Insulin treated Diabetes Mellitus (ITDM)

FMCSA Guidelines and the Diabetes Exemption Program Requirements

Federal Motor Carrier Safety Regulation (FMCSR) 49 CFR 391.41(b)(3):   "A person is physically qualified to drive a commercial motor vehicle if that person — Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control." 

The FMCSA guidelines further state:  "As a medical examiner, your fundamental obligation during the assessment of a driver with diabetes mellitus is to establish whether the driver is at an unacceptable risk for sudden death or incapacitation, thus endangering public safety. The risk may be associated with the disease process and/or the treatment for the disease."


Although the risks with hyperglycemia can impair a driver's ability to operate a commercial vehicle safely, the prevention of hypoglycemia is the most critical factor in ensuring safety in driving because of its ability to cause sudden incapacitation.  Furthermore, long term complications from diabetes such as retinopathy, neuropathy, nephropathy if severe or uncontrolled can disqualify a driver.  Please note that although we are addressing ITDM here, the medical complications of diabetes mentioned here can occur in all diabetics, whether or not they use insulin. Therefore, it is most important as usual to carefully assess each driver on an individual basis as you would with any other medical condition or drug use to assess their risk for sudden incapacitation by using the medical guidelines provided.  ITDM being one of four non-discretionary standard (others include epilepsy, vision, and hearing), requires that the medical examiner evaluate the driver and perform a physical examination to see if he would meet the standards otherwise, if not for the condition (i.e. ITDM , epilepsy etc).  If the driver is qualified otherwise, then he can seek relief from the standard through an exemption process or variance by applying to the Federal Diabetes Exemption Program.  Only by going through the Federal Diabetes Exemption Program can it be determined that the driver meets the program requirements and be granted an exemption. 

Please consult the FMCSA Medical Examiner's Handbook for more information regarding the risks of diabetes with respect to the operation of a commercial motor vehicle, as well as the evaluation and guidelines for certification of diabetics in general (whether using insulin or other medications).

Federal Diabetes Exemption Program 

For drivers who have met all medical standards and guidelines other than the use of insulin.


Steps to Follow:

  1. Obtain a Diabetes Exemption Package.  Complete the Applicant Information Checklist.
  2.  Medical Examiner.  Bring Certifying Medical Examiner Evaluation Letter from Diabetes Exemption package to the appointment with the medical examiner. The medical examiner must determine that you meet all other FMCSA physical qualification guidelines except for the fact that you use insulin. If the driver has any other medical problems or conditions (besides the use insulin to treat their diabetes), they must be corrected before applying to the Federal Diabetes Exemption Program. The applicant driver must provide the medical examiner with a 5 year medical history for review.  Applicant is to submit completed Medical Examination Report Form and Medical Examiner's Certificate with his application to the Diabetes Exemption Program. The form and certificate is available from the medical examiner.  The medical examiner's certificate should indicate that the driver is certified ONLY if he has a diabetes exemption and expires 1 year from the date of examination.  The medical examiner's certificate is NOT valid unless the insulin exemption is granted by the FMCSA.
  3. Endocrinologist Evaluation (Board Certified or Eligible).  After the medical examiner certifies the driver, the applicant must bring the Endocrinologist Evaluation Checklist from the Diabetes Exemption Package and glucose logs to the appointment with the endocrinologist.  Endocrinologist will complete all parts of the 4 page checklist. Apllicant is to submit the checklist, signed endocrinologist letter head and any additional report outlined in the check list.  The endocrinologist evaluation is good for 6 months and must be renewed if it expires during the application process
  4. Ophthalmologist or Optometrist.  Vision Evaluation Checklist is also to be performed after the medical examiner certifies applicant.  An ophthalmologist evaluation is required if applicant has retinopathy.  The optometrist or ophthalmologist will complete all parts of the 2 page checklist.  Again, this checklist is also valid for 6 months and must be renewed during the application process if it expires.  A signed letterhead from the ophthalmologist or optometrist is also required. 
  5. Mail completed Applicant Information Checklist, Both sides of driver's license and current commercial motor vehicle record along with items 2, 3 and 4 above to the address listed on the Diabetes Exemption Package.

Please consult the FMCSA Medical Examiner's Handbook online for further recommendations.

To book a DOT physical exam please call 718-701-5949 or 718-939-9020.

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Only the Federal Diabetes Exemption Program can determine if the driver meets the program requirements and grant an exemption.  An exemption is a temporary regulatory relief from one or more Federal Motor Carrier Safety Administration Regulation.  When granted it is valid for 2 years.  The commercial driver is required to carry both his medical examiner's certificate and exemption when operating a commercial vehicle and keep them current.  Quarterly and annual monitoring and reporting are part of the exemption program and the driver is responsible to stay in compliance.

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