Too sweet to fly

The FAA's policy guidelines on diabetes mellitus on oral medications

November 11, 2013

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Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

Diabetes mellitus that is diet and exercise controlled does not require a special issuance, so your aviation medical examiner may issue a medical certificate without approval from the FAA. However, you will need some documentation for your AME at the time of your next FAA physical examination.

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The information should include a letter from your treating physician that states when the diagnosis was made, if you have developed any complications of diabetes, and a statement confirming how the diabetes is treated. You will also need a current lab report with hemoglobin A1C level.  The “hemoglobin A1C level” indicates blood sugar level over the previous 90 days.   

If your diabetes has progressed to where you require oral medication or one of the newer subcutaneous injectable medications, you now have one of the mandatory disqualifying conditions specified in the FAA regulations. For most medications, you will need to be on the treatment regimen for 60 days before you can apply for consideration for a special issuance. During this time you should not fly.   

Although all the current FDA-approved oral medications are acceptable to the FAA, there are some combinations of these medications that are not acceptable. You need to check AOPA's online information report for a great table that lists all the oral medications and what combinations are acceptable.

Once you are stable on the medication for 60 days, you will need a current status letter from your treating physician that states what symptoms you had that resulted in the diagnosis, what medication(s) you were placed on and when, and how you have done since starting the medication. The report also needs to include a statement from the physician that you have or have not experienced any cardiovascular, peripheral vascular, renal, or neurological symptoms or complications. If you do have any organ system effects of your diabetes, your physician needs to explain these in the letter. The diabetic status report should be accompanied by a current hemoglobin A1C level. 

Even though some of the oral diabetic medications do not result in low blood sugar, the treating physician needs to include a statement in the letter that says you have or have not had any “hypoglycemic” episodes. The FAA is most concerned with a low blood sugar reaction (hypoglycemia) as it can result in mental confusion or other neurological symptoms. 

The FAA does not currently require regular eye examinations for Type 2 diabetics, but you should be seeing your eye care specialist regularly as one complication of poor diabetic control is a condition called diabetic retinopathy.   

The FAA allows a special issuance for all medical classes for airmen treated with these oral medications but only grants third-class medical certification privileges to diabetics treated with insulin.   

As of Dec. 31, 2011, there were 1,015 first-class airmen, 1,375 second, and 4,486 third-class airmen who were issued with diabetes mellitus on oral medication and insulin. A recent check of the data in September 2013 revealed that there were 443 pilots currently flying on special issuance with insulin therapy.  

Dr. Warren Silberman is the former manager of FAA Aerospace Medical Certification and a doctor of osteopathic medicine. A pilot since 1986, he is recognized nationally as an expert in aerospace/preventive medicine, and is a regular writer for AOPA’s Pilot Protection Services.