Insulin – The Final Rule is Posted. What Now?


The FMCSA has come to an agreement on Insulin usage. There are many nuances, but here are the major points.

  • The rule takes effect November 19, 2018, 60 days from today. 
  • driver’s on “a stable insulin regiment and proper control of his or her diabetes” will be eligible to operate a Commercial Motor Vehicle
  • to get the maximum 12-month certification, the driver must:
    • Provide at least three months of self-monitoring glucose records
    • Visit their Treating Clinician (TC) and complete form MCSA-5870
    • Conduct a DOT Physical with a Certified Medical Examiner (CME) within 45 days of the MCSA-5870 form completion


As with any regulation, there are many details, loopholes, and grandfather clauses. We have created a FAQ section on our website to address any additional questions that you may have.


The FMCSA has shifted more responsibility to the CMEs with this ruling.


Physicians, nurse practitioners, physician assistants, and chiropractors are now tasked with helping to ensure that an insulin-dependent diabetic is safe to operate a Commercial Motor Vehicle.

CMEs are well-educated and informed professionals. However, we know that even good doctors make mistakes. With this additional burden on them, it is more important than ever to ensure that when you buy a physical, a competent review is performed to ensure the exam was performed by a CME in good standing AND that all work was done to DOT standards – without shortcuts.

Many clients depend on CMS’s DOT Physical Review service to solve issues that they don’t have the time or experience to handle by themselves. We review tens of thousands of physicals annually so we know exactly what to look for and where the trouble spots usually are. This is just one of the services that make CMS “more than an MRO.”

What are your thoughts on the new ruling? We’d love to hear from you.