Diabetes affects tens of millions of Americans, which means you will encounter it regularly in your life insurance practice. The good news is that diabetic clients can absolutely get life insurance coverage. The challenge is that the underwriting varies significantly depending on the type of diabetes, how well it is controlled, what medications are involved, and whether complications are present. Here is what you need to know to place these cases effectively.
Type 1 vs Type 2: underwriting sees them differently
Type 1 and Type 2 diabetes are fundamentally different conditions, and carriers underwrite them differently. Type 1 diabetes is an autoimmune condition typically diagnosed in childhood or early adulthood where the body produces little or no insulin. Type 2 diabetes is a metabolic condition usually diagnosed later in life where the body becomes resistant to insulin or does not produce enough of it.
From an underwriting perspective, Type 1 diabetes is generally considered a higher risk because it requires lifelong insulin dependence and has a longer duration of disease exposure. Most carriers will offer coverage to Type 1 diabetics, but the rate classes available are typically more limited. A Type 1 diabetic with excellent control and no complications might receive a Standard or Table 2 rating from more favorable carriers. Preferred or Preferred Plus is generally not available for Type 1 applicants.
Type 2 diabetes is more common and more variable in how carriers evaluate it. A Type 2 diabetic who was diagnosed relatively recently, maintains good A1C numbers, is not insulin-dependent, and has no complications can often qualify for Standard or even Standard Plus with certain carriers. The range of outcomes is wider, which means carrier selection matters more.
A1C: the number that matters most
If there is one number that drives diabetes underwriting, it is the A1C. This blood test measures average blood sugar control over the previous two to three months. It gives underwriters a clear picture of how well the applicant is managing their condition, regardless of what their fasting glucose looked like on any single day.
Most carriers look favorably on A1C readings below 7.0. An A1C in the 6.5 to 7.0 range with no complications generally positions the applicant well for Standard or better rate classes on the Type 2 side. As A1C climbs above 7.5 or 8.0, the available rate classes worsen, and above 9.0 or 10.0, many carriers will decline or postpone the application.
When you are working with a diabetic client, ask about their most recent A1C before you submit the application. If they do not know it, encourage them to get recent lab work done before applying. Submitting a case without knowing the A1C is like walking into a negotiation without knowing your numbers. You might get lucky, but you are more likely to waste time.
Insulin dependence and medication considerations
Whether the applicant uses insulin is a significant factor in underwriting. For Type 2 diabetics specifically, carriers generally view non-insulin-dependent applicants more favorably than those on insulin. A Type 2 applicant managing their condition with metformin alone, along with diet and exercise, will typically receive better offers than one who has progressed to insulin therapy.
That said, the trend in underwriting has shifted somewhat. Many carriers now recognize that early, proactive use of insulin for Type 2 diabetes can reflect good medical management rather than disease progression. The context matters. An applicant who started insulin early alongside lifestyle changes is viewed differently from one whose diabetes was poorly controlled for years before insulin was introduced as a last resort.
Other medications also factor in. The number and type of diabetes medications can signal the severity and trajectory of the condition. An applicant on a single oral medication is a simpler case than one on three medications plus insulin.
Complications change everything
The presence or absence of diabetic complications is often the line between an approvable case and a decline. Underwriters look closely for signs of retinopathy, neuropathy, nephropathy, and cardiovascular disease. A diabetic applicant with well-controlled blood sugar but evidence of kidney damage or peripheral neuropathy is a very different risk profile than one with good control and no complications.
Before submitting a case, ask your client directly about complications. Have they had any eye issues related to diabetes? Any numbness or tingling in their extremities? Any kidney function concerns flagged by their doctor? Any cardiovascular events? These are the questions underwriters will be asking through the medical records, and you want to know the answers before they do.
Carrier selection is critical
Not all carriers evaluate diabetes the same way. Some are significantly more accommodating than others, particularly for well-controlled Type 2 cases. The difference in offers between a diabetes-friendly carrier and a conservative one can be the difference between Standard and Table 4, or between approval and decline.
Develop relationships with your brokerage general agencies and underwriting contacts to learn which carriers are currently writing competitive diabetes cases. Carrier appetites shift over time as they review their claims experience, so what was the best option a year ago may not be today. Staying current on carrier positioning is one of the highest-value activities you can do for impaired risk cases.
When you have a diabetic client with strong control and no complications, consider submitting to two or three carriers simultaneously if the face amount and your relationship with the client justify it. Getting multiple offers gives your client options and increases the chances of placing the case at the best available rate.
Realistic expectations and how to position cases
Be upfront with your diabetic clients about what to expect. Most will not qualify for Preferred or Preferred Plus rates. That is okay, and you should frame it that way. The goal is to get them approved at the best rate their health profile supports, and having coverage in place is far more valuable than holding out for a rate class that is not realistic.
When you position the case to the carrier, include a cover letter or agent notes highlighting the positives: stable A1C trend, compliance with medication, regular doctor visits, no complications, healthy lifestyle habits. Underwriters appreciate context that helps them see the full picture rather than just a list of diagnoses and lab values.
Closd helps you compare quotes across carriers so you can match diabetic clients with the most favorable underwriting for their specific situation. Try it free at getclosdai.com