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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).
Scope
Commercial drivers using insulin to control diabetes must meet the current federal physical qualification requirement in 391.46 to be medically qualified.
Regulatory citations
- 49 CFR 391.41 — Physical qualifications for drivers
- 49 CFR 391.46 — Physical qualification standards for an individual with diabetes mellitus treated with insulin for control
Key definitions
- Commercial motor vehicle: Any self-propelled or towed motor vehicle used on a highway in interstate commerce to transport passengers or property when the vehicle:
- Has a gross vehicle weight rating or gross combination weight rating, or gross vehicle weight or gross combination weight, of 4,536 kg (10,001 pounds) or more, whichever is greater; or
- Is designed or used to transport more than 8 passengers (including the driver) for compensation; or
- Is designed or used to transport more than 15 passengers, including the driver, and is not used to transport passengers for compensation; or
- Is used in transporting material found by the Secretary of Transportation to be hazardous under 49 U.S.C. 5103 and transported in a quantity requiring placarding.
- Driver: Any person who operates any commercial motor vehicle.
- Medical examiner: An individual certified by the Federal Motor Carrier Safety Administration and listed on the National Registry of Certified Medical Examiners.
Summary of requirements
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
- Fill out a new “ITDM Assessment Form” and provide it to drivers to give to the DOT medical examiner, and
- Certify that drivers maintain a stable insulin regimen and proper control of their diabetes.
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.