What Diabetes Is All About
In diabetics, the body either doesn't produce enough insulin, which processes glucose and allows it to be used by the body, or the body does not adequately absorb the glucose into muscles and other tissues. This unprocessed sugar builds up in the blood stream. Having too much sugar in the blood for too long can impair vision and cause irreversible limb and nerve damage, kidney failure, and cardiovascular problems. Body weight, age, family history, stress, and diet-particularly carbohydrate intake-directly influence the amount of glucose in the blood.
After fasting for eight hours, most people have glucose levels of 70 to 100 milligrams per deciliter of blood. For diabetics, this number routinely exceeds 126, and may be much higher.
The Next Step
The diagnosis has been made. You have diabetes. Now what? First, you should realize that more than just your flying is at stake here. Diabetes is dangerous. Nearly 200,000 people will die in the United States this year from diabetic complications. It is the nation's seventh leading killer.
The most important thing you can do is to get your diabetes under control. That means getting your blood sugar level into the normal range and keeping it there. Your doctor may recommend weight reduction, diet restrictions, exercise, oral medications, insulin injections, or a combination of treatments.
Begin by finding an informed physician who has expertise in treating diabetes. It takes an expert team-of which you are the key member-to beat diabetes. Building your team starts with finding the right doctor.
Next, if diet restrictions are to be part of your treatment, seek out a dietician who understands diabetes and can design a balanced diet that will help you control your carbohydrate intake. The American Diabetes Association (ADA) can refer you to knowledgeable dieticians near you.
As you go through this process, it is important that you inform yourself about diabetes. As a diabetic pilot, I have discovered the value of understanding the disease in managing it. It's equally important that you understand the flight certification procedures and the medications prescribed for you. (See sidebar for resources available to help diabetic pilots learn more.)
Working with a knowledgeable physician, your aviation medical examiner (AME), a dietician, and your family, develop a concrete plan to get your blood sugar into an acceptable range and keep it there. At the very least, you can expect your program to include frequent monitoring of your blood glucose levels, losing weight, getting exercise, and eating a balanced diet.
Closely and frequently monitoring blood glucose levels is especially important for pilots. No pilot worth his or her salt would go up for a flight without knowing the allowable glucose limits. Use-at-home glucose meters, typically costing $50 to $120, are available at most pharmacies. Daily monitoring with these devices is the only way to keep track of your progress. Home testing typically takes less than a minute, so there's no excuse not to do it.
Losing weight is generally the most immediate and effective step that you can take to control diabetes. Even if you are only slightly overweight, your doctor may suggest that you lose a few pounds.
Get regular exercise. A trainer prescribed vigorous walking and resistance training for me. Walking promotes cardiovascular health. Weight training improves muscle tone, and well-conditioned muscles are more likely to absorb harmful excess glucose. Your program might be different, but whatever it is, stick to it.
Eat a balanced diet as prescribed by your doctor and dietician. Be sure to check out food labels. If you don't know how to read them effectively, ask your dietician for help. Diet control is an every meal, every day, for-the-rest-of-your-life responsibility if you are diabetic, but it is a very small price to pay for your health. Diet is the critical ingredient of glucose control, which is the key to preventing damage from diabetes. In fact, more than 2,000 diabetic pilots have earned permission to fly thanks to diet control programs.
Dr. Steve Carpenter, head of FAA medical appeals in Oklahoma City, says that the most common reason diabetic pilots are no longer permitted to fly is because poor control of their glucose levels has resulted in irreversible damage that precludes safe flight. So the key, again, is control.
If weight loss and diet alone prove inadequate, consistent exercise could help to dissipate glucose by "burning it up" and by conditioning the body so that it processes glucose more efficiently.
When diet and exercise don't lower blood sugar sufficiently, oral medications may be prescribed. Talk to a diabetes-savvy physician. Currently, more than 2,100 pilots fly using oral diabetes medications. Under special circumstances and with sufficient documented tests, insulin can help to control blood sugar so that flying might be authorized.
Once You Have Control
By now, you've gotten the message that control is the name of the game. The FAA is looking for pilots who are conscientious about maintaining good diabetic health-blood sugar within acceptable levels and no adverse symptoms. These pilots are excellent candidates for continued flying.
Once control has been achieved, documented, and certified by qualified professionals, assemble the information using the FAA's guidelines as a checklist. Submit it to the Airman Certification Branch in Oklahoma City. Don't send in your submission piecemeal.
Your documentation will be evaluated and, if it is acceptable, you may receive a special-issuance authorization to fly. Be sure to comply exactly with its provisions. Document and submit the tests and certifications required to the FAA, and do it on time. Failure to do so could mean no more flying.
Doing whatever you have to to re-gain your medical certificate is worth it. Where there's a will, now there's a way to return to the skies.
Resources for Diabetic Pilots
- The Aircraft Owners and Pilots Association: AOPA has two specific fact sheets on procedures for regaining medical certification using oral medication and insulin. AOPA members can visit the Web site (www.aopa.org/members/files/medical/hotsheet.html ) to view the fact sheets. The Web site also includes the text of the federal aviation regulations that apply to medical certification. For more information call 800/USA-AOPA or write to AOPA, 421 Aviation Way, Frederick, Maryland 21701.
- The American Diabetes Association: The ADA telephone hotline and Web site provide excellent information on virtually every pertinent subject involving diabetes, including detection and treatment. The hotline number is 800/342-2383; or visit the Web site (www.diabetes.org ); or write to ADA, 1701 North Beauregard Street, Alexandria, Virginia 22311.
- The Federal Aviation Administration, Airman Certification Branch: The Web site (www.cami.jccbi.gov ) contains the text of Part 67 of the federal aviation regulations (the governing aviation medical directive), information on medical certification procedures and tests, links to FAA medical certification staff, extensive questions and answers, and similar information. Telephone 405/954-4821, or write to the Federal Aviation Administration, Airman Certification Division, CAMI Building Room B59, 6700 South MacArthur Boulevard, Oklahoma City, Oklahoma 73169.
- The Mayo Clinic: An abundance of diabetes background and treatment information is available at (www.mayohealth.org ). The site includes symptoms, long-term implications, factors that push blood levels up or down, monitoring and treatment tools, and a great deal of other related information.
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