Dear All,
Some people on here may be interested in learning that the FAA has just updated and liberalised their approach to medical certification for pilots with insulin dependent diabetes.
Although they were initially more relaxed about pilots with insulin dependent diabetes flying, this was always restricted to holding a Class 3 and within the US National Airspace.
The new approach allows also the issue of a Class 1 and 2 Medical and it is no longer limited to the US NAS.
This means that the options for FAA certificated pilots with insulin dependence now mirrors that of pilots holding medicals issued by a few of the EASA NAA’s such as the UK CAA and Irish IAA.
More details below and on the website linked to below:
The FAA launched a new insulin treated diabetes protocol in the AME guide.
It has at least 4 implications all AMEs need to know:
1) 1st and 2nd class airmen may be able to fly (previously it was only 3rd class).
2) The new protocol requires Continuous Glucose Monitoring (CGM) for 6 months and other testing/reports.
3) The new protocol removes the “not valid outside the borders of the United States” limitations.
4) 3rd class airmen can choose between the current 3rd class protocol (non-CGM), or the new CGM protocol.
Please take a moment to review the guidance at this link: www.faa.gov/go/itdm
I wonder if this will generate yet another disinformation campaign on FAA Class 3 medicals allegedly being non ICAO compliant and therefore not acceptable in “gold plated Europe”.
It took many years to debunk that one.
Even the UK CAA’s head of licensing bought into that myth.
No need for the slash in the subject line, according to the Oxford English Dictionary, “liberalize” is perfectly cromulent in British English (both “-ise” and “-ize” are acceptable).
Note that this is Type 1 diabetes, which you are born with. This isn’t the far more prevalent (these days) Type 2 which you get by eating vast amounts of crap food, and which can be reversed by an appropriate dietary change (the medical profession generally doesn’t accept that).
It is good to hear that the FAA is being progressive in this way. In other areas they are stuck firmly in the past e.g. requiring a repeat angiogram (in cardio cases) for regaining a Class 1 or 2, which must be at least 30 years behind the times.
It also includes Type 2 diabetes patients.
While it is great that FAA opens up Medical certification for diabetes patient, one should not underestimate the requirements in the fine print: One of the requirements, e.g. is that the patient wears a CGM device (i.e. Freestyle Libre, Dexcom) and can provide 6 months of data. Every single incident with blood sugar level below 70 (which is quite high as lower level) hads to be documented individually including a statement of what caused it and what has been done to correct…
That’s lots of effort for an average pilot.
This isn’t the far more prevalent (these days) Type 2 which you get by eating vast amounts of crap food, and which can be reversed by an appropriate dietary change (the medical profession generally doesn’t accept that).
Peter, please do not spread such patently untrue statements. “Lifestyle change”, which includes dietary change, is actually the first line therapy for type 2 Diabetes in medical guidelines. Many patients are not willing or able to change their diet accordingly, which is why the they recieve antidiabetic drugs in addition.
Medewok, I am pleased that Germany is well ahead of the game on obesity 
because this is going to sink the UK NHS and nobody can do anything about it, due to various forms of political correctness.
And that if a guy who is 1.75m and 200kg visits a doctor, he is told that if he carries on like this, he will at best have a really low quality of life (which in all likelihood he had already), and not for long anyway, and that the doctor will not get any repercussions from telling him that.
I looked up those devices mentioned by Malibuflyer. It doesn’t look particularly pleasant… but there is no known cure for T1 so this is a lot better than nothing.
I wouldn’t say Germany is well ahead of the game on obesity. There certainly is a “health(y) food” trend in the last few years. Meat, a staple of German cuisine, is viewed increasingly sceptical. The problem remains however that vegetables and quality meat are more expensive than processed foods, so paradoxically poorer people are more likely to be obese. They also often lack the knowledge on how to eat healthy.
As far a treatment of Diabetes goes: Diet has been the first line therapy for quite a while, but there may be a peculiarity of the German health system that reinforces this: A doctor with his own practice/surgery gets allocated a pharmaceutical budget by the health insurance companies. If you exceed that budget, you either have to deliver a good justification for why your practice in particular needs a higher budget, otherwise you have to pay the difference out of your own pocket. This creates a financial incentive not to prescribe tablets or medications in general unless necessary.
Back to the OP: A person with Type 2 Diabetes only is at risk of hypoglycemia if they recieve certain medications, like Metformin (standard therapy according to the NICE guidelines) or Insulin. With other medications, there is no such risk and from my point of view these people should not be restricted from flying.
With Type 1 Diabetes, in Germany at least most of these patients nowadays have an insulin pump which applies the necessary dosage according to current blood glucose levels. Patient input may be necessary for “extraordinary” stress or unusual meals, otherwise these pumps work pretty well on their own.
These people should also be able to receive a class 2 medical in my view.
With Diabetes, it is all about compliance and clever self-management. A person that is able to fly an aircraft should usually possess the necessary skills to manage their Diabetes properly.
Nice. Good for him!
Type 1 Diabetes is very dependant on patient compliance. A person who is disciplined enough to fly as a commercial pilot should usually also be the “right” personality type to manage their Diabetes well, thus posing almost no additional risk to third persons compared to a non-diabetic pilot.
The article doesn’t say anything about his therapy regime, which would be interesting from a medical perspective. I wonder if he has an insulin pump?
It is also notable that he seems to have late onset type 1 Diabetes. Most patients are diagnosed young, but he already flew for a long time before his diagnosis.
