Diabetes, Insulin Treatment

Endocrine System—Diabetes, Insulin Treatment

Diabetes, diet, The FAA may consider certification, under the Special Issuance provisions of the Federal Aviation Regulations, of individuals with insulin-treated diabetes mellitus (ITDM). The following restrictions apply:

ITDM individuals:

  • May be issued only a third class medical certificate;
  • May exercise only the privileges of a student, recreational, or private pilot certificate;
  • Are prohibited from operating an aircraft as a required crewmember on any flight outside the airspace of the United States of America;
  • Are required to be in compliance with the monitoring requirements of the following protocol while exercising the privileges of a third class medical certificate.

In order to be considered for aeromedical certification, an individual with ITDM should have been receiving appropriate insulin treatment (injections or pump) for at least six months prior to submitting a request for medical certification.  All FAA-allowed oral diabetes medications may be used in combination with insulin therapy; however, the FAA does not allow the use of beta-blockers (blood pressure medications) in tandem with insulin and oral medications. Januvia and Byetta are newer diabetes medications, and are also NOT allowed with insulin therapy.

For initial certification:

  1. Applicants must have no otherwise disqualifying conditions, especially significant diabetes-related complications such as arteriosclerotic coronary or cerebrovascular disease, retinal disease, or chronic renal failure, and must have had no recurrent (two or more) hypoglycemic reactions within the past five years that:
    • Resulted in a loss of consciousness or seizure;
    • Required intervention by another party;
    • Resulted in impaired cognitive function without warning symptoms.

Following the first episode of hypoglycemia, a period of one year of demonstrated stability is required.

In order to provide an adequate basis for an individual medical determination, the applicant seeking special issuance of a medical certificate must submit the following:

    1. Copies of all medical records concerning the individual's diabetes diagnosis and disease history and copies of all hospital records, if admitted for any diabetes-related cause, including accidents and injuries;
    2. Copies of complete records of any incidents or accidents, particularly involving moving vehicles, whether or not the event resulted in injury or property damage, if due in part or totally to diabetes complications;
    3. Results of a complete medical evaluation by an endocrinologist or other diabetes specialist. This report should detail the individual's complete medical history and current medical condition. The report must include a general physical examination. 
    4. Two measurements of glycosolated hemoglobin (total A1 or A1C concentration and the laboratory reference normal range), the first at least 90 days prior to the second measurement. Be sure to include the actual laboratory report printout and not just a statement from the treating physician.
    5.  A detailed report of the insulin dosages (including types) and diet utilized for glucose control.  
    6.  Appropriate examinations and tests to detect any peripheral neuropathy or circulatory compromise of the extremities and any other tests deemed necessary by the treating specialist or that are clinically indicated.
    7. Confirmation by an ophthalmologist of the absence of clinically significant eye disease. The eye examination should assess visual acuity, ocular hypertension, and presence of lenticular opacities, if any, and include an examination of the retina for evidence of any diabetic retinopathy or macular edema. Individuals with active retinopathy or vitreous hemorrhages will not be considered until the condition has been confirmed as stabilized by an ophthalmologist.
    8.  If the applicant is age 40 or older, a report of a maximal graded exercise stress test, including complete tracings.
    9. 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.
    10.  Verification that the individual has been educated in diabetes and its control and has been thoroughly informed of and understands the monitoring and management procedures for the condition and the actions that should be followed if complications of diabetes, including hypoglycemia, should arise. The examining physician should also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes.
    11. The individual must agree to immediately report any adverse medical changes to the FAA.
    12. Applicants shall maintain appropriate medical supplies for glucose management while preparing for flight and while exercising piloting privileges. Such supplies shall include:
      • A whole blood digital glucose monitor with memory.
      • Supplies needed to obtain blood samples and to measure whole blood glucose.
      • An amount of rapidly absorbable glucose, in 10 gram (gm) portions appropriate for the planned duration of the flight.
      • All disposable supplies listed above must be within their expiration dates.

Not more than 1/2 hour before takeoff, the pilot shall establish and document a blood glucose concentration equal to or greater than 100 milligrams/deciliter (mg/dl) but not greater than 300 mg/dl. If the concentration is within 100-300 mg/dl, flight operations may commence. If less than 100 mg/dl, an appropriate glucose snack (at least 10 gm.) must be ingested and a recheck done. If over 300 mg/dl, the flight must be postponed.

In flight:
One hour into the flight, at subsequent hourly intervals, and within one half hour of landing, the pilot shall monitor the blood glucose concentration. If the concentration is less than 100 mg/dl, a 20 gm snack shall be ingested. If the concentration is between 100-300 mg/dl, no action is required. If the concentration is greater than 300 mg/dl, the pilot must land at the nearest suitable airport and may not resume flight until the glucose concentration can be maintained in the 100-300 mg/dl range.
With respect to determining blood glucose determinations in flight, the airman must use good judgment in deciding whether measuring concentrations or operational demands of the flight environment, such as adverse weather, air traffic control concerns, or engine trouble should take priority. In cases where operational considerations take priority, the airman should ingest a 10 gm glucose snack, fly the airplane, and measure blood glucose concentrations one hour later. If measurement is not practicable at that time, the airman must ingest a 20 gm glucose snack and land at the nearest suitable airport until a determination of the blood glucose concentration can be made.

For subsequent recertification:
Individuals who are granted special issuance of third class airman medical certificates must:

  1. Submit to a medical evaluation by a specialist every three months. This evaluation must include a general physical examination, a review of the interval medical history, and a report of glycosolated hemoglobin (total A1 or A1C) concentrations and any other tests deemed necessary by the treating specialist or that are clinically indicated. Also, the examining physician must review the record of the airman's daily blood glucose measurements and comment on the results. The evaluation shall also contain an assessment of the individual's continued ability and willingness to monitor and properly manage his or her diabetes and whether the diabetes or its complications could reasonably be expected to adversely affect the airman's ability to safely control an aircraft.
  2. Provide to the FAA, immediately upon request, a report by a specialist or other physician, of any evidence of loss of diabetes control, significant complications, or inability to manage the diabetes. In such a case, the individual shall cease exercising the privileges of his or her airman certificate until again medically cleared by the FAA.

How/Where to Submit to the FAA

Helps you find the contact information for submitting your medical records.

Updated March 27, 2015