Here’s a question about diabetes exemption in DOT Commercial driver from one of our NRCME training program students:

Let’s see if I understood <the diabetes> exemption guidelines sequence.
If the driver is insulin diabetic…
I do the exam. He is qualified except for the insulin…so I fill out the Medical Exam Form, indicate he is currently disqualified, say why, but don’t write anything on the certificate. ( in this case the driver has never had an exemption before).
Then…the driver applies for the Federal <diabetes> exemption program and shows a copy of my Medical Exam Form. In my geographic area they get that exemption application form from the DMV.
Then…if and when he receives the Federal exemption form, I fill out a follow-up Medical Exam Form and certificate indicating he can drive if accompanied by the Federal Exemption form.

Not exactly.

If the driver is otherwise qualified except for using insulin, on the exam form you mark qualified for one year due to diabetes AND :

Mark the “accompanied by a __________ exemption checkbox
Write “federal diabetes” on the line
Circle “exemption”

So the confusing part about diabetes exemption in DOT Commercial driver is although you have marked “meets standards” they are still disqualified UNLESS accompanied by the exemption, which they now have to apply for. See driver exemption programs for more details. They do not have to return to you for another exam after getting the exemption, until the one year has passed.
Once they are already in the federal exemption program and presenting for recertification, they must provide for you: