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Endocrine SystemDiabetes, Insulin Treatment

Diabetes, Insulin Treatment


FAA policy currently allows for special issuance medical certification for Third Class applicants only.  A review is currently underway to eventually consider First and Second class applicants on a case by case basis but there has been no change in certification policy for applicants who fly for hire. For Third Class special issuance, the requirements for initial certification are comprehensive, but if you are well managed and attentive to your management, the process is not difficult.

For initial certification:

You will need to have been on insulin therapy with either injections or pump for at least six months prior to submitting a request for medical certification.

You should have no other history of significant diabetes-related complications such as arteriosclerotic coronary or cerebrovascular disease, retinal disease, or chronic renal failure, and cannot have had any 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; or
  • Resulted in impaired cognitive function without warning symptoms.

If there has been an episode of hypoglycemia, you will need at least one year of stability after the event in order to be considered.

You will need good documentation of your history of diabetes, including:

  • Copies of all medical records related to the diagnosis, and any records involving hospitalization for diabetes-related cause, including accidents and injuries;
  • Results of a complete medical evaluation by an endocrinologist or other diabetes specialist. This report needs to include your complete medical history, current medical condition, and results of a complete general physical examination;
    • 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.
    • A detailed report of the insulin dosages (including types) and other oral medications being taken, and diet utilized for glucose control;
    • Examinations and indicated tests to detect any peripheral neuropathy or circulatory deficiencies of the extremities, and;
    • A thorough ophthalmological evaluation that shows absence of clinically significant eye disease. Click here for the eye evaluation form.
  • If you are age 40 or older, you will also need a maximal graded exercise stress test, including complete tracings.
  • You will need a statement from your treating physician, aviation medical examiner, or other knowledgeable person attesting to your dexterity and ability to determine blood glucose levels using a recording glucometer. 
  • Your doctor will also need to verify that you have been educated about diabetes complications and control, and that you understand the monitoring and management procedures for the condition and the actions that should be followed if complications of diabetes, including hypoglycemia, should arise.

    The protocol for certification includes Preflight and Inflight procedures to maintain adequate glucose levels.

For subsequent recertification, your special issuance authorization letter will specify what you will need to provide to the FAA on an annual basis.

How/Where to Submit to the FAA

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

Updated September 13, 2017