Having a hypo behind the wheel, even if it’s of no consequence, is enough for suspension in some states.

In others, severe hypoglycemia is enough for suspension, even if it doesn’t occur behind the wheel. If driving is a key part of your life, the importance of keeping blood sugars under control cannot be overstated. Especially as many states don’t take into account extenuating circumstances, such as illness or changes to medication.

If your license is suspended, most states allow you to appeal. How many days you have to appeal depends on the state in question.

Driving safely: Driving and hypoglycemia

Safe driving isn’t just important to keep your license; not doing so can endanger your life. And for people with diabetes, safety at the wheel concerns more than just how you operate your car.

The main risk that people with diabetes – particularly type 1 diabetes – are exposed to is hypoglycemia, or low blood glucose levels. It is paramount that people with diabetes who are susceptible to hypoglycemia (such as those with insulin-dependent diabetes or certain type 2 medications, such as sulfonylureas) test their blood glucose levels before driving. Do not drive if your blood glucose levels are below 90mg/dL. If they are, eat or drink something sugary, or some form of fast-acting carbohydrate. Ensure your blood glucose levels have been above 90mg/dL for at least 45 minutes before driving.[1]

Although hypoglycemia is a problem that primarily affects people with type 1, certain type 2 drugs can also cause low blood glucose levels.

In many states, the Department of Motor Vehicles (DMV) will be strict on hypoglycemia. Most will suspend your license in the event of any severe hypoglycemia (loss of consciousness, in particular). Keeping your blood sugars in check is vital not just for your safety, but in order to keep your driver’s license.

To lower the risk of hypoglycemia while driving, avoid injecting bolus insulin while driving a short distance. In some situations – longer journeys, for example – you’ll have to take insulin. If so, consider injecting slightly less than you normally would. If you inject, be sure to keep a sugary drink or something similar nearby in case of a hypo.

Driving with vision problems

Different states have different eyesight requirements for drivers; these can vary significantly. In California, for example, the state requires 20/40 vision. In Oregon, drivers are required to have 20/70 vision. Be sure to check the specific rules in your state.

There are several diabetic complications that can harm your vision. The most common is retinopathy. Others include glaucoma and cataracts.

Driving with foot problems

Nerve damage (often known as diabetic neuropathy) can damage your feet, and affect your ability to drive safely. If you have neuropathy, be sure to let the DMV know. Like most driving rules, different states will have different regulations regarding neuropathy and driving competency.

Almost all states need to know about your neuropathy, however. Particularly if it affects the feet and legs.

Car insurance and diabetes

Car insurance isn’t always mandatory: in states such as Alabama, Iowa, Mississippi, New Hampshire, and Pennsylvania, motorists have other options. In most others you need to have car insurance. Be sure to check the specific insurance rules in your state.

You should tell your insurer about your diabetes. People who have a health condition that could make them less safe as a driver – such as epilepsy or diabetes – may have to pay more money.

Different insurers will offer different rates to people with diabetes, however, so it’s worth shopping around. Consider a number of different insurers, compare the various options, and find the insurer that’s best for you and your diabetes.