What does 49 CFR 391.46 (Physical qualification standards for an individual with diabetes mellitus treated with insulin for control) require?

Short answer

49 CFR 391.46 requires an individual with diabetes mellitus treated with insulin for control to meet specific physical qualification standards to operate a commercial motor vehicle. The individual must maintain a stable insulin regimen, properly control their diabetes, and meet other standards.

The rule says

"The individual is not physically qualified to operate a commercial motor vehicle if he or she is not maintaining a stable insulin regimen and not properly controlling his or her diabetes mellitus." (49 CFR 391.46(a)(1))

"The individual is not physically qualified on a permanent basis to operate a commercial motor vehicle if he or she has either severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy." (49 CFR 391.46(a)(2))

"The individual is not physically qualified to operate a commercial motor vehicle up to the maximum 12-month period under 391.45(e) until he or she provides the treating clinician with at least the preceding 3 months of electronic blood glucose self-monitoring records while being treated with insulin that are generated in accordance with paragraph (d) of this section." (49 CFR 391.46(a)(3))

In plain English

This rule is about ensuring that individuals with insulin-treated diabetes can safely operate commercial vehicles. The medical examiner must consider the individual's ability to control their diabetes and maintain a stable insulin regimen. If the individual has severe diabetic retinopathy, they are not qualified to drive. The rule also requires individuals to provide their treating clinician with electronic blood glucose self-monitoring records for at least 3 months before they can be certified to drive for up to 12 months.

What to do

• Ensure the individual with diabetes mellitus treated with insulin for control meets the physical qualification standards in 49 CFR 391.46.
• Maintain a stable insulin regimen and properly control diabetes.
• Provide the treating clinician with at least 3 months of electronic blood glucose self-monitoring records.
• Obtain a medical examiner's certificate that is valid for up to the maximum 12-month period allowed by 49 CFR 391.45(e).