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Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or disorientation in time and space. Diabetes is often controlled with insulin, but individuals who use insulin have conditions which can get out of control by the use of too much or too little insulin, or food intake not consistent with the insulin dosage. Incapacitation may occur from symptoms of hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabetic coma, or insulin shock).
Commercial drivers using insulin to control diabetes must meet the current federal physical qualification requirement in 391.46 to be medically qualified.
If a driver’s diabetes can be controlled by the use of oral medication and diet, without the use of insulin, then the driver may be qualified under the current rules for up to two years based on the guidance provided to medical examiners.
Section 391.46 allows certified medical examiners to grant medical certificates to drivers with insulin-treated diabetes mellitus (ITDM) for up to 12 months. Before doing so, a driver’s treating clinician — the healthcare professional who manages and prescribes insulin for treatment of the individual’s diabetes — must
The DOT examiner then must decide if the individual meets FMCSA’s physical qualification standards and can operate commercial motor vehicles in interstate commerce.
The FMCSA says drivers should not be certified if they have certain complications affecting their eyes: either severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. In addition, a severe hypoglycemic episode — one that requires the assistance of others or results in loss of consciousness, seizure, or coma — is immediately disqualifying.