Fly Well: Sweet talk

Humans must consume a balanced diet in order to fly (and do other stuff people do), which includes carbohydrates, protein, and more. Without sugarcoating this, consuming huge amounts of sweet food—and huge amounts of any food—has contributed to the increased incidence of diabetes mellitus, a condition in which either not enough insulin is made or cells are resistant to its effect.

Sometimes presenting during otherwise healthy pregnancy, an early onset version of the disease occurs in fit young people where autoimmune destruction of islet cells is to blame. However, obesity and massive sugar intake are driving the surge in diabetes. Initially, diabetes induces fatigue and malaise, and is often downplayed as, “I’ve got a little bit of sugar in my urine.” Basically, the kidneys give up trying to filter the stuff and glucose floods out. In fact, mellitus derives from Latin for “honey,” referring to the sweet taste of diabetic urine. Whoever decided to taste urine? If you donut care what you eat, and how much, don’t be surprised when you become a victim.

The implications are significant. High sugar concentrations damage multiple blood vessels, which increases the incidence of stroke; heart attack; kidney disease; impotence; loss of fingers, toes, and limbs; and very often, blindness. Nerves are damaged, causing often-severe pain, disturbed sensations, and altered gut function. Skin integrity falters, and resulting ulcers may fail to heal.

Loss of control of sugar levels can lead to hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), both of which can have serious consequences.Treatment always starts by controlling weight and diet, and introducing exercise. Drugs are added, at first oral and then, often, insulin injections are required. Longer-lasting medications have been developed to reduce required frequency of administration. Patients must check their blood sugar with skin pricks daily (or more often), adjusting dosage of medications accordingly. Miniaturized sensing technology incorporated into contact lenses can measure glucose in tears to help patients manage their diabetes. Losing control of sugar levels can lead to hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), both of which can have serious and even life-threatening consequences—one of the reasons FAA takes diabetes very seriously.

In some cases, insulin is pumped into the patient via a computerized device to help control glucose levels. Sometimes, pancreas transplantation is necessary, maybe in concert with a kidney transplant when diabetes has induced renal failure. Transplantation of islet or stem cells is also a means to address the disease.

In 1882, Robert Koch ascertained that tuberculosis was caused by a bacteria that came to bear his name. For years, the BCG (Bacillus Calmette-Guerin) vaccination has dramatically reduced the scourge of TB. A recent scientific study has shown that BCG can positively affect blood sugar levels. Additionally, although not yet finished, a study from Finland is evaluating a coxsackie virus vaccine that might prevent diabetes. Keep your eyes peeled—and your oranges, as eating fruit is the right kind of sweet.

Other fascinating developments? The titular Mexican cave fish is essentially diabetic but with no ill effects, which might help us understand diabetes. The Australian platypus, an egg-laying mammal, produces venom that may play a role in treating diabetes. Now put that soda down and maybe eat some broccoli—there is some evidence that sulforaphane, a substance found in the humble veg, may help manage blood sugar.

For diabetes regulated solely with diet, FAA allows office issuance by the AME if there is a favorable report from the treating doctor and HbA1c (a blood test documenting glucose levels over time) shows good control.

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