DOT Physical: Diabetes Guidelines 2024

DOT regulations on diabetes can be murky. Foley clears up the confusion surrounding diabetes and DOT physical requirements during National Diabetes Awareness Month.

To drive a commercial vehicle over 10,000 pounds, you need to pass a DOT (Department of Transportation) physical. The DOT physical isn’t something you need to be afraid of, but if you have diabetes or high blood sugar levels (or suspect you do), you may have some concerns about your ability to pass.

Drivers must pass their DOT physicals at least once every 24 months, so whether you’re preparing for your first DOT physical or your fifth, it’s a good idea to familiarize yourself with the rules and restrictions surrounding diabetes and blood sugar levels. 

Below, we’ll answer all the most frequently asked questions regarding DOT physicals and diabetes, but if you’re new to DOT physicals, read our overview here first. 

Impact of Diabetes on CMV Drivers

When diabetes is undiagnosed and so uncontrolled (which accounts for around 7.3 million people in the US), it can cause fatigue, stress, and sluggishness, all of which can impede your ability to drive a CMV. According to the National Institute for Occupational Safety and Health, truck drivers have a 50% higher risk of developing Type 2 diabetes than the general population.

In worst-case scenarios, it can lead to hypoglycemia which may result in loss of consciousness and seizure, so it’s important to control diabetes if you do indeed have it. 

Does the DOT Physical Test for Diabetes?

The DOT physical will look for signs of diabetes and may recommend further investigation if they believe you have diabetes.

Your examiner will ask whether you have a history of diabetes or control elevated blood sugar levels with your diet, pills, or insulin. They’ll also examine you for other conditions potentially caused by diabetes, and test your urine for the presence of sugars.

Can You Pass a DOT Physical with Diabetes?

Yes, however, diabetes is one of the four conditions that have objective disqualifiers – that means that if your symptoms of diabetes meet one of their disqualifying conditions, you’ll automatically fail the exam. This will not apply to most but will apply if you’ve been diagnosed with severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. 

It is also subject to other standards that are “discretionary,” which means your medical examiner will determine whether they believe your condition may impede your ability to safely do your job.

If you have diabetes or another health condition such as high blood pressure, you will be required to have your DOT physical annually (or more frequently) to ensure you continue to be fit enough to operate large commercial vehicles. You’ll also be required to have annual eye tests because diabetes can lead to some vision impairment.

Can You Pass a DOT Physical With Type 2 Diabetes?

Yes, though it will depend on the circumstances of your condition and the opinion of your medical examiner. It will be largely up to their professional opinion whether you are safe to operate a CMV. If you control your diabetes and regularly monitor your condition, you won’t likely have a problem getting the all-clear from your medical examiner. 

Your medical examiner may ask you: 

• Do you regularly monitor your blood sugar level? 
• Do you take any over-the-counter medications/supplements for diabetes? 
• Do you have a history of feeling faint, dizzy, or any other loss of consciousness? 
• Have you had a hypoglycemic reaction in the past? What did that look like? When did it happen? What were the circumstances?

Your doctor will also test your urine for the presence of sugars.  

What is the FMCSA Diabetes Standard?

Previously, the only way for diabetic drivers to legally operate commercial vehicles in interstate commerce was through applying for an exemption in the Diabetes Exemption Program; however, the program was officially discontinued in November 2018.

Instead, the healthcare professional who prescribes insulin for a driver must now provide the Insulin-Treated Diabetes Mellitus Assessment Form (ITDM Assessment Form), MCSA-5870, to the certified medical examiner performing the DOT physical, which indicates the driver has a stable insulin regimen in place.

This means the entire process is faster and less burdensome for all involved, and you no longer have to obtain a separate evaluation by the doctor treating your diabetes. 

Drivers who have diabetes also need to bring their latest lab work to the examination, which should include fasting blood sugar and HGA1C. This needs to be from within the last four months. If you are new to using insulin to control your diabetes, you need to have used it for four months before you can pass the DOT physical. 

If you have another medical condition and you're wondering how it may impact your DOT physical results, check out this Foley article for more information.

How to Pass A DOT Physical with Diabetes

Don’t worry, passing the DOT physical with diabetes isn’t complicated — you just need to have your diabetes under control.

In other words, you need to prove that you’re healthy and properly managing your condition. If you already monitor and treat your diabetes appropriately, you shouldn’t have a problem. However, if you’re concerned you may not pass, here are a few things you can do to improve your ability to pass:  

• Stay on top of monitoring your blood glucose and treating your diabetes appropriately 
• Get some exercise — even just a short walk can help you keep your insulin levels in a healthy range 
• Cut back on foods that spike your insulin levels (sugary, processed foods, sodas, salty foods, and so on) 
• Make sure you don’t overeat — your insulin levels will spike after eating 
• Cut back on alcohol, smoking, and caffeine 
• Make sure you’re well-hydrated before your physical 

How long is a DOT physical valid with diabetes?

Under the new FMCSA final rule on insulin-treated diabetes, the maximum period of medical certification is 12 months. 

A1c Guidelines for DOT Physical

Hemoglobin A1c is blood sugar that can show in your urine test if you have poor glucose control — as would be the case if you have uncontrolled diabetes. This is the sugar that is detected that we discussed above, and so 10% is the A1c limit for the physical exam. 

The DOT A1c guidelines 2024 are that you must have less than 10% to pass. However, if it is higher than 8%, your medical examiner may have some concerns about your ongoing health, and so may refer you for further testing and monitoring. 

If you haven’t been diagnosed with diabetes, you can improve your diet and get more regular exercise to lower your A1c levels. High A1c levels are from excess sugars being produced when your cells have enough energy to function, so if you eat foods with less sugar and avoid overeating, your A1c levels will naturally start to lower. 

Remember that your medical examiner isn’t trying to find reasons to fail you – they’ll want to pass you but they also have to make sure you’re healthy and safe to operate CMVs, for your safety and that of others. If you find you do have high A1c levels, speak to your physician about what next steps you can take to avoid future health problems that may cause you to fail the DOT physical in the future. If you do fail due to uncontrolled diabetes or high A1c levels, you’ll be able to reapply once your condition is under control. 

What are the DOT Physical Blood Sugar Requirements?

If you haven’t been diagnosed with diabetes but know or suspect you have blood sugar levels, then you may be concerned about having a nasty surprise when your urine is tested for excess sugar. The physical requires you to have a blood sugar level of less than 8% in this test — a normal range is less than 5.7%.

What are Acceptable Blood Sugar Levels?

If you have a blood sugar level of under 5.7%, you’re within a normal range. If it’s between 5.7% and 6.4%, then you’re considered “pre-diabetic,” and so your medical examiner may have some concerns and refer you for further investigation or monitoring, or recommend you make some lifestyle changes. That alone is not enough to fail the DOT physical, but you do need to be aware that it’s high and monitor it so that you don’t get diabetes or end up with a level that’s too high when you go for your next physical.

New DOT Physical Requirements for Diabetes in 2024

As long as you have a diabetes management regime in place, your blood sugar levels are monitored, and your insulin-prescribing doctor provides the Diabetes Mellitus Assessment Form (ITDM Assessment Form), MCSA-5870, to the certified medical examiner performing the DOT physical, you should be in good standing to pass it.

Now that you know the FMCSA diabetes guidelines for 2024, it's time to schedule your DOT physical.

Foley makes it easier for owner-operators and fleet managers to schedule DOT physicals for drivers. Our NEW automated DOT physicals software automatically sends alerts whenever drivers need a physical and auto-orders them for you. Plus, the system uploads new medical certificates to drivers’ electronic files once they pass their DOT physical exams. 

Ready to stop tracking medical certificate expirations on your own? Get a FREE demo of the Foley DOT physical software now.

Links to Related Articles in This Series:

The DOT Physical: Everything You Need to Know 

DOT Physicals: Can Chiropractors and Other Doctors do DOT Physicals?

DOT Physicals: Vision Requirements for the Eye Exam      

DOT Physicals: Can You Pass with a High BMI or While Overweight? 

DOT Physicals: Can I Get a DOT Physical in Any State? 

DOT Physicals: Can You Pass with a Hernia? 

DOT Physical Blood Pressure: Requirements & Tips for Passing 

DOT Physicals: Can I Pass With Sleep Apnea? 

DOT Physicals: What if I have a Medical Condition? 

DOT Physicals: Do They Include a Drug Test? 

How to Prepare for Your DOT Physical? 

DOT Physicals: What Happens When You Fail? 

Fail a DOT Physical? You Have a Right to a Second Opinion 

DOT Physicals: Understanding Medical Variances