Flying with Diabetes?

"Off the Record Q & A with a Local A.M.E."

DR. Larry

Dr. Larry, I worked with a pilot in the training department who was a diabetic and unable to fly. Why, if managed properly with medication, can’t a pilot fly with Diabetes? Are there different kinds? Is this something that could be completely controlled with diet? Any information you can send would be helpful.

Dr. Larry:

Great question, especially at this time of year when many of us are making the annual New Year’s resolution to get healthier, shed excess pounds and ward off disease.

The FAA actually does allow pilots to fly with diabetes, depending upon the type of diabetes (see below), the extent of control and the class of certification desired. For the record, the pilot in the training department would not be allowed a First or Second Class medical certificate if they required insulin for blood sugar control. However, they could be issued a Third Class medical certificate so long as they adhered to protocols for monitoring their blood sugar while flying and proving good control otherwise.

Diabetes mellitus is an inability to control one’s blood sugar (glucose) and comes in three types. Type 1 (T1DM) is a failure of the body to produce insulin, is typically genetically determined, often presents in childhood or young adulthood and is controlled by giving the body insulin, typically in an injectable form. It comprises only 5-10% of the diabetic population.

Type 2 diabetes mellitus (T2DM) is far more common (90% of diabetics) and begins with insulin resistance or the body’s inability to utilize insulin adequately. This form of diabetes typically responds early on to lifestyle changes, such as diet, exercise, rest, etc. Even in its later stages, those changes will make a difference.

For completeness, a third type is called gestational diabetes and occurs when pregnancy brings on elevated blood sugars which may or may not require insulin for control. This typically would not be an issue for the FAA since the pregnancy itself would likely be reason not to fly.

The FAA makes a significant distinction between the types of diabetes predominately because of the volatility and difficulty of regulating one’s blood sugar in Type 1. Too little insulin and the blood sugar will be too high. Too much insulin and one will induce hypoglycemia (low blood sugar) and if the blood sugar drops low enough, it can lead to lightheadedness, mental confusion and passing out, even death.

T2DM patients may be on various oral medications to help control their blood sugar levels if lifestyle alone is not enough. However, these medications have a much higher level of predictability than insulin, allowing for better consistency and performance which allows the FAA to be relatively comfortable allowing T2DM pilots to fly.

Diabetes is also monitored because it is associated with a high rate of cardiovascular, stroke and peripheral vascular disease, all things which can prevent pilots from following their passion. In fact, the diagnosis of diabetes carries the same risk for heart and stroke attack as the person who has already had a vascular event!

Yearly monitoring by the FAA via time a limited special issuance would be necessary if one reports they have diabetes and are treated with medication. Interestingly, aerospace medical research teams recently examined medical certification records and accident investigation reports of diabetic pilots. Their findings revealed that a significant number of diabetic pilots do not report or are unaware of their condition. Researchers also found that 75% of insulin-dependent diabetics were either overweight (44%) or frankly obese (31%).

If one needs additional motivation, diabetes that is reversed or controlled by lifestyle modification only (no meds) is not something needing FAA clearance.

Diabetes is a serious health issue, both in aviation and the general population. It is showing up in staggering numbers and will tax our healthcare system to the limit in the next 20 to 30 years. The best treatment is to not allow your body to start down the path. Even though the FAA will allow people to fly with the disease, it doesn’t mean it’s healthy to have it. Prevention is once again the best tool we have for keeping us airworthy.

To your good health,

Dr. Larry