1. Obtain a Diabetes Exemption Package.   Read Letter to driver and Instructions Letter to driver & Instructions_diabetes-exemption-package . Complete the driver Applicant Information Checklist & Statement of Qualification Applicant Checklist & Statement of Qualification_diabetes-exemption-package.  All required paperwork for driver and for evaluating health care professionals (medical examiner, endocrinologist and ophthalmologist) to complete can be found in the Exemption Package.
2. Medical Examiner:  Bring Certifying Medical Examiner Evaluation Letter (CME Evaluation Guidelines Letter_Diabetes Waiver Package ) from Diabetes Exemption package to the appointment with the medical examiner. The medical examiner must determine that you meet all other FMCSA physical qualification guidelines except for the fact that you use insulin. If the driver has any other medical problems or conditions (besides the use insulin to treat their diabetes), they must be corrected before applying to the Federal Diabetes Exemption Program. The applicant driver must provide the medical examiner with a 5 year medical history for review.
3. Endocrinologist Evaluation(Board Certified or Eligible).  After the medical examiner certifies the driver, the applicant must bring the Endocrinologist Evaluation Checklist Endocrinologist Evaluation Checklist_diabetes-exemption-package from the Diabetes Exemption Package and glucose logs to the appointment with the endocrinologist.  Endocrinologist will complete all parts of the 4 page checklist. Applicant is to submit the checklist, signed endocrinologist letterhead and any additional report outlined in the checklist.  The endocrinologist evaluation is good for 6 months and must be renewed if it expires during the application process.
4. ​Ophthalmologist or Optometrist.  Vision Evaluation Checklist Vision Evaluation Checklist_diabetes-exemption-package to be performed after the medical examiner certifies applicant.  An ophthalmologist evaluation is required if applicant has retinopathy.  The optometrist or ophthalmologist will complete all parts of the 2 page checklist.  Again, this checklist is also valid for 6 months and must be renewed during the application process if it expires.  A signed letterhead from the ophthalmologist or optometrist is also required. 
5. Mail completed Applicant Information Checklist, Both sides of driver’s license and current commercial motor vehicle record along with items 2, 3 and 4 above to the address listed on the Diabetes Exemption Package.​​

Applicant is to also submit completed Medical Examination Report Form and Medical Examiner’s Certificate with his application to the Diabetes Exemption Program. The form and certificate is available online and also from the medical examiner.  The medical examiner’s certificate should indicate that the driver is certified ONLY with a diabetes exemption and expires 1 year from the date of examination.  The medical examiner’s certificate is NOT valid unless the insulin exemption is granted by the FMCSA. 

Please note that the diabetes exemption process can take up to 6 months or 180 days. Make sure that all paperwork is completed along with any required additional documentation to avoid delay in processing of your application.  The endocrinologist and ophthalmologist/optometrist reports must be repeated if more than 6 months has passed before the Exemption process is completed.  FMCSA will publish requests for exemptions in the Federal Register for a 30 day comment period. 

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