How Insurance Companies View Type 1 Diabetes

Insurance underwriters recognize Type 1 diabetes as a manageable chronic condition rather than an automatic disqualifier. That said, however, getting approved for coverage isn’t a foregone conclusion and will primarily focus on one fundamental question: How well do you control your blood glucose, and have you developed complications?

Primary Underwriting Considerations

Insurance companies examine several key factors when assessing Type 1 diabetes applications:

• HbA1c levels: Current and historical glycemic control measured by HbA1c percentage
• HbA1c stability: Whether control is improving, stable, or deteriorating over time
• Management consistency: Regular healthcare visits, engagement with an endocrinologist or diabetes specialist
• Complication status: Presence or absence of diabetic neuropathy, retinopathy, nephropathy, or cardiovascular complications
• Associated conditions: Presence of hypertension, high cholesterol, or other cardiovascular risk factors
• Medication adherence: Type of insulin therapy, pump use, CGM use—indicators of engagement with management
• Duration of diagnosis: Less important than control; well-controlled recent diagnosis beats poorly-controlled long history

Why Management Quality Determines Outcomes

Type 1 diabetes itself isn’t the underwriting concern—poor management and resulting complications are. Someone with Type 1 diabetes for 30 years, maintaining HbA1c below 7% without complications, faces dramatically better underwriting than someone diagnosed 2 years ago with HbA1c above 9% and early signs of neuropathy.

This distinction reflects medical reality. Well-controlled Type 1 diabetes has minimal impact on mortality. Poorly controlled diabetes or diabetes with established complications creates significant health risks. Underwriters, therefore, focus intensely on management quality rather than diagnosis alone.

The Critical Role of HbA1c Levels

HbA1c is the single most important number in Type 1 diabetes life insurance underwriting. This three-month average blood glucose measurement determines more about your approval prospects than any other factor.

Understanding HbA1c Ranges in Underwriting

HbA1c Trend Matters as Much as Current Level

Underwriters examine not just your current HbA1c, but whether control is improving, stable, or deteriorating. An applicant with a current HbA1c of 8.5% showing consistent improvement over six months gets rated more favorably than someone with a stable HbA1c of 8.2% with no trend toward improvement.

This reflects practical risk assessment. Someone actively improving their control demonstrates engagement with diabetes management and suggests future improvement. Someone stalled at a plateau raises questions about motivation or barriers to better control.

Coverage Options at Different Management Stages

Your coverage pathway depends significantly on both the quality of your diabetes management and your stage of diagnosis and treatment.

Recently Diagnosed (Within 12 Months)

A recent Type 1 diagnosis typically requires initial management stabilization before traditional underwriting. Most carriers postpone fully underwritten applications for 3-6 months after diagnosis to allow diabetes adjustment and insulin regimen optimization.

Typical outcome with good early control: Standard to Table 2 rates at 3-6 months post-diagnosis, assuming HbA1c below 7% and no complications.

Well-Managed, Established Diabetes (1+ Years)

Applicants with established Type 1 diabetes (typically diagnosed 1-5+ years ago) with consistent HbA1c below 7.5%, no complications, and regular healthcare engagement usually access excellent rates.

Typical outcome: Standard to Table 2 rates with straightforward underwriting. Most carriers view well-managed, established diabetes as a resolved underwriting concern, similar to other chronic conditions that you manage well.

Suboptimally Controlled Diabetes (HbA1c 8.0–9.0%)

Applicants with longer-standing diabetes but HbA1c in the 8-9% range face moderate underwriting. Some carriers will approve applications with readings this high, but only at Table 4-6 ratings. However, some may request additional information or impose brief postponements until control improves.

Strategic consideration: If your HbA1c is 8-9%, consider delaying application 3-4 months while aggressively improving control. The rating reduction from improving to sub-8% often outweighs the benefit of immediate approval at a higher rate.

Poorly Controlled Diabetes (HbA1c Above 9.0%)

Poor glycemic control creates significant underwriting obstacles. Most carriers will postpone or deny traditional underwriting applications or apply significant substantial ratings (Table 6+). Guaranteed issue products remain available without medical underwriting.

How Complications Affect Underwriting

Diabetic complications—neuropathy, retinopathy, nephropathy, and cardiovascular disease—significantly increase life insurance ratings or create postponements/denials. The presence and severity of complications matter more than the diagnosis of diabetes alone.

Diabetic Neuropathy (Nerve Damage)

Peripheral neuropathy is relatively common and typically creates a Table 2-4 rating (at best). Autonomic neuropathy (affecting heart or blood pressure regulation) creates more significant underwriting concerns—typically Table 4-6 ratings (at best) or postponement/denail until medical documentation confirms stability.

Underwriting approach: Carriers request recent neurologic evaluation documentation and assess symptom severity. Stable neuropathy requiring ongoing management usually receives moderate ratings. Progressive neuropathy typically results in postponement pending stabilization.

Diabetic Retinopathy (Eye Disease)

Early/nonproliferative retinopathy typically results in Table 2-4 ratings with good glucose control. Proliferative retinopathy requiring laser treatment or anti-VEGF injections creates more significant ratings—typically Table 4-6 (at best), depending on visual status and disease stability.

Documentation requirement: Recent ophthalmology exam reports are essential, particularly documenting current visual acuity and disease stability.

Diabetic Nephropathy (Kidney Disease)

Early kidney disease with preserved kidney function typically results in Table 4-6 ratings (at best). Advanced chronic kidney disease or dialysis-dependent nephropathy creates significant underwriting concerns—typically substantial postponements or Table 6+ ratings depending on kidney function stability if not postponement/denial.

Key metric: Glomerular filtration rate (GFR) and urine albumin-to-creatinine ratio are critical underwriting factors. Stable or improving kidney function receives a more favorable assessment than declining function.

Cardiovascular Complications

Diabetes-related cardiovascular disease—coronary artery disease, prior myocardial infarction, heart failure, stroke—creates substantial underwriting complexity beyond standard diabetes assessment. These typically require specialized underwriting, similar to that of non-diabetic cardiovascular disease applicants.

The underwriting approach depends on the specific type of cardiovascular event, the time since the event, current stability, and residual cardiac function. Most recent events (within the last 12 months) result in postponement pending stabilization.

When Should You Apply for Life Insurance?

Application timing has a significant impact on approval outcomes and premium costs. Strategic timing in diabetes management optimization yields dramatic improvements in results.

If You Have Well-Controlled Diabetes (HbA1c Below 7%)

Apply now. Well-controlled diabetes with no complications typically receives standard to Table 2 rates immediately, with straightforward underwriting. Delaying application won’t improve your rates—control at this level is optimal. The sooner you apply, the sooner your family has protection in place.

If You Have Recently Diagnosed Type 1 Diabetes

Wait 3-4 months before applying for traditional coverage while stabilizing your insulin regimen and achieving initial good control.

If You Have Suboptimal Control (HbA1c 8–9%)

Strongly consider delaying 3-6 months while working aggressively with your endocrinologist to improve control. The rating reduction from achieving sub-8% control typically outweighs immediate approval at a higher rate. Most applicants in this range benefit from postponement and improved control far more than immediate application.

If You Have Poor Control (HbA1c Above 9%)

Secure guaranteed issue coverage immediately, then focus on diabetes management improvement for 3-6 months. Applying with HbA1c above 9% typically results in postponement or Table 6+ ratings anyway. Using this time to improve control, then reapplying at better control levels, usually produces better overall outcomes than immediate application.

If You Have Experienced Recent Complications

Wait until the complication stabilizes and resolves, typically 3-6 months depending on the complication type. Applying during active complication management typically results in postponement. Allow medical documentation time to demonstrate stability, then submit applications.

What Should You Expect for Premium Costs?

Premium costs for life insurance with Type 1 diabetes vary dramatically based on control quality and complication status. Well-controlled diabetes results in favorable pricing; poorly controlled diabetes or complications increase costs substantially.

Well-Controlled Type 1 Diabetes (HbA1c Below 7%)

Expected rates: Standard to high table rates with no diabetes-related adjustment. This represents optimal pricing and is quite achievable with good management.

Example: A 45-year-old with well-controlled Type 1 diabetes for 10 years (HbA1c 6.8%) and no complications typically pays standard rates identical to someone without diabetes.

Good Control (HbA1c 7.0–8.0%)

Expected rates: Table 2 ratings (10-15% above standard). Good but not optimal control typically results in modest premium increases.

Example: A 40-year-old with HbA1c of 7.5% might pay 10-12% more than standard rates.

Moderate Control (HbA1c 8.0–9.0%)

Expected rates: Table 4-6 ratings (40-75% above standard). Moderate control with room for improvement results in more significant premium increases.

Example: A 40-year-old with HbA1c of 8.5% might pay 50-60% more than standard rates.

Poor Control (HbA1c Above 9%)

Expected rates: Table 6+ ratings (75%+ above standard) or postponement. Poor control with significant complication risk results in substantial premium increases or application postponement.

With Complications

Expected additional impact: Add 25-100% to the base diabetes rating if approved, depending on the complication type and severity. Retinopathy, neuropathy, and nephropathy each add separate underwriting adjustments.

Example: Someone with HbA1c of 7.8% and early neuropathy might face Table 4 ratings instead of Table 2, increasing premiums 40-50%.

How Should You Approach the Application?

Successful applications with Type 1 diabetes require thorough documentation and a clear presentation of your diabetes management. Here’s how to optimize your application approach.

Gather Comprehensive Medical Documentation

Collect and organize medical records before submitting your application. This demonstrates preparedness and significantly accelerates underwriting:

• HbA1c results from the last 6-12 months (showing trend, not just current level)
• Recent endocrinologist or primary care physician notes documenting a diabetes management plan
• Current medication list (insulin types, doses, other diabetes medications)
• Recent laboratory work (kidney function, lipid panel, urinalysis)
• Complication screening documentation, if applicable (eye exams, kidney function assessment, cardiac workup)
• Healthcare provider statement confirming diabetes diagnosis date and current management status

Be Complete and Honest in Health History

On the application:

• Provide the precise Type 1 diabetes diagnosis date
• List the current HbA1c level and note when it was last measured
• Document insulin therapy type (MDI, pump, pen) and any other diabetes medications
• Disclose any episodes of severe hypoglycemia or DKA (diabetic ketoacidosis)
• Be transparent about complication screening or results
• List associated conditions (hypertension, high cholesterol, thyroid disease)
• Provide healthcare provider contact information for medical record requests

Emphasize Management Engagement

Highlight your active diabetes management: regular endocrinology visits, use of continuous glucose monitors (CGM) or insulin pumps, regular complication screening, and demonstrated improvement in HbA1c if applicable. Underwriters want to see that you take your condition seriously and actively manage it.

Carrier Selection Considerations

Type 1 diabetes underwriting varies moderately between carriers. Some carriers are known for favorable Type 1 diabetes assessments, particularly for well-controlled applicants. Working with a broker familiar with individual carrier diabetes underwriting approaches can optimize carrier matching.

Frequently Asked Questions