Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.
There are two main types of diabetes – type 1 diabetes and type 2 diabetes. In 2010, there were approximately 3.1 million people aged 16 or over with diabetes (both diagnosed and undiagnosed) in England. By 2030, this figure is expected to rise to 4.6 million, with 90% of those affected having type 2 diabetes.
The charity Diabetes UK estimates that around 850,000 people in England have diabetes but haven't been diagnosed. Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as prediabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased. It's very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated.
You should therefore visit your GP as soon as possible if you have symptoms, such as feeling thirsty, passing urine more often than usual, and feeling tired all the time.
Symptoms of diabetes
The main symptoms of diabetes are:
- feeling very thirsty
- urinating more frequently than usual, particularly at night
- feeling very tired
- weight loss and loss of muscle bulk
- itching around the penis or vagina, or frequent episodes of thrush
- cuts or wounds that heal slowly
- blurred vision (caused by the lens of the eye becoming dry)
Type 1 diabetes can develop quickly over weeks or even days.
Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.
What causes diabetes?
The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).
When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it's broken down to produce energy.
However, if you have diabetes, your body is unable to break down glucose into energy. This is because there's either not enough insulin to move the glucose, or the insulin produced doesn't work properly.
Type 1 diabetes
In type 1 diabetes, the body's immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body's organs.
Type 1 diabetes is often known as insulin-dependent diabetes. It's also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years.
Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes.
If you're diagnosed with type 1 diabetes, you'll need insulin injections for the rest of your life.
You'll also need to pay close attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced.
Type 2 diabetes
Type 2 diabetes is where the body doesn't produce enough insulin, or the body's cells don't react to insulin. This is known as insulin resistance.
Type 2 diabetes is far more common than type 1 diabetes. In the UK, around 90% of all adults with diabetes have type 2 diabetes.
If you're diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels.
However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets.
Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it's more common in older people.
You can use the BMI healthy weight calculator to check whether you're a healthy weight.
Read more about type 2 diabetes.
Diabetic eye screening
Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year.
If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it's not treated.
Screening, which involves a half-hour check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively.
Read more about diabetic eye screening.
Gestational diabetes (in pregnancy)
During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes and affects up to 18 in 100 women during pregnancy.
Pregnancy can also make existing type 1 diabetes worse. Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it's important to keep your blood glucose levels under control.
In most cases, gestational diabetes develops during the second trimester of pregnancy (weeks 14 to 26) and disappears after the baby is born.
However, women who have gestational diabetes are at an increased risk (30%) of developing type 2 diabetes later in life (compared with a 10% risk for the general population).
Read more about gestational diabetes.
Diabetes, Driving and the Law
If you have diabetes and wish to drive, it is important to know the law and how it affects you. This will help to keep you as safe as possible, as well as making sure you aren't prosecuted for illegal driving. This section will help explain your rights and responsibilities as a driver with diabetes.
Do you need to inform the Driving and Vehicle Licensing Agency (DVLA)?
If you have a driving licence, it is probably for Group 1 vehicles i.e the usual licence for cars and some types of motorcycle that most people hold. If this is the case, you do not automatically inform the DVLA if your diabetes is treated by diet alone or by diet, tablets and/or non-insulin injections (e.g. exenatide).
However the law requires you to inform the DVLA as soon as possible if:
- You are treated with insulin, alone or in combination with tablets
- You have a complication of diabetes, such as eye problems or nerve damage to your legs and feet
- You have a problem with your vision or require laser treatment or injections for your eyes
- You develop any problems with the cirulation or sensation in your legs or feet which means you can oly drive certain types of vehicles e.g automatic vehicles or those with a hand operated accelerator or brake
- There are changes in your medical condition or treatment e.g you start using insulin
- You currently experience severe hypoglycaemia* (low blood sugar) or have had more than one episode of this in the past 12 months
- You or your carer feels that you are at high risk of developing severe hypoglycaemia at the wheel
- You have difficulty recognising the warning signs of hypoglycaemia (see section below entitled 'Hypoglycaemia')
- An existing medical condition gets worse or you develop any other condition which may affect safe driving
*Note - 'severe Hypoglycaemia' is defined as an episode requiring the assistance of another person.
To notify the DVLA you'll need to fill in and return a medical questionnaire form called a DIAB1 (see 'Further information' at the end of this section). The DVLA will then look at your individual circumstances and let you know if any further action is needed.
Safe Driving measures
You should carry your blood glucose meter and test strips with you and check your blood glucose before driving on any journey, and at frequent intervals (every 2 hours) on longer journeys. If your blood glucose is less than 5.0mmol/L before you start a journey, make sure that you have a snack and do not start driving until your blood glucose has been sustained above 5.0mmol/L for at least 45 minutes. It can take up to 45 minutes for your brain to recover after a period of low blood glucose, during which time your responses will be slower.
The DVLA advises that you carry a supply of fast-acting carbohydrate within easy reach in your vehicle (for example glucose tablets.)
*Always stop at a safe place to test, never perform a blood glucose whilst driving.
Hypoglycaemia, also known as 'hypo', is the medical word for low blood glucose. In other words, the amount of sugar in the blood is too low for the body to work as it normally would when enough sugar is available.
Hypoglycaemia can cause a person to feel tired, dizzy and confused, have blurred vision and even pass out completely. The risk of hypoglycaemia is the main danger to safe driving in people with diabetes who are treated with insulin, tablets or both these.
Many of the accidents caused by Hypoglycaemia happen because people carry on driving even though they get one or more of the early warning signs of the condition:
- Feeling confused, weak or tired
- Feeling irritable or anxious
- Feeling hungry
- Having shakiness or trembling
- Having a headache
- Awareness of heart beating faster than usual
- Having tingling lips
If you have any of these early signs of Hypoglycaemia, stop driving as soon as it is safe to do so and secure your vehicle. Then have a fast acting carbohydrate snack, such as glucotabs or fruit juice. After this,eat something containing starch, such as a sandwich or banana or eat your next meal if this is due. only continue driving when you feel totally fine again, your blood glucose has returned to over 5mmol/L and has stayed in the normal range for at least 45 minutes. If in any doubt, do not drive and seek medical assistance.
Licence to drive large vehicles such as buses or lorries
A Group 2 licence is required to drive large lorries (Category C) and buses (Category D). The medical standards that must be met for a Group 2 licence are much higher than those for a Group 1 licence, because of the additional size and weight of the vehicles.
If you are treated with non-insulin medication that may cause Hypoglycaemia
If you hold a Group 2 licence and take sulphonylureas (e.g glibenclamide or gliclazide) or tablets from the prandial glucose regulator group of medicines (e.g nateglinide or repaglinide) you must notify the DVLA, as these increase the risk of hypoglycaemia. other tablets for diabetes tend not to increase the risk of Hypoglycaemia when used alone, but may do so when used in combination with other medicines. To make sure you meet legal requirements, ask your doctor or diabetes nurse to confirm which type of tablets you take and whether the DVLA should be notified as part of holding a Group 2 licence. You must also notify the DVLA if there is any change in your condition.
To notify the DVLA, complete and return a DIABV1 form (see 'further information' at the end of this section) The DVLA will then, with your consent, seek further information from your healthcare team. Each case is considered individually.
If you are treated with insulin
From November 2011, the DVLA removed the ban on people driving Group 2 vehicles whilst receiving insulin therapy. People with diabetes treated with insulin can now undergo individual medical assessment to determine their fitness to drive these vehicles.
To apply for a Group 2 licence you'll need to meet the following requirements:
- You have has no episode of Hypoglycaemia requiring the assistance of another person in the previous 12 months
- You have full Hypoglycaemia awareness
- You can show adequate control of your diabetes by regular blood glucose monitoring at least twice daily and at times relevant to driving using a blood glucose meter with a memory function**
- You have at least 3 months of blood glucose reading available for review.
- You can demonstrate an understanding of the risks of Hypoglycaemia
- You have no other medical conditions which would make you a danger when driving e.g. eyesight problems
- You must keep a fast acting carbohydrate in your vehicle at all times when driving e.g glucose tablets.
**IMPORTANT - you will need to take your blood glucose measurements using a blood glucose meter that has a memory function. Not all blood glucose meters have this function, so ask your diabetes nurse if you are unsure. The ability to convert data from the memory into an easy to read visual form, such as graphs and charts, is also useful for monitoring and displaying your blood glucose control.
If you can meet all the above requirements there are then three stages in the application process for a Group 2 licence:
- Ask the DVLA for a D2 application form and a DIAB1V medical questionnaire, then fill these in
- Ask your doctor to complete a D4 Medical Examination Report - (this is classed as non NHS work, which you will be reponsible for paying a fee)
- Send the completed D2, DIAB1V and D4 forms to the DVLA
- The DVLA will send a medical questionnaire (DIAB2V ot DIAB2VC) to your GP or hospital diabetes consultant, depending in which one you saw most recently
- The DVLA will pay if your GP or consultant charges a fee for completing this questionnaire
- The DVLA will arrange for a hospital consultant specialising in diabetes to examine and assess you
- At this examination, the consultant will need to see 3 months of blood glucose readings taken with a meter that has a memory function
- This diabetes consultant will then complete a report and send it to the DVLA
- The DVLA will issue a Group 2 licence if you meet their medical requirements and have passed the relevant driving test
Annual Assessment once a Group 2 licence has been granted
Every 12 months the DVLA will arrange an examination by an independent hospital consultant who specialises in diabetes. At this examination the consultant will need to see blood glucose records for the previous 3 months, showing testing at least twice daily and at times relevant to driving, obtained using a blood glucose meter with a memory function. The licence holder must notify the DVLA immediately if there is any change in their condition.
Further information is available in the following DVLA publications by clicking on the link:
- Leaflet INF188/2. Information for drivers with diabetes treated by non insulin medication, diet, or both. DVLA
- Leaflet INS186. A guide for drivers with insulin treated diabetes who wish to apply for vocational entitlement (C1, C1E, D1, D1E, C, CE, D or DE). DVLA
Visit www.gov.uk/diabetes-driving to download these leaflets, get more information online and access the notification forms mentioned above. You can also contact the DVLA by post, telephone, fax or email:
Drivers Medical Group, DVLA, Swansea, SA99 1TU
Tel: 0300 790 6806
Fax: 0856 850 0095
Diabetes, Driving and the Law Information supplied by Bayer Diabetes Care.
Diabetes and Travel
preparing to travel
- Travel insurance: always declare diabetes as a pre-exisiting condition and list all your health medications. Do you need a European Health Insurance Card (EHIC)?
- If you take insulin, pack more than you would normally need for the period you are away, as you may need to alter your dose while away.
- Take a copy of your repeat prescription with you, especially if you are taking injections for your diabetes. Ask your practice nurse of diabetes specialist nurse for a letter stating you may need to carry needles in your hand luggage.
- Pack your glucose-testing meter, finger-pricking device and lancets, testing strips for glucose (and ketones if you have type 1 diabetes) and needles if you are using injection therapy. A spare glucose meter is useful in case of loss or malfunction.
- Consider purchasing a cool bag for insulin and injectable therapy if you will be carrying insulin with you during the day.
- Find out some useful diabtetes phrases in the language of your destination in case of emergencies.
- It is not necessary to request a special diabetes meal while travelling.
While you are away:
- Keep monitoring as you may be eating different foods and have different levels of activity, so your diabetes control may change. You may need to adjust your insulin if your blood glucose levels are much higher or lower than usual.
- Be aware that alcohol can increase your risk of hypos if you drink and take insulin or certain diabetes tablets. Alcohol and increased physical activity (e.g drinking and dancing) are particular risks for hypos.
- Always wear swim-shoes or sandals even when swimming in the sea. Cuts and open areas on feet can quickly become infected and cause high blood glucose levels. Walking barefoot on hot sand or tiles can also cause blisters. people who have nerve damage to their feet may not be aware of any injury.