Diabetes is one of the most common health conditions that life insurance underwriters evaluate, and it is also one of the most misunderstood from the applicant’s perspective. Many people with diabetes assume they cannot get coverage or that it will be prohibitively expensive. That assumption is wrong often enough that it is worth walking through exactly how underwriters think about diabetes, what they look at, and what you can do to improve your chances of getting a good rate.
The reality is that millions of Americans with diabetes carry life insurance at rates that are reasonable relative to their actual risk. Underwriting has become more sophisticated about distinguishing between a well-controlled diabetic with no complications and one whose condition is poorly managed with multiple comorbidities. These are genuinely different risk profiles, and good underwriters treat them differently.
Type 1 Versus Type 2 Diabetes in Underwriting
The first thing underwriters want to know is which type of diabetes you have, because Type 1 and Type 2 are different conditions with different risk profiles, different management challenges, and different long-term trajectories.
Type 2 diabetes accounts for roughly 90 to 95 percent of all diabetes cases. It typically develops in adulthood, is strongly associated with lifestyle factors, and in many cases can be effectively managed through medication, diet, and exercise. Underwriters have a great deal of actuarial data on Type 2 diabetics because there are so many of them, and the data supports a wide range of ratings depending on control and complication status. A Type 2 diabetic with a good A1C, no complications, and a clean cardiovascular profile can often get standard rates or rates that are only modestly above standard.
Type 1 diabetes is an autoimmune condition that typically develops in childhood or early adulthood and always requires insulin. Underwriters view Type 1 more conservatively than Type 2, both because of the absolute insulin dependence and because the long-term complication risks are generally higher. That said, well-controlled Type 1 diabetics absolutely can obtain life insurance. The rates will typically be higher than for a comparable Type 2 diabetic with similar A1C levels, but coverage is available at many carriers. Some underwriters will not write Type 1 at all, which is why working with a broker who knows which carriers are receptive to Type 1 applicants matters enormously.
What Underwriters Actually Look At
When an underwriter reviews a life insurance application from a diabetic, they are building a picture of how well-controlled the condition is and whether complications have begun to develop. Several specific data points drive that assessment.
A1C is the single most important number in diabetic underwriting. The A1C test measures average blood sugar over the past two to three months and gives the underwriter a more reliable picture of control than a single fasting glucose reading. Most underwriters have clear A1C thresholds that correspond to different rating classes. An A1C under 7.0 is generally viewed favorably. An A1C in the 7.0 to 7.5 range is workable for many carriers. An A1C above 8.0 or 9.0 starts to generate more significant rate increases or even declines, depending on other factors. Some carriers will not offer coverage at all once A1C exceeds a certain threshold, typically around 10.0 or higher.
Complication history is the second major factor. The complications most relevant to underwriting are diabetic nephropathy, which is kidney disease; retinopathy, which is eye damage; neuropathy, which is nerve damage; and cardiovascular disease, including coronary artery disease and peripheral artery disease. The presence of any significant complication substantially increases the underwriting risk and will typically result in a rated policy, meaning one with higher premiums than a standard classification, or in some cases a decline. The more complications present and the more advanced they are, the harder it becomes to find coverage at any reasonable price.
Medication and treatment regimen also matter. Underwriters want to know whether diabetes is controlled through diet and exercise alone, with oral medications like metformin, or with insulin. Diet-controlled Type 2 diabetes is viewed most favorably. Oral medication is viewed reasonably favorably if control is good. Insulin use for Type 2 diabetes is a yellow flag that generates closer scrutiny, because the need for insulin in a Type 2 patient often indicates that the condition has progressed or that control has been more difficult to achieve. Insulin for Type 1 is expected and does not carry the same negative signal, though other factors compensate.
Control history over time also factors in. An applicant who has maintained consistent A1C readings in a good range over several years is viewed differently from someone whose A1C fluctuates widely or who had very poor control in the recent past and improved only recently. Underwriters want evidence of sustainable management, not just a good number at the moment of application.
Other health factors compound or mitigate the diabetes risk. Weight, blood pressure, cholesterol levels, smoking status, and cardiovascular health all interact with the diabetes assessment. A diabetic who is also obese, a smoker, and has hypertension is a very different underwriting profile from a diabetic who maintains a healthy weight, does not smoke, and has well-controlled blood pressure. The insurer is looking at the whole picture, not just the diabetes in isolation.
How Control Levels Affect Rates
The practical range of outcomes for diabetic life insurance applicants is wide. At one end, a 40-year-old with well-controlled Type 2 diabetes diagnosed within the last few years, an A1C of 6.5, no complications, healthy weight, and no other significant health issues might qualify for a Standard rating at many carriers. That means paying the same premium as someone without diabetes in a similar age and health profile would pay at the standard class. Some preferred carriers will even consider a Table 2 or Table B rating, which is only modestly above standard, for very favorable profiles.
Moving up the risk scale, a 45-year-old with Type 2 diabetes, an A1C of 7.5, no complications, and otherwise decent health might land in a Table 2 to Table 4 rating range, meaning premiums 50 to 100 percent above the standard rate. Still insurable, and the death benefit protection is still worth the cost for most families, but the pricing reflects the elevated risk.
A 50-year-old with Type 2 diabetes, an A1C of 8.5, early-stage nephropathy, and hypertension is going to face a significantly higher rating, possibly Table 6 or higher, or a decline at preferred carriers. They may need to work with carriers that specialize in higher-risk cases or consider simplified-issue or guaranteed-issue products as a fallback.
Type 1 diabetics with excellent control, documented by consistently low A1C and no complications, can often find coverage at carriers that are willing to write the risk, though they will typically be rated higher than a comparable Type 2 applicant with the same A1C. The typical starting point for a well-controlled Type 1 applicant might be Table 4 to Table 6, with better ratings possible at carriers that have developed favorable experience with this population.
Which Carriers Are Known for Favorable Diabetic Underwriting
Not all life insurance carriers approach diabetic underwriting the same way, and the difference in pricing between a carrier that is aggressive in writing diabetic cases versus one that is not can be dramatic for the same applicant. This is one of the strongest arguments for working with an independent broker rather than going directly to a single carrier, because the broker can assess your profile and identify which carriers are most likely to offer competitive terms.
Several carriers have developed reputations in the broker community for taking a favorable approach to well-controlled Type 2 diabetes. These carriers have accumulated enough experience with the diabetic risk pool to price it confidently, which allows them to be more competitive on well-controlled cases. The specific carriers that lead in this space shift over time as their books of business evolve, which is another reason why working with a broker who actively tracks underwriting trends matters.
For Type 1 diabetes, the list of carriers willing to write the risk is shorter, and the ones that do have often invested in actuarial experience specifically with this population. A broker who specializes in impaired risk underwriting will know which carriers are receptive and what profile elements they want to see. Going direct to a carrier as a Type 1 diabetic without that guidance is likely to result in either a decline or an unnecessarily high rating because you landed with the wrong company for your profile.
Some carriers have begun using continuous glucose monitoring data as part of their underwriting process for diabetic applicants. This data, which provides a detailed picture of blood sugar variability throughout the day, can actually help applicants who are well-controlled demonstrate the consistency of their management in a way that a single A1C reading cannot. If you use a CGM and have good data, some underwriters will look at that data favorably.
Practical Steps to Improve Your Application Before Applying
If you have diabetes and you are thinking about applying for life insurance, there are concrete steps you can take to put yourself in the best possible position before you submit an application.
The most important thing you can do is get your A1C as low as possible and keep it there consistently. If your most recent A1C is 8.2 and you are scheduled for another check in three months, it may be worth waiting for that next reading and working with your doctor to improve your control before applying. Showing up to underwriting with a 7.3 is meaningfully better than showing up with an 8.2. The premium difference on a significant policy amount can be thousands of dollars per year.
Address other modifiable risk factors before applying as well. If you smoke, quit. If your blood pressure is elevated, work with your doctor to bring it into a better range. If your weight is a factor in your diabetes management and in your underwriting profile, any meaningful improvement matters. Each of these factors is assessed alongside the diabetes, and improvement in any of them can shift your overall rating class.
Have your medical records organized and up to date. Underwriters will request records from your treating physicians, and having a clear, complete record of your diagnosis date, treatment history, A1C trend, and complication screening results helps the underwriter build a favorable picture. Gaps or inconsistencies in the medical record create uncertainty, and underwriters typically resolve uncertainty in a conservative direction.
Work with a broker who has experience placing diabetic cases specifically. Ask them which carriers they plan to approach and why. Ask about pre-qualification calls, which are informal conversations between the broker and the underwriter where the broker describes your profile and gets a sense of how the carrier is likely to rate you before you formally apply. This kind of intelligence gathering can save you from submitting to a carrier that will rate you too conservatively or decline you, since a record of declines can make subsequent applications harder.
Alternative Products When Traditional Underwriting Does Not Work Out
If your diabetes is poorly controlled, you have significant complications, or you have received declines from traditional carriers, the options narrow but do not disappear. Simplified-issue life insurance requires you to answer a limited set of health questions but does not involve a full medical review. These products have lower benefit limits and higher premiums per dollar of coverage, but they can provide meaningful protection when traditional underwriting is not accessible.
Guaranteed-issue life insurance asks no health questions and cannot decline anyone. It is expensive relative to the benefit, and most guaranteed-issue products cap the death benefit at $25,000 to $30,000. There is also typically a graded benefit period of two years during which the full death benefit is not payable for death from natural causes. But for someone who has been declined everywhere else, a guaranteed-issue policy provides at least some protection for their family.
Group life insurance through an employer is another avenue worth considering. Many employer-sponsored group life plans offer a base amount of coverage without medical underwriting, and some offer guaranteed issue up to higher benefit amounts during open enrollment periods. If you have not taken advantage of your employer’s group life coverage, particularly during a guaranteed-issue enrollment window, that is worth doing regardless of what you pursue in the individual market.
The key message for anyone with diabetes who is thinking about life insurance is to not assume the worst and avoid applying. The underwriting landscape for diabetics has improved substantially over the past two decades, and a well-controlled diabetic today has access to coverage that simply was not available to them a generation ago. The right broker and the right carrier can make a significant difference, and the only way to find out what your actual options look like is to go through the process with someone who knows how to navigate it.