My 2007 f250 6.0 this truck is an everyday driver on the road10 to 20 hours a day. this truck is used as a tow truck. so it goes through a rough day. I have never had any problems with the truck except when starting after sitting for more 3 or 4 hours. if its its for a long time and then you started up it starts up just fine but then rocks like the motors going to blow up. it sounds like every lifter is knocking and then after a couple minutes it stops and goes and runs right. I thought here was something wrong with so I took it to ford. they told me the only thing they can find wrong with the truck is the exhaust pressure sensor. this seems to be getting worse. I'm not sure what to do to fix this issue do any of you guys have any ideas on what I can check or what may cause this.

the only thing work that's been done to the truck mechanically by me since I have owned is . the car lot I bought the truck from said that they replaced for injectors. since then I replaced the glow plugs. I change the oil and fuel filters every 5000 miles.

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Okay update now the truck is smoking and the exhaust smells awful not sweet

 

What color is the smoke? When my injectors suck open, the smoke was grey and it had a choppy idle. Have you hooked up a scanner to it for DTCs?

 

Could be any number of things, more info on the truck would help.

Typically a hard hot start is a high pressure oil leak, which could also easily make the truck run rough.