Medically Speaking

Happy Endings

October 1, 2006

Diabetes, insulin, the FAA, and AOPA

It's August 26, 2004. "Here you are, Mr. Thompson, please sign right here," the pretty young woman behind the desk at the aviation medical examiner's (AME) office said as she handed over my third class medical certificate. I looked at Sandy, my wife of 40 years, standing patiently in the lobby. We both had tears in our eyes. I know you are probably asking yourself, "What's the big deal?" Let me back up about 17 years.

I've always been consumed with aviation. Even as a small child, when asked the inevitable question, "What do you want to do when you grow up?" my answer was always the same: "I want to be a pilot." As a teenager I was a cadet in the Civil Air Patrol and got my first flight in a general aviation airplane. It was in a Piper J-3 Cub that the Chattanooga Composite Squadron kept at Lovell Field in Tennessee. While serving as a hospital corpsman in the U.S. Navy during the late 1960s I flew with a search-and-rescue crew out of Argentia, Newfoundland, and became more determined than ever to get a pilot certificate.

Life got in the way for a while, but in 1976 my dream came true. I earned my private pilot certificate, and over the next few years I added a commercial certificate, an instrument rating, a multiengine rating, and CFI and CFII tickets. Along the way our daughter caught the aviation bug too, and she went on to graduate from the U.S. Air Force Academy, fly Air Force jets for nine years, and now has the second-best seat in a Boeing 737-800 for one of the major airlines.

I had been employed by 3M for several years when 3M purchased Stormscope from Paul Ryan on April 1, 1981. I joined that business a short time later. Talk about an ideal job. Here I was, the prototypical airport bum, and I was getting paid to, well, hang around airports and talk to pilots and people in avionics shops all day, every day. I had to turn in my company car, but was given a nice company airplane and about a quarter of the country to cover in it. In addition I was doing some part-time flight instructing, and I was an FAA accident prevention counselor, a chief check pilot for the Civil Air Patrol, and a member of the board of advisors for an aviation department at a community college. My life revolved around aviation and life was good.

In April 1987 it was time to renew my second class medical certificate, and I made the appointment with an AME in Greensboro, North Carolina, with nary a worry. The first clue that something was amiss came when the AME explained that I would have to have a blood test because my "sugar" was "too high." When those results arrived he advised me I had to have a glucose tolerance test, and those results would have to be submitted to the FAA for further consideration before he could issue a medical certificate to me.

It's fair to say it was downhill from there. No matter what kind of "approved" oral medication I tried, I couldn't meet the profile the FAA established for the glucose tolerance test. It was time to face the fact that I had diabetes and figure out how to deal with it.

Finally, in January 1990 I had to start on insulin and I knew that was the end of my hopes to fly again. I had been half-owner of a nice Piper Cherokee 180, and after a year or so of not being able to fly I sold my interest to my partner. While the company was great about my losing my medical, it was truly painful to be in the aviation business and not be able to fly, so I found a job in another division of 3M and did my best to put it all behind me.

3M transferred me to Jacksonville, Florida. In the years following I went to a general aviation airport only once and that was to take a ride with our daughter when she came down to get her airline transport pilot certificate. I still followed aviation but certainly not with the interest or enthusiasm I once had. Even when I learned that the FAA had made provisions for insulin-dependent diabetics I wasn't encouraged, because my disease had progressed and I didn't think I could meet the requirements for a special issuance.

In 2003 my doctor asked me if I would consider an insulin pump. Since I was then taking three injections of insulin each day, I thought the pump was a dandy idea. After only a few weeks with the pump some great things began to happen; soon my blood studies became so "normal" that the doctor asked me once if I had sent a healthy 19-year-old to take the blood test.

A glimmer of hope appeared and I logged on to the AOPA Web site, went to the medical section, and started reading. After many weeks of research I still had a lot of questions, and I called AOPA and talked many times with the very knowledgeable medical staff. The information the medical technicians provided was invaluable, and the encouragement they gave me led me to believe I could get through the process.

I was even encouraged to check in on the AOPA message boards, as there was a Medical Matters section where insulin-dependent diabetes is often a subject of discussion. There I found others in the same situation trying to achieve the same goal. Online, I also met Dr. Bruce Chien, an AME with a practice in Peoria, Illinois, who contributes a great deal to the AOPA message-board discussions. His advice about the tests and the format the FAA prefers was very helpful. All of a sudden it wasn't just me alone against the bureaucracy — there was a team of professionals to help. That was a great feeling.

Armed with this information, and a little hope, I started building my packet to submit to the FAA. Diabetics who use a pump to deliver insulin have to demonstrate nine months of stability on the pump; patients who use injectable insulin need to show six months of stability. That gave me plenty of time to get the rest of the information, examinations, and studies together that would complete the packet. Looking back, it seems that at every turn there was something I didn't understand; the AOPA team either had the answer or knew where to get it and always got back to me quickly. I honestly think that there were weeks when I talked with those good folks every day. They probably think I took a lot of handholding, but I wanted everything to be in order, in the correct form, and presented in the proper way.

When the day came to submit the completed packet I called the medical specialists and was told to submit my information and call back in about six weeks if I hadn't heard anything. When the time elapsed and I hadn't had a response, I again talked to the AOPA medical staff, and two weeks later, on Friday, August 13, I received an e-mail from AOPA telling me that the FAA was mailing an "AME may issue" letter. It was my wedding anniversary, but even that wonderful event paled in comparison to this news. After 17 years, who would have believed it? Answer: AOPA believed, and it let me believe. Because of AOPA I have a third class medical certificate in my wallet, I've renewed my Jeppesen subscription, and my logbook has a freshly signed-off flight review. I'm currently working on an instrument competency check with a young man who is now a naval aviator. I taught him to fly in the Civil Air Patrol 20 years ago.

It can be done. I'm living proof. When you hit some unexpected turbulence at the office of the aviation medical examiner, having the resources and expertise of AOPA behind you is as good as it gets. Above all, don't give up. I didn't and with AOPA's help my dream has come true a second time.

Robert "Mike" Thompson, AOPA 596326, of Jacksonville, Florida, is the AOPA Airport Support Network volunteer at St. Augustine Airport.

Links to additional information about medical conditions affecting your ability to fly may be found on AOPA Online.

Guidelines for Diabetics


The FAA removed the "blanket ban" for insulin-treated diabetes in 1996, and today there are about 400 pilots who hold medical "special issuances" (third class only) for insulin-treated, or type 1, diabetes. Another 6,000 are flying while using oral diabetes medications. The FAA relies on the hemoglobin A1C (also known as glycated hemoglobin or HbA1c) test to establish the adequacy of blood sugar control. While your treating doctor probably wants to see your A1C in the "normal" range of between about 4.8 percent and 7.0 percent, the FAA will allow you to fly with a reading of up to about 9 percent.

Our brains function pretty much on two fuel sources, oxygen and glucose, so it's important to maintain adequate glucose — or blood sugar — levels to preserve cerebral integrity. Diabetics, especially, or anyone with a metabolic disorder that puts him or her at risk for wild excursions of blood sugar levels, need to avoid a low-blood-glucose condition called hypoglycemia. Hypoglycemia is the body's response to glucose starvation, which can result in nervousness and jitters, dizziness or lightheadedness, confusion, disorientation, or even total loss of consciousness, all bad things to have happen in the airplane, especially when it's in the air.

By capping the blood glucose levels higher and further away from the "red zone" of hypoglycemia, the FAA broadens the safety net to allow more pilots to be considered acceptable risks. The certification guidelines for insulin-treated diabetics are a bit more complicated than those for oral medication control, but not all that much different. These guidelines are online. If you have questions about the certification process, the medical specialists in AOPA's Pilot Information Center can help. Give them a call at 800/872-2672.

E-mail the author at [email protected].