Aeromedical Forum: May 2015

It has been a while since we’ve talked about diabetes (January, 2011). Back last fall the FAA revised their rules on certification including acceptable medications and medication combinations.

To back up a bit, you might remember that diabetes mellitus is a disorder of glucose metabolism. That’s doc talk for problems with your blood sugar. Your pancreas is an organ that looks a little bit like a fillet of sole. It’s between you liver and spleen in your abdomen. It secretes insulin. Insulin is a hormone that helps the cells of your body take glucose from your blood stream to use it as fuel for your metabolism.

If you don’t make enough insulin, your blood sugar goes up and a lot of other bad things happen. Short term, you start to loose fluids, become groggy and with sever (Type I) diabetes you can slip into coma and die. Not good. Also worrisome is the fact that treatment with insulin injections sometimes can cause an excessive drop in blood sugar (hypoglycemia). This also can cause a rapid loss of consciousness. Also not good.

Milder, Type II diabetes usually doesn’t have such dramatic short term complications but you still feel awful. With both forms of diabetes long term complications can include damage to the eyes, kidneys, heart and nervous system. Happily there is pretty good evidence that if you keep your diabetes under good control, a lot of these bad things can be avoided or at least minimized. Yet another good reason to do what your doc tells you!

As you can imagine diabetes and its complications as well as its treatment can cause trouble in the cockpit. Not surprisingly, the FAA has some pretty stringent guidelines as to which diabetics can fly and under what circumstances. First of all, any diabetic requiring insulin treatment by injection or by insulin pump is barred from holding a First or Second Class Medical Certificate. That pretty well closes the door to any pilot seeking a career in aviation in Part 121 or 135 operations. That might be a good reason to have your family doc do a fasting blood sugar and maybe even a glucose tolerance test if you have a family history of Type I diabetes and are thinking of enrolling in a college aviation program. If these tests do show a latent tendency to diabetes you might want to rethink your long-term goals. If all you need for your flying is a Third Class Certificate, you still will have to jump through a few hoops to get your ticket.

The FAA Guide for Aviation Medical Examiners states that “a medical history or clinical diagnosis of diabetes mellitus requiring insulin or other hypoglycemic drugs for control are disqualifying.” This means two things. One - if your doc finds that you have a mildly elevated fasting blood sugar but thinks it can be controlled by losing weight, exercise and modifying your diet, you are OK. It’s probably not a severe enough condition to warrant further scrutiny by the FAA. But don’t get complacent! Do what your physician suggests and shave off those pounds. It may well prevent you getting more severe diabetes down the road. Two - if your diabetes is bad enough that you have to be put on pills or insulin, you will have to go through the Special Issuance (SI) process (Aeromedical Forum, January, 2013). Faithful readers of this column will remember that that involves a bunch of lab and physicians’ reports being packed off to the FAA’s Medical Institute in Oklahoma City. The folks down there are going to be closely looking for any complications of the disease that could cause incapacitation in the cockpit.

Hypoglycemic episodes or secondary eye damage are big concerns. If they don’t find anything to get hot under the collar about they will give you an SI. With an SI you will have to be periodically re-evaluated, usually once a year, by your physician. You will have to take the results of the evaluation to your local Aviation Medical Examiner. If she or he finds that you meet the requirements set by the FAA, you’ll get a new time-limited medical certificate, usually good for 12 months.

The bottom line is, keep your diabetes under good control. Take your medicines regularly and watch your diet. Reduce any risk factors that could make it worse such as lack of exercise, poor diet, smoking, over-weight. That way you’ll dramatically increase your chances of keeping that medical certificate for a long, long time!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.