U.S., Canada kill prohibition on insulin-using diabetic truckers

January 17, 2020

Jami Jones


An agreement between the United States and Canada has been updated to green light insulin-using diabetic truckers to operate in cross-border operations between the two countries.

In September, the Federal Motor Carrier Safety Administration and Transport Canada updated an agreement dating back to 1998 that agrees to mutual recognition of medical fitness requirement for truck drivers. That agreement previously prevented insulin-using diabetics from either country from operating in cross-border operations.

The ball started rolling in late 2018, when FMCSA cut the last bit of regulatory red tape that stood between insulin-dependent diabetics and a life on the road behind the wheel of a truck, a move whole-heartedly supported by the Owner-Operator Independent Drivers Association.

FMCSA announced in September 2018 it will no longer require insulin-dependent truckers to acquire an exemption from the agency to operate in interstate commerce.

Rather, the agency will now allow a treating clinician who manages and prescribes insulin for the treatment of diabetes to decide if the driver meets the physical standards to drive a truck. The driver will have to maintain a stable insulin regime and proper control of his or her diabetes, according to the Federal Register notice.

The ban was ultimately lifted in November 2018. However, because of the existing agreement between the U.S. and Canada on physical fitness requirement, cross-border trucking was still off limits.

In March 2019, William Quade with FMCSA sent a letter to Transport Canada to notify the agency of the change in medical requirements in the U.S. that now allowed insulin-dependent truckers to drive interstate without a waiver.

The letter stated that FMCSA had reviewed the Canadian requirements on insulin-treated diabetics and determined that the U.S. regulations were equivalent.

On Sept. 9, Michael DeJong, director general of multimodal and road safety programs for Transport Canada, responded with a letter that proposed new language for the country’s agreement regarding medical fitness requirements.

The new language states:

“Transport Canada and FMCSA agree that as of November 19, 2018, the standards in the Federal Motor Carrier Safety Regulations and the Canadian National Safety Code for commercial drivers with insulin-treated diabetes mellitus are equivalent. Commercial drivers with insulin-treated diabetes qualified to operate commercial motor vehicles under the standards of one country will also be qualified to operate such vehicles in the other country.”


Ray Martinez, who was still administrator of FMCSA, responded to DeJong’s letter agreeing to the proposed new language.

“Accordingly, the prohibition on cross-border operations for commercial drivers with insulin-treated diabetes mellitus is removed effective as of the date of this letter,” Martinez wrote in the letter.

Even with the ban lifted, Canadian drivers with insulin-treated diabetes can’t operate in the U.S., yet.

The Canadian Trucking Alliance reports that because of the change Canadian jurisdictions are searching the driver licensing system to identify licenses with the diabetes-related code W and notifying those individuals that the ban is lifted.

According to the Alliance, that will take time to complete depending on jurisdiction. Additionally, Canadian jurisdictions are also at various implementation timelines issuing new drivers licenses without the code W designation.

The Alliance also advises affected drivers to contact their provincial and territorial jurisdictions directly regarding the removal of the code W.


Jami Jones has been in journalism since 1991 – focused on the trucking industry since 2000. Whether judging Shell SuperRigs or writing hard-hitting analyses, she covers trucking from lug nuts to legislation – always with the trucker in mind.