For commercial truck drivers using insulin to control their diabetes, the FMCSA has a special Federal Diabetes Exemption Program in place for qualified drivers who wish to apply for an exemption. An exemption is a temporary regulatory relief from one or more Federal Motor Carrier Safety Administration Regulation. The diabetes exemption is for relief from the diabetes standard 391.41(b)(3) which states that a person is physically qualified to drive a commercial vehicle if the person has no established medical history or clinical diagnosis of diabetes mellitus currently requiring the use of insulin for control. Diabetes requiring the use of insulin is one of the four non-discretionary medical standards (others being epilepsy, vision and hearing). A standard or regulation is law and must be followed. Whereas a guideline is an advisory criteria based on medical advisory report and intended as best practice for medical examiners. An example of a guideline would be the hypertension or cardiac guidelines or for that matter non-insulin treated diabetes mellitus. The medical examiner has a “lee way” with guidelines but must follow standards which are law. In the case of Insulin treated diabetes mellitus the Federal Diabetes Exemption Program is the path to pursue if the driver wishes to get an exemption or relief from the insulin standard.
For a discussion on the general evaluation of commercial drivers and a discussion of insulin treated diabetes and the Diabetes Exemption Program please see: http://www.blogtalkradio.com/truthabouttrucking/2010/10/01/insulin-diabetes-and-the-commercial-truck-driver.
For a summary on the instruction on how to apply for the Diabetes Exemption Program see: https://www.usdotmedicalexaminer.com/diabetes.html