NRCME Diabetes Mellitus Standards 3 — Questions and Answers
Question 1: The FMCSA Federal Diabetes Exemption Program requires that an insulin-treated applicant be evaluated by:
- Any licensed nurse practitioner
- An endocrinologist or primary care physician familiar with their diabetes management (Correct answer)
- A cardiologist only
- A state DMV-approved examiner
Correct answer: An endocrinologist or primary care physician familiar with their diabetes management
The treating endocrinologist or knowledgeable primary care physician must complete the required attestation forms.
Question 2: A driver with diabetes has a resting blood pressure of 160/100 mmHg at the examination. The examiner should:
- Ignore it since diabetes is the primary concern
- Address hypertension per FMCSA standards, as comorbidities compound cardiovascular risk (Correct answer)
- Certify for 1 year if diabetes is controlled
- Issue a waiver automatically
Correct answer: Address hypertension per FMCSA standards, as comorbidities compound cardiovascular risk
Hypertension and diabetes together significantly elevate cardiovascular risk and must both be evaluated under FMCSA standards.
Question 3: What is the minimum pre-driving blood glucose level recommended for insulin-treated exempt CMV drivers before operating a CMV?
- 60 mg/dL
- 80 mg/dL
- 100 mg/dL (Correct answer)
- 140 mg/dL
Correct answer: 100 mg/dL
Insulin-treated exempt drivers are generally advised to confirm blood glucose is at least 100 mg/dL before driving.
Question 4: A CMV driver with diabetes develops diabetic nephropathy with creatinine of 3.5 mg/dL. The primary concern for certification is:
- Increased infection risk
- Cardiovascular risk and potential for uremic symptoms impairing alertness (Correct answer)
- Vitamin D deficiency
- Increased bleeding tendency
Correct answer: Cardiovascular risk and potential for uremic symptoms impairing alertness
Severely reduced kidney function elevates cardiovascular risk and may cause uremic symptoms that impair driving ability.
Question 5: Which piece of documentation is NOT typically required for the Federal Diabetes Exemption Program application?
- Physician's statement of diabetes management
- HbA1c results
- Record of hypoglycemic episodes
- Proof of automobile liability insurance (Correct answer)
Correct answer: Proof of automobile liability insurance
The exemption program requires medical and glycemic control documentation, not personal automobile insurance.
Question 6: How often must insulin-treated CMV drivers under the diabetes exemption check blood glucose when driving long hauls?
- Once before the trip only
- Every 4 hours and within 1 hour before driving (Correct answer)
- Only if they feel symptomatic
- Every 8 hours
Correct answer: Every 4 hours and within 1 hour before driving
FMCSA exemption guidelines typically require checks every 4 hours and within 1 hour before beginning to drive.
Question 7: Which type of diabetes medication carries the LOWEST risk of hypoglycemia relevant to FMCSA driving safety?
- Insulin glargine
- Glipizide (sulfonylurea)
- Sitagliptin (DPP-4 inhibitor) (Correct answer)
- NPH insulin
Correct answer: Sitagliptin (DPP-4 inhibitor)
DPP-4 inhibitors work glucose-dependently and have a very low intrinsic risk of causing hypoglycemia.
NRCME Diabetes Mellitus Standards 3
The FMCSA Federal Diabetes Exemption Program requires that an insulin-treated applicant be evaluated by: