Diabetes is a complex medical condition that affects millions of Americans. Because it can lead to serious complications, which can come on suddenly and impact an individual’s ability to drive, the Department of Transportation (DOT) did not allow those with insulin-treated diabetes to drive commercial vehicles before 1990. However, believing that those with diabetes could safely drive, the American Diabetes Association petitioned on behalf of drivers for a way to become certified on a case-by-case basis.
That petition was granted in 1990, and from 1990 to 2018, commercial vehicle drivers with insulin-dependent diabetes had to apply for a medical exemption to become certified drivers. Many qualified and were able to drive. Then, in 2018, the Federal Motor Carrier Safety Administration (FMCSA) introduced new guidelines for drivers with diabetes that opened a pathway to certification that considers both driver health and public safety. If you have diabetes and take insulin, you can qualify to drive commercially, provided you meet specific criteria.
Why Insulin-Dependence Matters for Commercial Drivers?
Insulin-dependent diabetes is a chronic condition in which the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. Insulin is the hormone that helps regulate blood sugar levels by allowing glucose into the body’s cells, providing energy. You can’t produce a sufficient amount of insulin on your own and must take insulin every day to keep your blood sugar levels steady.
If you drive a truck, managing your condition is especially important because it can directly affect your ability to drive safely. If your blood sugar drops too low (hypoglycemia), it can cause dizziness, confusion, or even loss of consciousness. Fluctuations in your blood sugar can also damage body organs and systems, such as the eyes, which may impact your ability to operate a vehicle safely. That’s why you must meet specific requirements to maintain your status as a certified driver.
The FMCSA Insulin-Treated Diabetes Assessment Protocol
Passing a CDL physical exam when you have insulin-dependent diabetes is not as complicated as you might think. What once was a disqualifying condition is now only one factor that the medical examiner will consider. Before certifying that you are healthy enough to drive a commercial vehicle, they need to be confident that:
- Your symptoms do not interfere with your ability to drive safely
- You are on a stable insulin regimen
- Your insulin-dependent diabetes is properly controlled
Because the medical examiner you see for your physical may not be familiar with your health history, you must provide them with information about your diabetes treatment and history. The first step is meeting with the doctor who prescribes your insulin. They must fill out the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870). This form covers your insulin use, blood glucose monitoring habits, physical conditions associated with your diabetes, and any recent hypoglycemic episodes.
To help your doctor make an accurate assessment, you should bring a digital blood sugar monitoring record for the past three months. You will also need your most recent fasting hemoglobin A1C test (HbA1C) results. If you haven’t had a test in the past four months, your doctor can order one. Once your doctor completes this form, you can schedule your physical with a certified medical examiner. Be sure to bring this form and your test results to your appointment.
Unique Requirements for Drivers with Insulin-Treated Diabetes
If you take insulin for diabetes, the medical examiner will pay special attention to a few specific health criteria. In addition to other indicators of physical health, they will look at:
The Insulin-Treated Diabetes Mellitus Assessment Form
Does the physician overseeing your diabetes treatment believe that your diabetes is properly controlled by a stable treatment protocol? Even though it is up to the medical examiner to decide whether or not you qualify for a commercial driver’s license, your treating physician’s opinion matters. Uncontrolled diabetes can cause drivers to become confused or lose consciousness behind the wheel, leading to serious accidents.
Your HbA1C
Are your test results below the limit of 10%? If your A1C is below 10% but approaching the threshold this may be an indicator that your diabetes is not as well-controlled as it could be. The medical examiner may recommend follow-up testing or treatment with your physician. You may also only receive a certification for three months.
Your Eyes
Are there signs of diabetic retinopathy? Proliferative or severe non-proliferative diabetic retinopathy can lead to blurred vision and vision loss. They are permanently disqualifying conditions.
While many drivers will only need a physical exam every two years, individuals who take insulin for diabetes will need to pass a physical exam and vision test each year.
Managing Insulin-Treated Diabetes on the Road
The unpredictable nature of commercial driving makes managing insulin-dependent diabetes on the road more challenging. Long shifts, irregular meal times, limited healthy food options, physical inactivity, and difficulty finding safe places to check blood sugar or administer insulin can all make glucose management harder. Stress, sleep disruption, and inconsistent schedules can further throw off blood sugar control.
It’s important to take proactive steps to keep your blood sugar on track and prioritize your health.
- Stick to a Routine: Even with a changing schedule, try to eat meals and take insulin at the same times each day. Sticking to a schedule will help keep your blood sugar steady throughout the day and your A1C on track.
- Pack Healthy Food: Relying on foods high in carbohydrates to feed your body will lead to blood sugar spikes. Instead, bring balanced, diabetes-friendly meals and snacks high in protein and fiber. Your body will digest these more slowly, preventing blood sugar spikes and keeping you full longer.
- Monitor Blood Sugar Frequently: Use a continuous glucose monitor (CGM) or check your blood sugar manually throughout the day, especially before driving. Don’t wait until you feel hypoglycemic to check your blood sugar. Make is a part of your daily routine.
- Keep Emergency Supplies Handy: Finding quick-acting carbohydrates when you need them may not be possible in the middle of Nebraska. Always have quick-acting glucose (like juice or glucose tablets) nearby in case of hypoglycemia.
- Stay Active When Possible: Regular exercise helps maintain healthy blood sugar levels and control your A1C. Use driving breaks to stretch or walk. It will help with insulin sensitivity and circulation.
- Plan for Medication Refills: Running out of insulin is not an option. Plan ahead and get insulin and supply refills in advance, especially for long-haul routes.
- Communicate with Your Doctor: Connecting with your provider in person is inconvenient when you are always on the road. Try using telehealth to keep in touch with your care team about your health concerns.
With preparation and commitment, you can successfully manage insulin-dependent diabetes and stay safe behind the wheel.
Safety First
FMCSA rules and regulations exist to keep everyone on the road safe. If the medical examiner determines that your insulin-dependent diabetes is well-controlled and does not interfere with your ability to drive safely, it won’t stand between you and your ability to drive. Maintaining your status as a certified driver will take more diligence. But the steps you take to safeguard your certification will also help protect your body from the damaging effects of high and low blood sugar. Commercial driving is a career option open to all who are physically and mentally fit, including those who take insulin. If you are interested, talk to your doctor about starting the process.
