Diabetics May Still Put Flying in Their Diets

by Charlie Spence, Aviation Writer and IFA Member

According to the American Diabetes Association 23.6 million children and adults in the United States have diabetes. Many myths about the condition persist, one being that people with the condition cannot get a pilots license.  That myth might keep many people who love flying from even trying for a medical certificate or those with a pilot certificate to not go for the next flight physical. Let’s set it straight: the Federal Aviation Administration has established a policy that permits the special issuance medical certification of insulin-treated applicants for third-class medical certification.

It is estimated that nearly one quarter—about 5.7 million—of the people who have the condition do not realize it. Symptoms include:  increased appetite, fatigue, blurred vision, increased thirst, increased urination, slow-healing infections, and impotence in men. Health care providers can determine whether or not an individual has pre-diabetes or has diabetes by conducting a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT).

The medical examiner you see may issue a medical certificate if the applicant has Diet and Exercise Controlled Diabetes Mellitus and there is normal Hgba1c and no glycosuria. Others require FAA decisions.

FAA decision is needed for any class of medical certificate if the applicant has Diabetes Insipidus, and for the first issuance to an applicant who has Diabetes Mellitus II that is medically controlled. Diabetes Mellitus I & II requiring insulin requires FAA decision.

 Under federal aviation regulations (Part 67.401), a person who does not meet the provisions for a regular medical certificate may apply for an Authorization for special issuance medical certification. This applies only to third-class medical certificates. The FAA is not currently granting special issuance for first and second-class medicals.

To be eligible for a special issuance, the applicant’s diabetes must be medically controlled, he or she must have had no recurrent (two or more) episodes of hypoglycemia in the past five years and none in the preceding one year resulting in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning. Copies of all medical records as well as any accident or incident records that might be pertinent to the applicant’s history of diabetes will be required.

Reports of a complete medical exam will be required. The FAA prefers that this exam be performed by a physician who specializes in the treatment of diabetes. The agency summarizes its requirements in this way. The report must include:

• Two measurements of glycated hemoglobin, the first at least 90 days prior to the current measurement.
• Specific reference to the applicant’s insulin dosages and diet.
• Specific references to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy.
• Confirmation by an eye specialist of the absence of clinically significant eye disease.
• Verification that the applicant has been educated in diabetes and its control and understands the actions that should be taken if complications, especially hypoglycemia, should arise.
• The examining physician must also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes.
• If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test.
• The applicant shall submit a statement from his/her treating physician, aviation medical examiner, or other knowledgeable person attesting to the applicant’s dexterity and ability to determine blood glucose levels using a recording glucometer.

For individuals who do not have a pilot’s certificate, the FAA recommends that the medical information and the application for airman medical certificate or medical certificate and student pilot certificate be submitted before beginning or resuming flight instruction or training.

When issuing a first time authorization for the special issuance, the medical examiner must defer and submit all documentation to the Aerospace Medical Certification Division.

Examiners may re-issue the medical certificate without getting an FAA decision

If the applicant provides an authorization granted by the FAA, a statement attesting that the airman is maintaining his or her diabetic diet, a statement regarding any diabetic symptomology, and the results of any current HgA1c level performed within the last 90 days.

Airmen with diabetes who are certificated in this manner are expected to adhere to stringent monitoring requirements and are not permitted to operate an aircraft outside the United States.

Go ahead. You don’t let diabetes stop you from enjoying other pleasures in life so go ahead, see a medical examiner and add flying to your diet.

The information contained herein is meant for informational purposes only. Neither IFA nor Charles Spence assume any responsibility or liability for events that occur due to actions you or others on your behalf take based on the information given in this article. You are proceeding at your own risk. It is strongly advised that you seek the opinion and advice of a qualified aviation medical examiner and appropriate medical physician for any medical needs you may have.