I am a 74-year-old who has had diabetes for the past 20 years. I work part-time driving large trucks 3½ days or more every week. I now take two pills a day. How am I going to be able to keep my Department of Transportation (DOT) license if I need to start using insulin? The exam states in large print not to use insulin. I sent a request to DOT in Washington for an exemption, but with the doctors they want me to see and the papers they want me to fill out, I’m not sure if it’s worth it.

Herb Bertsche
Woodburn, Ind.

Katie Hathaway, Associate Director, Legal Advocacy, American Diabetes Association, responds: The situation you are facing is common and is why ADA has been fighting for so long on behalf of commercial drivers with diabetes.

For many years, federal law prohibited anyone with insulin-treated diabetes from operating a commercial motor vehicle in interstate commerce. While some states permitted people who use insulin to drive within their state, that only allowed a few people to maintain jobs in commercial driving.

These rules, dating back to the 1970s, were based on a misunderstanding of diabetes, especially how the disease is managed today. It is true that some people, because of the complications of diabetes, cannot safely drive a commercial vehicle. That is not true for most people. Fairness requires that each person be judged as an individual based on how diabetes affects him or her.

ADA worked for many years, through Congress and the administrative process, to eliminate this blanket ban. In 2003, we succeeded, and the Diabetes Exemption Program was born, establishing a system of individual assessment. This was a big step forward, but the program contained a provision that disqualified anyone who hadn’t been driving a commercial vehicle while using insulin for the prior three years—and that meant almost no one could apply. This requirement was not necessary to ensure safety, as the program contained over 50 other safety provisions. So, ADA went back to Congress and in the summer of 2005 a new law was signed, eliminating the 3-year requirement.

The exemption program isn’t perfect—it can take up to 6 months for an application to be processed, and sometimes longer than that for a final decision. The process involves an examination by an endocrinologist and either an ophthalmologist or optometrist, and you will be asked to provide information about your diabetes, including any complications, hospitalizations, or history of hypoglycemia.

The good news is that since 2005, over 400 people with insulin-treated diabetes have been granted exemptions. Like Mr. Bertsche, many of the people who received exemptions have type 2 diabetes and needed to begin using insulin. Prior to the Diabetes Exemption Program, these individuals had three choices: hope they lived in a state that offered medical waivers and could find a job that didn’t require interstate driving; start a new career after years as a commercial driver; or jeopardize their health by ignoring their doctor’s advice to begin using insulin.

We continue to fight to improve the system. Our goal is to eliminate the administrative burden of the Diabetes Exemption Program and replace it with a system for individual assessment that is done in the regular course of applying for DOT certification.

For more information about the ADA’s efforts in this area, please visit diabetes.org/CDL.