Table 1 Recommendations for safe driving practice for drivers with insulin-treated diabetes [25, 72]

• Always carry your glucose meter and blood glucose strips with you

• Check your blood glucose no more than 1 h before the start of the first journey and every two hours whilst you are driving

• If driving multiple short journeys, it is not necessary to test before each additional journey as long as you test every 2 h while driving. More frequent testing may be required in circumstances where a greater risk of hypoglycemia is present, e.g., after physical activity or altered meal routine

• Try to ensure that blood glucose is kept above 5.0 mmol/l (90 mg/dl) while driving. If your blood glucose is 5.0 mmol/l or less, have a snack. Do not drive if blood glucose is less than 4.0 mmol/l (72 mg/dl) or you feel hypoglycemic

• If hypoglycemia develops while driving, stop the vehicle in a safe location as soon as possible

• Always keep an emergency supply of fast-acting carbohydrate such as glucose tablets or sweets within easy reach inside the vehicle

• Do not start driving until 45 min after blood glucose has returned to normal (confirmed by measuring blood glucose). It takes time for the brain to recover fully from hypoglycemia

• Carry personal identification to indicate that you have diabetes in case of injury

• Particular care should be taken during changes of insulin regimen, change in lifestyle, following exercise, during travel and during pregnancy

• Take regular meals, snacks and periods of rest on longer journeys. Do not drink alcohol before, or while driving