Living with Diabetes

When the Diabetes Exemption Program began in 2003, it required that someone with insulin-treated diabetes must have driven a commercial vehicle while using insulin for the previous three years before he or she would be qualified for an exemption. This "three year rule" made the Diabetes Exemption Program useless for almost all potential drivers. The only way to meet this requirement was to live in a state that allows people who use insulin to drive intrastate and meet the individual state criteria. Even in those states, there was very little commercial driving that counted as "intrastate" (even if you stay within your state if the goods or passengers are on their way to or from another state this is "interstate" driving). Primarily because the "three year rule" was a Catch 22 that prevented most qualified drivers from even applying, only four diabetes exemptions were issued from 2003 until the new law went into effect in late 2005.

The new law required that the Federal Motor Carrier Safety Administration revise the 2003 rule regarding the Diabetes Exemption Program. FMCSA accomplished this by issuing a Notice in the Federal Register on November 8, 2005 announcing changes to the Diabetes Exemption Program. The changes include no longer requiring three years of prior commercial driving experience and a minimum period of insulin use to establish good control of diabetes. In the November 8th Notice, the agency also recommended that individuals have an A1C between 7-10%. See Federal Motor Carriers Safety Administration Revises Diabetes Exemption Program (PDF) for more information.

Under the law passed by Congress, FMCSA's new rule will require that individuals with insulin-treated diabetes demonstrate stable control of diabetes while on insulin. Individuals who have type 1 diabetes will need to have been on insulin for two months before they are eligible to apply for an exemption, and individuals with type 2 diabetes will have had to have been on insulin for one month.

Individuals who are granted a diabetes exemption will need to meet certain safety and medical screening requirements, operating guidelines, and monitoring and accountability standards. A list of these criteria (PDF) can be found in the September 3, 2003 Federal Register notice announcing the Diabetes Exemption Program.

Yes, as part of the transportation bill passed by Congress in July 2005, and signed into law by President Bush in August 2005, people who use insulin to treat their diabetes will have an easier time getting an exemption that will allow them to drive trucks and other commercial vehicles in interstate commerce.

No. The law passed by Congress eliminated the three year rule and replaced it with the individual assessment and 1-2 month period of insulin use recommended by the FMCSA Expert Medical Panel. However, your treating physician may extend the time period of insulin use if he or she deems it necessary.

The agency is currently reviewing all of its physical qualification standards, including diabetes. This work is being done through research panels (including a diabetes panel), the Medical Review Board, a soon-to-be appointed Chief Medical Officer, and rulemakings such as the March 2006 Advance Notice of Proposed Rulemaking.

It is possible that in the future individuals who use insulin to treat their diabetes will not need to obtain an exemption from FMCSA in order to operate commercial motor vehicles in interstate commerce, but rather, would undergo the regular DOT medical examination (with input from a diabetes specialist and receive certification under a revised standard.

In conjunction with the review of the physical qualification standards, FMCSA is establishing a National Registry of Certified Medical Examiners (NRCME) to perform all DOT medical examinations. All commercial drivers will be required to be examined by an individual on the NRCME; these examiners will receive training on the various physical qualification standards and disease-specific guidelines developed by the agency. Under the agency’s plan, only individuals who are examined by a NRCME examiner will be granted DOT certification. Visit the NRCME Website for more information.

This process of evaluating the current standards, receiving input from medical professionals, developing guidelines and publishing rulemakings will take several years. In the meantime, insulin-treated individuals will need to continue applying for an exemption under the current program.

Insulin use alone will no longer be a barrier to interstate commercial driving, as long as you demonstrate stable control. The new law requires that a person with type 2 diabetes beginning insulin use will need to be on insulin for one month before they may apply for a diabetes exemption. After one month on insulin, assuming you have demonstrated stable control of your diabetes, you will be eligible for apply for an exemption.

Individuals who have type 1 diabetes will need to have been on insulin for two months before they are eligible to apply for an exemption.

In all cases, however, your treating physician may extend the time period needed to demonstrate stable control of diabetes before you can apply for an exemption.

You do not need to do anything if you hold a valid state waiver and do not wish to drive a commercial vehicle in interstate commerce. If you want to begin driving across state lines, or otherwise driving in interstate commerce (defined below), and you use insulin to treat your diabetes, you will need to apply for an exemption with the Federal Motor Carrier Safety Administration.

For many years there was a blanket ban that prohibited anyone with diabetes who used insulin from driving commercial vehicles in interstate commerce. In 2003, the Federal Motor Carrier Safety Administration (FMCSA) at the U.S. Department of Transportation replaced this blanket ban and announced a Diabetes Exemption Program to allow for case-by-case assessment of commercial drivers. Under this Program, individuals with insulin-treated diabetes would be allowed to operate commercial vehicles in interstate commerce if they met certain conditions.

By law, FMCSA must either grant or deny an exemption within 180 days of receiving an application. However, it sometimes takes longer than 180 days if an application is incomplete or the agency requests additional information. ***If you are asked to provide duplicate information, or receive requests to provide additional test results, provide the requested information and results to the agency and call 1-800-DIABETES or email legaladvocate@diabetes.org to let us know about the request(s).

Once the agency has made a tentative decision about your application, it will publish a notice in the Federal Register giving the public 30 days to comment on your application, and then issue a final determination. You will receive written notice of the agency's decision. If you are granted an exemption, you will receive written information from the FMCSA about the requirements during the two-year exemption period.

Individuals wishing to apply for a diabetes exemption should download a copy of the application (PDF) available on the FMCSA web site at. The application requires that you be evaluated by an endocrinologist and an ophthalmologist or optometrist, and that these doctors provide certain information about your diabetes. You or your doctor may also need to provide other information as requested by the agency.

Yes. Under the new law, FMCSA may no longer require that a person applying for a diabetes exemption have any prior commercial driving experience while using insulin. You will not need to prove that you have three years of commercial driving experience while using insulin, or even three days worth while using insulin. You will, however, need to meet all other 57 screenings, operating guidelines, and accountability provisions of the exemption program, in addition to whatever your state licensing agency requires in order to hold a commercial drivers' license.

Until FMCSA amends the physical qualification standard in the regulations, individuals with insulin-treated diabetes who wish to drive in interstate commerce will still need to apply for an exemption with FMCSA. Drivers who wish to continue driving intrastate only, and who are licensed by their state to do so, may continue driving as normal and do not need to apply for a diabetes exemption unless they wish to drive interstate.