Answers for Pilots: Diabetes

Stepping on the scale in January can be discouraging if the festivities of the recent holidays have resulted in unwanted pounds. Unfortunately, pilots with diabetes face the fight on two fronts as stuffing and sugar plums also wreak havoc on blood glucose levels. However, those with diabetes treated with oral medications and under good control can still obtain a special issuance medical under the current guidelines, as follows:

Diabetes controlled with oral medications

This is one of the mandatory disqualifying conditions, so your aviation medical examiner (AME) should defer your application to the FAA for a special issuance authorization.  However, your AME can call the FAA and request a phone authorization to issue your certificate, pending review and an FAA authorization letter.  In order for that to happen, though, you will need all the required documentation with you at the exam, including:

1. Laboratory Reports. After being on medications for the required observation period (click here to see the chart) you will need an A1C hemoglobin report (HgbA1C). Normal laboratory values for A1C hemoglobin range from about 5.0% to 7.0 %. For medical certification purposes, the FAA will allow up to 8.9%. Be sure to include the actual printed laboratory report and not just a statement from the treating physician. The Hgb A1C test should be done after the required wait time is completed and submitted to the FAA within 30 days of testing.
2. A detailed, current diabetes evaluation report from your treating physician that summarizes your general medication, the medications, dosages, frequency of use of all your medications, including the ones you take for diabetes. The number of available medications to treat diabetes is growing, and with that comes increasing limitations on which drug combinations the FAA allows. Refer to this chart which shows the most common medication combinations, their acceptability with other medications, and the required observation time after starting the medication.

Diabetes controlled with insulin

In order to be considered for a medical certificate, an individual with insulin-treated diabetes mellitus (ITDM) should have been receiving insulin treatment (injections or pump) for at least six months.  FAA-allowed oral diabetes medications may be used in combination with insulin therapy; Again, refer to the chart above to be sure.

The FAA may consider certification for ITDM with these restrictions.

• You may obtain third class certification only;
• You may exercise only the privileges of a student, recreational, or private pilot certificate;
• You may not operate an aircraft as a required crewmember on any flight outside of U.S. airspace;
• You must comply with the guidelines in the relevant protocol (click here to view) while exercising the privileges of your third class medical certificate. These guidelines include preflight and inflight monitoring.

Pre-diabetes and CACI

For pilots with a condition referred to as pre diabetes, there’s good news: The FAA now has a process known as CACI (Conditions Aviation Medical Examiners Can Issue) that allows AMEs to issue medical certificates for certain conditions at the time of your office appointment. Specific worksheets provide both the pilot’s treating physicians and the AME with a checklist of information needed for office certification, making the process easier and faster than it’s ever been.

You can download the Pre-Diabetes Worksheet and show it to your treating doctor who will provide you with the information outlined on the sheet. Bring all the required reports and documentation to your AME when you go for your airman medical exam.

The AME will review the status report from your treating physician along with the supporting documents to determine your eligibility for certification. If you meet all the certification criteria listed on the worksheet, the Examiner can issue your medical certificate in the office while you are there.

Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information at the regularly scheduled third class medical exam.

If you have questions, please give the medical technical specialists in the Pilot Information Center a call, 800-USA-AOPA (872-2672), Monday through Friday 8:30 a.m. to 6 p.m. Eastern Time.