3rd Class Med.. Diabetes

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Viper.R6

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Viper.R6
Just applied & received my student cert, went in for my 3rd Class AME yesterday,
thinking this would be a easy process..

Unfortunately that wasn't the case.. failed because of the urine test (ie high blood sugar/diabetes)
Hindsight being 20/20.. should have done the consultation first, but I really did not know that was an option... Should have done my homework....

Called my PCP to see follow up, but I guess what I want to know is whether this will prevent me from getting my PPL or do I have options...

I don't take any meds(not even an aspirin), don't drink or smoke.....
 
what was the glucose level in the urine? have you done a finger stick to measure glucose? can you have your primary doc order a blood test to measure both glucose as well as A1C?
 
The damn stick in the urine is not a good test. I am surprised your AME didn’t order you a fasting blood glucose test himself. Go to your PCP and get a fasting glucose and A1C.
 
Were you aware of a high A1C before going to the AME?
 
Ok - first, it's not the end of the world. You're almost certainly certifiable.

Quick education:
Type II diabetes is a disease of high blood sugar. That manifests in a couple of ways
1) sugar in the urine. When your blood glucose gets high, say above 300, your kidneys start spilling glucose into the urine. You have to be pretty high to get there, but this can be transient.
2) High blood glucose in the morning, measured as above 125 (129?). The norm is below 99. Unless you monitor this, you'll have no idea what it is.
3) an A1C test above 6.5. Above 8.9%, you cannot get a medical. A1C is a 3 month lookback based on glucose adhesion to red bloods cells. Since RBCs live for 90 days, the test is looking at that time frame.

The good news is that T2 is usually a disease of diet and weight, so if you fix those, you can fix or delay the onset of the impact of T2.

My advice is do not rush out to your doctor. Get an appointment in a month or so and crash your diet now. Your goal is to get your blood sugar down, so drop as many carbs out as you can - sugar in all forms, bread, potatoes, and rice especially. This will start to have an immediate impact on your A1C and your morning blood sugar. Then when your doctor tests in a month, you're good. Meanwhile, while the FAA reviews your file, you're prepared to give them the answers they want to hear - lost weight, good diet, low morning (fasting) glucose level and a low A1C. With that, you'll get a normal medical.

There is some debate about the roles of caffeine and artificial sweeteners in T2. I'm of the opinion that it has an impact, so drop them. I've been told that Splenda is ok, but I still limit it.

Do not do a glucose tolerance test unless the FAA demands it. It will cause more trouble with the FAA than it will provide information for you.

Eat better and lose weight. Give it a month to work before going to your doctor. You really want to be under the 6.5 A1C for medical insurance and for the FAA and be in "T2, diet controlled".

Pay the nurse on your way out.
 
bflynn said:
Ok - first, it's not the end of the world. You're almost certainly certifiable.

Quick education:
Type II diabetes is a disease of high blood sugar. That manifests in a couple of ways
1) sugar in the urine. When your blood glucose gets high, say above 300, your kidneys start spilling glucose into the urine. You have to be pretty high to get there, but this can be transient.
2) High blood glucose in the morning, measured as above 125 (129?). The norm is below 99. Unless you monitor this, you'll have no idea what it is.
3) an A1C test above 6.5. Above 8.9%, you cannot get a medical. A1C is a 3 month lookback based on glucose adhesion to red bloods cells. Since RBCs live for 90 days, the test is looking at that time frame.

The good news is that T2 is usually a disease of diet and weight, so if you fix those, you can fix or delay the onset of the impact of T2.

My advice is do not rush out to your doctor. Get an appointment in a month or so and crash your diet now. Your goal is to get your blood sugar down, so drop as many carbs out as you can - sugar in all forms, bread, potatoes, and rice especially. This will start to have an immediate impact on your A1C and your morning blood sugar. Then when your doctor tests in a month, you're good. Meanwhile, while the FAA reviews your file, you're prepared to give them the answers they want to hear - lost weight, good diet, low morning (fasting) glucose level and a low A1C. With that, you'll get a normal medical.

There is some debate about the roles of caffeine and artificial sweeteners in T2. I'm of the opinion that it has an impact, so drop them. I've been told that Splenda is ok, but I still limit it.

Do not do a glucose tolerance test unless the FAA demands it. It will cause more trouble with the FAA than it will provide information for you.

Eat better and lose weight. Give it a month to work before going to your doctor. You really want to be under the 6.5 A1C for medical insurance and for the FAA and be in "T2, diet controlled".

Pay the nurse on your way out.
Click to expand...

This! “so drop as many carbs out as you can - sugar in all forms, bread, potatoes, and rice especially.”

(This assumes this was news to you and you’re not already a type 1 diabetic and just didn’t know it would be a certification issue.)

Buy a finger prick test kit and couple of vials of test strips. You don’t need a prescription, pay out of pocket. I highly recommend NOT trying to get a prescription to get insurance to pay. Don’t give any doctor the chance to put “diabetes” in your record until it’s certain. I’ve got “diabetes” in my medical record and I have NEVER had any test in the diabetic range. All my tests have been only pre-diabetic but my doctor coded “diabetes” just to get insurance to pay for quarterly testing. She didn’t ask me. I would have said no, I will pay out of pocket if you want a quarterly A1c.

Use the finger prick test to see visible impact of what you eat. It is a great motivator. Test often. You will know before the doctors do if you really have t2 diabetes.

I recommend immediately eliminating juice, soda, sweet tea, all rice, all breakfast cereals, all dessert pastries, muffins, and cinnamon buns, and limit other bread and pasta to very small portions. Also limit fruit. Modern fruit is too high in sugar. The bulk of what you consume should be unsweetened liquids, meat and non-starchy fibrous vegetables. Maybe whole grains in small portions, but use the test strips to see the impact. I can handle some potatoes mixed with lots of butter to slow absorption. Test everything to see how you respond.

Eat bacon and eggs for breakfast with no toast, no jelly, no juice. Check your BS after 1 hour. Compare that to breakfast of cereal, juice, toast, oatmeal or sweetened yogurt. Big difference!

This website gives excellent guidance:

https://www.bloodsugar101.com/all-about-blood-sugar
 
Sweetened beverages is what did me in 12 years ago. Double Double Gulp sized portions of Dr. Pepper and Coca-Cola for a very long time before I was diagnosed.

I now carry a large water flask (and some lemon juice packs from the convenience store). And if I get anything from the soda fountain it's unsweetened ice tea.

Fortunately the Type 2 Special Issuance (pills) isn't difficult to obtain. But you do have to demonstrate control over your A1C in order to keep it going. As @bflynn pointed out, 9.0 is considered too much by The FAA. And it's actually too much for your healthy anyhow. Best target is under 7.0 with under 6.5 being even better.
 
9.0 is too much for any standard. I have a type I step son who was poorly controlled for a while in early adulthood. He's got shot vision, went into renal failure, lost a leg, etc... Don't want to go there. THe damage is cumulative. Get your A1Cs down.
 
Thank you all for your reply/ information
I was not aware of this issue….
So right now I’m just taking it all in and trying to determine what I need to do now…
 
If you are type 2, lose weight and get fit. Don't worry about carbs - worry about calories and physical activity - except the night before going to the test. It will almost certainly resolve, either completely or to an acceptable point. Diet soda is your friend, if you like soda or need an edge off a sweet tooth. Don't buy into "biohacker" or "insulin model" gimmick diets. Go easy on alcohol - mostly because of the calories.

Go to a good endocrinologist and get all your baselines measured, with better tests than a stick in urine.
 
N1120A said:
If you are type 2, lose weight and get fit. Don't worry about carbs -
Click to expand...

Paying close attention to your carbohydrate intake is extremely important for all people but especially for any that are diabetic or trending that way. For those that use a Dexacom monitor (or equivalent type sensor) you can see the immediate effect of carb intake.

Diet and exercise are needed but to say "don't worry about carbs" is not very good advice. o_O
 
Daleandee said:
Paying close attention to your carbohydrate intake is extremely important for all people but especially for any that are diabetic or trending that way. For those that use a Dexacom monitor (or equivalent type sensor) you can see the immediate effect of carb intake.

Diet and exercise are needed but to say "don't worry about carbs" is not very good advice. o_O
Click to expand...

Type 2 is caused by weight and body fat, not by carbohydrate intake. Diabetics need carbs to avoid going hypo. Keto zealots who use those monitors always intake carbs without protein, fiber or fat. "Oh, I ate a potato and now I'm diabetic." It doesn't work that way.
 
Viper.R6 said:
Thank you all for your reply/ information
I was not aware of this issue….
So right now I’m just taking it all in and trying to determine what I need to do now…
Click to expand...

What to do now? Set the flight training on the back burner. Health first. Fly later.

Make an appointment with your general physician or internist. Get this issue sorted out immediately.

Some additional information to read: https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278
 
N1120A said:
Type 2 is caused by weight and body fat, not by carbohydrate intake. Diabetics need carbs to avoid going hypo. Keto zealots who use those monitors always intake carbs without protein, fiber or fat. "Oh, I ate a potato and now I'm diabetic." It doesn't work that way.
Click to expand...

I know what I see in various family and friends with type 1 & 2 that I monitor closely. I didn't say that diabetics didn't need carbs I said that the advice of "don't worry about carbs" was bad advice ... and it was and still is.
 
Daleandee said:
I know what I see in various family and friends with type 1 & 2 that I monitor closely. I didn't say that diabetics didn't need carbs I said that the advice of "don't worry about carbs" was bad advice ... and it was and still is.
Click to expand...

My mother is what some call a type 1.5 (late onset type 1). If she doesn't have carbs, she gets very sick.

Type 2 is exclusively an issue with body composition, and this low carb idiocy has contributed to it.
 
N1120A said:
My mother is what some call a type 1.5 (late onset type 1). If she doesn't have carbs, she gets very sick.

Type 2 is exclusively an issue with body composition, and this low carb idiocy has contributed to it.
Click to expand...

Once again, I did not say that diabetics don't need carbs! I was referring to your statement of "don't worry about carbs."

I've seen a type 2 that can keep their blood glucose level rock steady with a protein diet using minimum carb intake and this reduces their need for insulin and/or metformin.
 
Daleandee said:
Once again, I did not say that diabetics don't need carbs! I was referring to your statement of "don't worry about carbs."

I've seen a type 2 that can keep their blood glucose level rock steady with a protein diet using minimum carb intake and this reduces their need for insulin and/or metformin.
Click to expand...

You've seen an anecdote on a proven unsustainable method. Over eating generally will lead to issues with blood sugar - saying to cut out a bunch of healthy, high volume, low calorie dense foods is not the way to deal with that.
 
N1120A said:
You've seen an anecdote on a proven unsustainable method. Over eating generally will lead to issues with blood sugar - saying to cut out a bunch of healthy, high volume, low calorie dense foods is not the way to deal with that.
Click to expand...

Now you are putting words in my mouth! I never suggested any of that and now you're adding that you know what I've seen and learned.

Where did overeating come from unless it's the advice of "don't worry about carbs"? Where did I say "to cut out a bunch of healthy, high volume, low calorie dense foods"? I didn't!

But back to the point ... it is important to keep an eye on carb intake. Some carbs are needed and are good. But to say "don't worry about carbs" to a diabetic is not good advice. That was the point I made.
 
N1120A said:
Type 2 is caused by weight and body fat, not by carbohydrate intake. Diabetics need carbs to avoid going hypo. Keto zealots who use those monitors always intake carbs without protein, fiber or fat. "Oh, I ate a potato and now I'm diabetic." It doesn't work that way.
Click to expand...

Sorry but carbs do matter with type II.

Get Smart On Carbs | ADA (diabetes.org)
 
I’m not a medical person ; so.

My wife became a Type 2 diabetic on 3 meds.

She confronted the disease with exercise and diet as others have said.

Key to diet was. “ nothing white “ as in bread, rice,potatoes and pasta .

A1C well below 7.0 and off of all meds.

The lifestyle is worth the effort.

You will likely consider the “ 8 hrs bottle to throttle” and find you don’t

need the alcohol either.

Your Rate of Climb will improve also!
 
N1120A said:
Type 2 is caused by weight and body fat, not by carbohydrate intake. Diabetics need carbs to avoid going hypo. Keto zealots who use those monitors always intake carbs without protein, fiber or fat. "Oh, I ate a potato and now I'm diabetic." It doesn't work that way.
Click to expand...

but it’s carbs that causes the weight. It’s “oh, I ate 100 potatoes in a month” that does it. Or, a potato, a bunch of bread, sugar drinks, a side of rice, and a dessert. It’s also carbs that prevent weight loss. It’s either cut carbs, raise activity, or both, but you need the energy to be over your carb threshold to lose weight.

When you have diabetes, your body also cannot process the carbs as well. While you might eat a candy bar and an hour later your blood sugar is back to normal, a diabetic might eat a candy bar and their blood sugar is high hours later. So yes, controlling carbs is important.
 
Magman said:
I’m not a medical person ; so.

My wife became a Type 2 diabetic on 3 meds.

She confronted the disease with exercise and diet as others have said.

Key to diet was. “ nothing white “ as in bread, rice,potatoes and pasta .

A1C well below 7.0 and off of all meds.

The lifestyle is worth the effort.

You will likely consider the “ 8 hrs bottle to throttle” and find you don’t

need the alcohol either.

Your Rate of Climb will improve also!
Click to expand...
So you telling me my Blue Bell Chocolate ice cream can stay on the list.
 
N1120A said:
Type 2 is caused by weight and body fat, not by carbohydrate intake. Diabetics need carbs to avoid going hypo. Keto zealots who use those monitors always intake carbs without protein, fiber or fat. "Oh, I ate a potato and now I'm diabetic." It doesn't work that way.
Click to expand...

Weight and body fat is caused by too many calories but carbs fuel the appetite. In addition they cause blood sugar spikes when cells lose their insulin sensitivity stressing the pancreatic beta cells trying to keep up, eventually causing their dysfunction.

This is not the mechanism for type 1 which is pancreas failure to produce insulin due to autoimmune attack. The pancreas just quits producing insulin. T1 and T2 really shouldn’t have the same name, it’s like logging and acting PIC. Apples and oranges. Type 1 need carbs to avoid going hypo because they must be on insulin, but not type 2, unless on insulin. (Or had primary hypoglycemia which is another thing.) Non-insulin dependent type 2 diabetics still have functional beta cells and if not progressed too far can completely manage their blood sugar by carefully avoiding blood sugar spikes and that is done by regulating carb intake.

Losing weight and exercising also helps in the long run but the main control mechanism is carb restriction for immediate results and hopefully halt the progression of damage being done to tissue by high blood glucose. If you have asymptomatic high blood sugar you must immediately detect that fact and act on it. Cutting out carbs affects it immediately. Don’t wait to lose weight.

While it is true that consuming carbs with protein, fiber and fat slows the absorption, that’s only true to a point. Example, I can consume a half cup of rice with a large stir fry and not spike BS too much but I cannot consume two cups of white rice with the same meal without spiking my BS. The only way to see the effect is to test yourself frequently and log the results.
 
N1120A said:
Go easy on alcohol - mostly because of the calories.

Go to a good endocrinologist and get all your baselines measured, with better tests than a stick in urine.
Click to expand...

AggieMike88 said:
What to do now? Set the flight training on the back burner. Health first. Fly later.

Make an appointment with your general physician or internist. Get this issue sorted out immediately.

Some additional information to read: https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278
Click to expand...

Agree about the alcohol, in fact, cut it out completely for best results.

While I agree wholeheartedly health comes first, it might not be necessary to run to a doctor immediately. We don’t know any details.

Assuming OP has no symptoms (fainting, extreme thirst, foot is rotting off) this is not an emergency. OP can go to a pharmacy today and buy a test kit. Test himself the minute he gets home. Don’t need to wait til fasting in the morning or after a meal. If the result is over 200, he has diabetes. Anything less than 200 no need to run to a doctor and open an unnecessary can of worms.

Good Lord.

Edit: less than 200 doesn’t mean he doesn’t have diabetes, but like bflynn says, there is an opportunity to get your blood sugar under control immediately and then present yourself to the doctor in much better shape a month down the road.

OP will have to use his judgment. If he has high BS and it does not respond immediately to cutting out carbs, he needs to go in now. Possibly needs to be on a med. It would have impacted his medical anyway. But if it’s not too high and responds immediately to cutting out carbs, I don’t see any risk in waiting a month unless there are other symptoms or concerns or pre-existing conditions.

This is not medical advice, I’m not a doctor I am telling you only what I would do given these assumptions. We don’t know how high the urine sugar was.
 
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Right - a lot of whats in here isn't medical advice, it's life advice.

From the health standpoint, you'll do better long term getting this under control. There are some nasty impacts. Minor one - my mother could not use her ipad because she lost circulation in the ends of her fingers. Majors - I have a friend who had to have a foot amputated and another who had popped capillaries in his eye and is now legally blind.

From a flying standpoint, you're probably ok for now, but you'll do better if your numbers show control.

From a money standpoint, your future insurances will be much better off if you are not classified as a diabetic.

Therefore, the advice is get it under control, A1C below 6.5 . Do this by losing weight, exercising when you can, and eating well - meat and vegetables mainly.
 
I believe it's a bit of a misnomer that our diets, for each one, of us can be all funneled down to a single 'formula' that -has- to work for everyone. The low carb, intermittant fasting has changed my health numbers drastically ( insulin levels, BP, etc, etc ). However, many would have their own heart attack if I was to list my diet and lifestyle (i.e my MD had me increase my salt intake, really o_O ). All I can say is it works for me, so find someone who has been successful in changing and improving their health, listen to them - then find a good MD that doesn't just regurgitate something out of a text book, and make some changes. You keep doing what your doing, you'll keep getting what your getting, no change = no change.
 
Another option is to self purchase a set of Continous Glucose Monitors. You are starting to see those in the Anti Aging practices now. I've used them as part of my diet modification and analysis. Libre 2 is what I've used.
 
Star Keeper said:
Another option is to self purchase a set of Continous Glucose Monitors. You are starting to see those in the Anti Aging practices now. I've used them as part of my diet modification and analysis. Libre 2 is what I've used.
Click to expand...
I've not used a continuous glucose monitor - however, I did take my BG quite a bit, sometimes several times a day, but under different circumstances. For me, I was very surprised how -many- different things other than food effect BG. Food intake is only part the picture.
 
You need these two sheets,

(1) the worksheet: HbA1c within 90 days priors to application AND at least the "Wait time" since any med was changed,
(2) and the resource sheet for your doc....

Relatively simple certification.
The HbA1c has GOT to be below 9.0, which is the mandatory denial line. Practically speaking however, 8.0 or less is "acceptable" control.

As to the original comment as to the dipstick being positive, the kidneys are generally able to hold back any glucose into the urine until about 170 mg/dl. That's pretty high and pretty bad control, unless you've just eaten a cinnamon roll....
 

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