DVLA — Diabetes and Driving
Fitness to drive guidance for patients treated with insulin or insulin secretagogues. All decisions must be assessed against current DVLA At a Glance guidance.
Open DVLA At a Glance guidance Patient information — Diabetes & Driving (PDF)| Treatment | Licence type | DVLA notification? | Action |
|---|---|---|---|
| Diet only / metformin / DPP-4i / SGLT2i / GLP-1 RA (no hypo risk) | Group 1 & Group 2 | Not required | Annual review. No driving restriction. |
| Sulphonylurea (gliclazide, glimepiride) or meglitinide | Group 1 | Notify DVLA | Complete D1/D4 form. CBG ≥ 5.0 mmol/L before driving. Annual DVLA review. |
| Sulphonylurea or meglitinide | Group 2 (HGV/bus) | Must notify DVLA | Individual assessment. Strict CBG monitoring required. |
| Insulin (all types) | Group 1 | Must notify DVLA | Complete DIAB1. Must satisfy all monitoring and hypo awareness criteria. |
| Insulin | Group 2 (HGV/bus) | Must notify DVLA | Much stricter criteria apply — see below. Most patients cannot hold Group 2 on insulin. |
- Check CBG ≥ 45 minutes before driving
- CBG must be ≥ 5.0 mmol/L before starting journey
- Recheck CBG every 2 hours on long journeys
- Fast-acting glucose must be accessible in vehicle (not in boot)
- Do not drive if CBG < 4.0 mmol/L — treat and wait 45 min before reassessing
- Must have adequate hypoglycaemia awareness
- Must not have had a severe hypoglycaemic episode whilst driving in the last 12 months
- Complete DVLA DIAB1 form and carry medical ID
- Two or more episodes of hypoglycaemia requiring assistance in last 12 months
- Severe hypo whilst driving
- Impaired hypoglycaemia awareness (unawareness)
- CBG consistently < 5.0 mmol/L pre-drive and unable to correct
- Inability to comply with CBG monitoring requirements
To be considered for Group 2 entitlement, an insulin-treated patient must satisfy all of the following:
- No episode of disabling hypoglycaemia in the preceding 12 months
- Full hypoglycaemia awareness
- CBG monitoring at least twice daily and at relevant times (pre-drive, every 2 hours)
- CBG ≥ 5.0 mmol/L before each driving period and after each 2-hour interval
- Ability to recognise and treat hypoglycaemia
- A consistent pattern of glucose control without severe excursions
- Annual independent medical examination by an endocrinologist / diabetologist
Use of CGM with low glucose alarm is strongly recommended but does not remove manual CBG requirement.
Refer to diabetes specialist or structured education (BGAT, HARPdoc)
Avoid CBG < 4.0 for minimum 3 months to restore awareness
Reassess awareness before re-licensing
| Form | Purpose | Completed by |
|---|---|---|
| DIAB1 | Insulin-treated diabetes — Group 1 notification | Patient (DVLA processes) |
| DIAB1A | Insulin-treated diabetes — Group 2 (HGV) notification | Patient + specialist |
| D1 / D4 | Sulphonylurea or other hypo-risk oral agent — Group 1 | Patient |
| Specialist report (INF240) | Consultant report for borderline / contested cases | Endocrinologist / diabetologist |
| Patient information leaflet — Diabetes & Driving | Patient information leaflet — diabetes and driving | Provide to patient at insulin start / SU start |
Patient Profile
Patient cohort — drives HbA1c target & NG28 therapy alignment
1 — HbA1c
Not entered2 — Lipids / statin management
Not entered3 — Blood pressure
Not entered4 — CKD / renal
Not entered5 — Foot risk / complications screening
Not entered6 — Liver / MASLD screening
Not enteredPRISM Diabetes Scorecard · © Gupta R, Gupta A (2026) · NICE NG28 / NG238
🏥 Sick Day Rules — Patient Card Generator
Choose a mode: Bespoke — tick the patient's actual medications to generate a personalised card. Standard — select a pre-set rule set for common combinations. Print the card to give to the patient.
Sick Day Rules — If you use INSULIN
Keep this information safe. Share it with your family or carers.
Even if you cannot eat, your body needs insulin. Stopping insulin causes dangerous ketones to build up in your blood — this can lead to DKA (diabetic ketoacidosis), which is a medical emergency.
Check for ketones if blood glucose above 14 mmol/L — use blood ketone meter (preferred) or urine ketone sticks if unavailable.
Sip regularly — even small amounts if feeling sick. If you cannot keep fluids down: call 999.
| Blood glucose reading | What to do |
|---|---|
| < 4.0 mmol/L | Treat hypo: 15–20 g fast glucose (4–5 glucose tabs). Recheck in 15 min. Do not drive. |
| 4.0–7.0 mmol/L | In target. Continue usual insulin. Eat if able. Monitor 2–4 hourly. |
| 7.1–14.0 mmol/L | Above target. Stay hydrated. Check ketones. Contact your GP or diabetes team if no improvement. |
| > 14.0 mmol/L | Check ketones immediately. Blood ketones ≥ 0.6 mmol/L (or urine 1+): contact GP urgently. Blood ketones ≥ 1.5 mmol/L: go to A&E. |
You are vomiting repeatedly and cannot keep fluids down · Blood ketones ≥ 3.0 mmol/L (or urine 3+) · You feel very confused, drowsy, or cannot be roused · Blood glucose consistently > 17 mmol/L despite extra insulin
Glucose tablets · Glucagon emergency kit (GlucaGen / Baqsimi) · Ketone testing strips · Spare insulin pen + needles · Written copy of these sick day rules
Phone: —
Out of hours: Call NHS 24 (111) or 999 in emergency
Sick Day Rules — If you take an SGLT2 inhibitor
Dapagliflozin (Forxiga) · Empagliflozin (Jardiance) · Canagliflozin (Invokana)
You are vomiting or have severe diarrhoea · You cannot eat or drink normally · You are fasting for surgery or a medical procedure · You have a serious infection or fever · You feel very unwell
You can restart your SGLT2 inhibitor tablet when you have been eating and drinking normally for at least 24–48 hours and you feel well again. If unsure — contact your GP or pharmacist.
SGLT2 inhibitors can cause a rare but dangerous condition called euglycaemic DKA. Unlike normal DKA, your blood glucose may be normal or only mildly raised — so you might not realise how unwell you are. Symptoms: nausea, vomiting, abdominal pain, excessive thirst, difficulty breathing.
Nausea or vomiting · Abdominal pain · Rapid breathing or shortness of breath · Unusual tiredness · Fruity-smelling breath · These symptoms need urgent blood ketone testing and medical review.
| Situation | Action |
|---|---|
| Vomiting / diarrhoea | Stop SGLT2i immediately. Stay hydrated. Monitor glucose. |
| Planned surgery / procedure | Stop SGLT2i at least 3 days before (some guidance says up to 5 days for major surgery). |
| Reduced oral intake | Stop SGLT2i if unable to eat normally. |
| Symptoms of DKA despite normal glucose | A&E immediately — request blood ketone measurement. |
Phone: —
Out of hours: Call NHS 24 (111) or 999 in emergency
Sick Day Rules — Insulin + SGLT2 inhibitor
You take both insulin injections AND an SGLT2 inhibitor tablet. Different rules apply to each.
Even when unwell and not eating — always take your insulin. Your body needs it.
Restart only when eating and drinking normally for 24–48 hours.
With SGLT2i: DKA can occur with near-normal glucose levels — don't be falsely reassured.
Vomiting repeatedly · Blood ketones ≥ 0.6 mmol/L (or urine 1+) (even with normal glucose) · Confusion or drowsiness · Unable to keep fluids down
Phone: —
Out of hours: Call NHS 24 (111) or 999 in emergency
Sick Day Rules — ACE inhibitor, ARB & diuretic
Ramipril · Lisinopril · Losartan · Candesartan · Furosemide · Indapamide · Bendroflumethiazide
When you are unwell, dehydrated, vomiting, or have diarrhoea, these medicines together can cause sudden kidney injury. This is sometimes called the "triple whammy" if you are also taking ibuprofen or other anti-inflammatory tablets.
Restart all your usual medicines when you have been eating and drinking normally for 24–48 hours and feel well again. If unsure — contact your GP or pharmacist before restarting.
These tablets (NSAIDs) put extra strain on the kidneys when combined with your BP medicines. Use paracetamol instead for pain or fever when unwell.
| Situation | Action |
|---|---|
| Vomiting or diarrhoea | Stop ACEi/ARB and diuretic. Keep hydrated with water/clear fluids. Restart when well for 48h. |
| Cannot eat or drink | Stop ACEi/ARB and diuretic. Seek medical advice if lasting > 24h. |
| Prescribed antibiotics or antifungals | Some antibiotics can interact — check with GP or pharmacist whether to pause BP medicines. |
| Planned surgery or procedure | Tell your surgeon you take these medicines. You may be asked to stop them 24–48h before. |
| Signs of kidney problems: passing very little or no urine, swollen legs, confusion | Seek urgent medical advice — call your GP or NHS 24 (111). |
Aim for 6–8 glasses of fluid per day. Staying hydrated is the single most important thing you can do to protect your kidneys when you are also taking these medicines.
Phone: —
Out of hours: Call NHS 24 (111) or 999 in emergency