Diabetes and Driving Practice Exam: Diabetes Chapter 21

Driving is a complex task that can be impacted by both the acute complications of diabetes (such as hypoglycemia) and chronic complications affecting vision or sensation. The 2018 Clinical Practice Guidelines emphasize that the fitness to drive must be assessed on an individual basis, balancing public safety with the quality of life for people with diabetes.

This practice exam tests your ability to apply the specific medical standards for private and commercial drivers, as well as your knowledge of the “safe driving” protocols that all insulin-treated drivers must follow.

Key Concepts Covered in This Exam:

Assessment Standards: Understanding that all drivers with diabetes should undergo a medical examination at least every 2 years, while commercial drivers require assessment at the time of license application.
Hypoglycemia Risks: Identifying unrecognized hypoglycemia as the most relevant driving hazard, with performance deteriorating at blood glucose levels below 3.8 mmol/L.
The “40-Minute Rule”: Mastering the safety protocol that if blood glucose is <4.0 mmol/L, the driver must not drive until at least 40 minutes after successful treatment to allow for cognitive recovery.
Patient Responsibilities: Recognizing the duty of the person with diabetes to report conditions like hypoglycemia unawareness or severe hypoglycemic episodes to their healthcare provider and licensing body.
Reporting Requirements: Differentiating between mandatory and discretionary reporting provinces and understanding the healthcare professional’s role in identifying high-risk drivers.

1. Within what timeframe should a person notify their health-care provider after experiencing severe hypoglycemia while driving?

Within 72 hours
Within 24 hours
Within 1 week
At their next scheduled appointment

2. In driving simulator studies, at what blood glucose level did most drivers finally self-treat their hypoglycemia?

≤4.0 mmol/L
≤3.5 mmol/L
≤2.2 mmol/L
≤2.8 mmol/L

3. A 52-year-old man with type 2 diabetes on a sulfonylurea checks his blood glucose before a long drive and finds it is 3.6 mmol/L. He feels fine. What should he do?

Start driving since he feels fine
Call someone else to drive
Ingest 15g carbohydrate, retest, and wait until BG is at least 5.0 mmol/L before driving
Eat a snack and immediately start driving

4. How many Canadian provinces and territories have mandatory reporting systems for medically unfit drivers?

5
10
13
7

5. How often should drivers with diabetes undergo a comprehensive medical examination to assess fitness to drive?

At least every 2 years
Every 3 years
Annually
Every 5 years

6. 52-year-old man with type 2 diabetes on a sulfonylurea checks his blood glucose before a long drive and finds it is 3.6 mmol/L. He feels fine. After treating his hypoglycemia and confirming BG is 5.2 mmol/L, how long should he wait before driving?

Wait 60 minutes
He can drive immediately
Wait 40 minutes
Wait 15 minutes

7. Which chronic diabetes complication is mentioned as potentially affecting driving performance through impaired motor function?

Nephropathy
Amputation
Dyslipidemia
Gastroparesis

8. A 48-year-old woman with type 2 diabetes managed with metformin and lifestyle modifications asks about driving safety precautions. What advice should be given regarding hypoglycemia risk while driving?

She should wear a CGM while driving
She should carry fast-acting carbohydrate at all times
She must test BG before every drive
Hypoglycemia is not a concern with metformin monotherapy

9. What is a potential unintended consequence of mandatory reporting systems for drivers with diabetes?

Increased use of CGM devices
Increased health-care utilization
Improved glycemic control
May discourage people from discussing their condition or reporting severe hypoglycemia

10. What is unique about driving itself in relation to blood glucose?

Driving causes blood glucose to rise
Driving has no effect on blood glucose
Driving is associated with significant metabolic demand and may cause BG to fall
Driving only affects BG in people with type 1 diabetes

11. Which factors have been shown to increase driving risk in people with diabetes?

Previous severe hypoglycemia within past 2 years
Type 2 diabetes and older age
Use of CGM devices
Use of metformin and high A1C

12. According to a study in Ontario, by what percentage did medical warnings reduce annual accident rates in people with diabetes?

15%
41%
55%
25%

13. What alternative to frequent blood glucose testing can this driver use?

A1C monitoring
Urine glucose testing
Flash glucose monitoring
Real-time continuous glucose monitoring (CGM) device

14. A 55-year-old man with type 2 diabetes on insulin is planning a 6-hour road trip. His pre-drive BG is 6.8 mmol/L. What recommendations should he follow during the long journey?

Take regular meals, snacks, and periods of rest
No stops needed if pre-drive BG is normal
Complete the journey as quickly as possible
Only stop if experiencing symptoms

15. Where should fast-acting carbohydrate be stored in a vehicle?

In the glove compartment
In a bag in the back seat
Within easy reach, such as attached to the visor or in the centre console
In the trunk

16. At what blood glucose level does driving performance start to deteriorate in people with type 1 diabetes?

Below 5.0 mmol/L
Below 3.8 mmol/L
Below 4.5 mmol/L
Below 3.0 mmol/L

17. According to driving simulator studies, what percentage of drivers were aware that their driving performance was impaired during hypoglycemia?

More than 75%
Approximately 60%
Approximately 40%
Fewer than 25%

18. How long may it take for cognitive function to fully recover after restoration of euglycemia following hypoglycemia?

10 minutes
20 minutes
30 minutes
40 minutes or more

19. In driving simulator studies comparing drivers with normal hypoglycemia awareness to those with impaired awareness, researchers asked participants if they would drive while hypoglycemic. What were the comparative findings?

No difference was found between groups
25% with normal awareness vs. 25% with impaired awareness stated they would drive while hypoglycemic
4% with normal awareness vs. 43% with impaired awareness stated they would drive while hypoglycemic
43% with normal awareness vs. 4% with impaired awareness stated they would drive while hypoglycemic

20. Which medications used in diabetes treatment are associated with the highest rates of motor vehicle accidents?

SGLT2 inhibitors
Insulin
DPP-4 inhibitors
Metformin

21. A patient with insulin-treated diabetes experiences hypoglycemia while driving on the highway. What is the correct immediate action?

Pull over and eat a meal
Continue driving to the next exit
Call 911 while continuing to drive
Stop the vehicle in a safe location and remove the keys from the ignition

22. In which province is reporting of medically unfit drivers discretionary?

Ontario
Alberta
Saskatchewan
Manitoba

23. A CDE is educating a new commercial driver with type 2 diabetes on insulin about driving safety. Why are higher medical standards applied to commercial vehicle drivers?

Commercial drivers cannot use CGM devices
Commercial drivers have higher rates of diabetes
They are on the road many hours, increasing time exposure, and accidents may be more serious
Commercial vehicles are more difficult to control

24. A 45-year-old truck driver with type 2 diabetes treated with insulin is applying for renewal of his commercial driver’s license. What blood glucose monitoring record should be available for the commercial license application?

The last 3 months of CBG measurements
The last 2 weeks of CBG measurements
The last 6 months of CBG measurements
The last 12 months of CBG measurements

25. A 38-year-old woman with type 1 diabetes has documented hypoglycemia unawareness. She works as a private driver for a ride-sharing service. How often must this driver measure her blood glucose while driving?

Immediately before and at least every 4 hours
Every 30 minutes
Immediately before and at least every 2 hours
Only at the start and end of each shift

26. A commercial truck driver with type 1 diabetes had 2 episodes of severe hypoglycemia while awake (not driving) in the past 10 months. What is the appropriate action for this commercial driver?

Switch to a private license
Continue driving with increased monitoring
The driver should stop driving and the health-care provider should report to the licensing body
No action needed as episodes were not while driving

27. A multinational study examined how often drivers with diabetes had discussed driving guidelines with their physician. What percentage of drivers with type 1 diabetes had discussed driving guidelines with their physician?

42%
75%
27%
52%

28. Which of the following medications, when used as monotherapy, is NOT associated with significant hypoglycemia risk while driving?

Repaglinide
Glyburide
Insulin glargine U-300
Repaglinide

29. A patient with diabetes is being assessed for fitness to drive. They have diabetic retinopathy, peripheral neuropathy, and a history of previous amputation. How should fitness to drive be assessed in this patient?

Only the retinopathy is relevant to driving fitness
Automatically disqualified from driving
Assessed on an individual basis considering all factors
No assessment needed if not on insulin

30. A 60-year-old private driver with type 1 diabetes experienced severe hypoglycemia requiring assistance while driving last month. This was his first episode while driving. According to guidelines, what action should be taken?

The driver should stop driving and the health-care provider should report to the licensing body
Continue driving with more frequent BG monitoring
Wait 3 months before driving again
Only report if another episode occurs

31. What is the minimum blood glucose level required before a person with diabetes should start driving?

4.0 mmol/L
5.0 mmol/L
3.5 mmol/L
3.0 mmol/L

32. A physician in Ontario identifies a patient with diabetes who has had recurrent severe hypoglycemia and continues to drive despite warnings. What is the physician’s reporting obligation in Ontario?

Only report if the patient requests it
Reporting is discretionary
Reporting is mandatory
Reporting is prohibited due to patient confidentiality

33. What is the minimum blood glucose level after treatment of hypoglycemia before resuming driving?

4.5 mmol/L
4.0 mmol/L
5.0 mmol/L
5.5 mmol/L

34. How often should this commercial driver consider measuring blood glucose while driving, at minimum?

Only when symptoms occur
Every 6 hours
Every 4 hours
Every 2 hours

35. A 35-year-old private driver with type 1 diabetes has had 2 episodes of severe hypoglycemia while awake (but not driving) in the past 4 months. What is the appropriate action according to guidelines?

Wait until an episode occurs while driving
Continue driving with no changes
The driver should stop driving and the health-care provider should report to the licensing body
Increase BG monitoring frequency only

36. What percentage of adults with diabetes routinely perform capillary blood glucose (CBG) monitoring before driving?

15%
50%
35%
5%

37. According to the guidelines, what role should people with diabetes play in assessing their fitness to drive?

An active role in assessing their own fitness to drive
No role; fitness should be determined solely by health-care providers
Defer all decisions to licensing authorities
Only responsible for reporting symptoms

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