iii
I regularly monitor my blood glucose at least twice daily and at
times relevant to driving using a glucose meter with a memory
function to measure and record blood glucose levels.
iv
I will arrange to be examined every 12 months by a hospital
consultant who specialises in diabetes.
v
At the above examination by the independent Consultant
Diabetologist, I will require provide evidence of my blood glucose
records for the preceding 3 months.
vi I have no other debarring complications of diabetes such as a
visual field defect.
7. B
For drivers managed by tablets which carry a risk of inducing hypoglycaemia (this includes
sulphonylureas and glynides).
I am the above named person and certify that:
i
I have had no episode of hypoglycaemia requiring the assistance
of another person in the preceding 12 months.
ii
I have full awareness of hypoglycaemia including an
understanding of the risks posed by this condition.
iii
I regularly monitor my blood glucose at least twice daily and at
times relevant to driving.
iv I have no other debarring complications of diabetes such as a
visual field defect.
7. C
For those drivers managed by tablets which do not carry a risk of inducing hypoglycaemia
(this includes sulphonylureas and glynides).
I am the above named person and certify that:
i I regularly monitor my blood glucose and at times relevant to
driving.
ii I am under regular medical review.
8
I sign this form as an undertaking to comply with the directions of
the doctor(s) treating my diabetes.
9
I will immediately report any significant change in my condition to
the Licensing Authority.
10
I understand that if I knowingly give false information that I am
liable to prosecution.
11
Signed:
Name:
Dated:
