It has been argued by many over the years that commercial drivers with controlled insulin-treated diabetes mellitus (ITDM) should be medically certified, provided they are otherwise physically qualified. And, it appears as if the Federal Motor Carrier Safety Administration (FMCSA) was listening. 

As of Nov. 19, 2018, individuals with a stable insulin regimen and properly controlled ITDM may be medically certified — for up to one year — to operate commercial motor vehicles (CMVs) in interstate commerce. Certification of drivers with ITDM no longer requires the considerably more time-consuming medical exemption from the FMCSA.

How to Obtain Medical Certification

Insulin-using drivers must complete three steps before they can be medically certified:  

Step 1: Monitor blood glucose levels.

A driver with ITDM is required to follow his or her treatment plan and maintain blood glucose records using an electronic glucometer. The glucometer must be able to record the date and time of each reading. Typed or handwritten logs are not acceptable.  

Step 2: Visit the treating clinician (TC).

The driver must make an appointment with his or her TC, the healthcare professional who manages and prescribes insulin for the treatment of his or her diabetes. The driver must provide the TC with at least the previous three months’ worth of blood glucose records. This is achieved through either presenting the glucometer or a printout of the device’s electronic records.  

If the TC determines that the driver’s diabetes is controlled, he or she then completes an FMCSA document, the ITDM Assessment Form (MCSA-5870) to attest to this fact. The driver may need to bring a copy of the form to the appointment if the clinic does not provide it. 

Step 3: Schedule an FMCSA exam.

The driver must schedule a medical exam within 45 days of the ITDM Assessment Form’s completion with a medical examiner (ME) listed on the National Registry of Certified Medical Examiners.  

The driver must bring the completed ITDM Assessment Form to the appointment for the ME’s review. Even though the driver has the TC’s stamp of approval, the decision to medically qualify still rests with the ME. If the ME is satisfied, he or she will qualify the driver (up to one year) based on the ME’s discretion. 

Complications Between Med Cards

Drivers with ITDM who are certified, but later suffer a severe hypoglycemic episode, are considered medically unqualified. A severe hypoglycemic episode requires the assistance of others or results in loss of consciousness, seizure, or coma. The driver must report the episode to the TC as soon as possible.

How to Stay Qualified

Once a driver with ITDM is medically certified, he or she must repeat these steps annually to remain qualified:

• Accumulate at least three months’ worth of blood-glucose monitoring data prior to each subsequent medical exam; 

• Time follow-up visits to the TC to ensure Form MCSA-5870 is completed and available to the ME before the current medical card expires; and 

• Schedule a physical exam with a certified ME before the current medical card expires and no later than 45 days after the TC completes the MCSA-5870.

A driver with a commercial driver’s license (CDL) who becomes medically unqualified, even temporarily, may have his or her CDL downgraded. The state licensing agency needs proof of renewed medical certification no later than 10 days after the prior certificate expires. Within 11 days of the expiration, but no later than 60, the CDL will be downgraded if proof of medical certification was not received. 

Educate Drivers on the Topic

Due to privacy issues, motor carriers may not be aware that a driver has been diagnosed with diabetes, let alone prescribed insulin as a treatment. 

Motor carriers can help facilitate the process of medical certification of insulin-using drivers (and avoid downgraded licenses) through providing education on the topic to all drivers. 

Editor's Note: This article was originally published in the January 2019 print issue of Work Truck, but was reviewed for continued relevance and accuracy as of August 2023.