OFF insulin, now how to report?

[groundpoundn2000]

Have been on insulin for type 1 diabetes for last 3 months from a internal medicine Doc.. I finally got to see my first endocrinologist and he is taking me off the insulin and back on metformin and glipozide..

My main question is, How to i report for my 1st class medical for further flight school? Will it make a difference if i talk about the insulin.. Just want to see the best way to approach the flight medical in a few months? Thank you..

BTW i am going to ATP if i can get my 1st class med cert...I have my 3rd now from early last year when i did not have diabetes...

 

[asgcpa]

Contact Dr Chien. He unfortunately is no longer in this board.

 

[poadeleted20]

Doesn't matter what class certificate you have in your pocket, you were grounded as soon as you were diagnosed with diabetes requiring insulin -- see 14 CFR 61.53 for details. The fact that the doctor took you off insulin and put you on two other diabetes meds doesn't change that. You will have to go through the Special Issuance process for diabetes before you are legal to fly again. Take CPA's advice and contact Dr. Bruce Chien for advice on how to accomplish that. You can find him on the AOPA Forums or on his web site.

 

[Gary F]

Doesn't matter what class certificate you have in your pocket, you were grounded as soon as you were diagnosed with diabetes requiring insulin -- see 14 CFR 61.53 for details. The fact that the doctor took you off insulin and put you on two other diabetes meds doesn't change that. You will have to go through the Special Issuance process for diabetes before you are legal to fly again. Take CPA's advice and contact Dr. Bruce Chien for advice on how to accomplish that. You can find him on the AOPA Forums or on his web site.

What is meant by requiring insulin? It is only required for Type 1 diabetics and those with Type 2 diabetes who can't be adequately controlled with other medications. Since the endocrinologist took him off the insulin it was never "required" and just part of the internist's selected medical regimen. There is nothing to stop a physician from using insulin as a first line agent for even mild diabetes although this would be unusual practice. Too bad Dr Bruce is not around to clarify.

 

[BrianR]

If it's controlled by metformin and glipizide, it's almost certain you have type 2 DM, not type 1. In fact, type 1 DM is a contraindication for glipizide.

If you truly have type 1, a first class medical is not obtainable. For type 2, it is, as long as you comply with the SI requirements. But, if you do require insulin, even for type 2, you are limited to third class.

Regardless of your aviation aspirations, you should do whatever is necessary to get and keep your diabetes under control. The implications of failing to do this are life-altering.

As mentioned above, you would do well to contact Dr. Chien for further certification advice.

 

[poadeleted20]

What is meant by requiring insulin? It is only required for Type 1 diabetics and those with Type 2 diabetes who can't be adequately controlled with other medications. Since the endocrinologist took him off the insulin it was never "required" and just part of the internist's selected medical regimen. There is nothing to stop a physician from using insulin as a first line agent for even mild diabetes although this would be unusual practice. Too bad Dr Bruce is not around to clarify.

OK, forget "requiring". If you are put on insulin, you are grounded thereafter until you get a Special Issuance. In fact, any diabetes med other than metformin (and only metformin) is automatically grounding until special issuance. Beyond that, ask Bruce.

 

[Gary F]

OK, forget "requiring". If you are put on insulin, you are grounded thereafter until you get a Special Issuance. In fact, any diabetes med other than metformin (and only metformin) is automatically grounding until special issuance. Beyond that, ask Bruce.

Bruce isn't always available when I have to treat patients. Some of them are pilots so it is good to know these things.

 

[RJM62]

OK, forget "requiring". If you are put on insulin, you are grounded thereafter until you get a Special Issuance. In fact, any diabetes med other than metformin (and only metformin) is automatically grounding until special issuance. Beyond that, ask Bruce.

Not that my opinion means anything, but I'm pretty sure I remember the good doctor saying that metformin also requires an S.I., but that it can be done in-office by a good AME. I suspect that glipizide may seriously complicate matters because it can cause hypoglycemia.

But I'm not a doc or an AME, just a diabetic. Call Dr. Bruce.

-Rich

 

[poadeleted20]

Not that my opinion means anything, but I'm pretty sure I remember the good doctor saying that metformin also requires an S.I., but that it can be done in-office by a good AME.

It's not a Special Issuance if you are pre-diabetic and not on anything other than metformin (i.e., you meet all the parameters on the pre-diabetic worksheet in the AME's Guide, mainly no problems, 1AC 6.5 or less, and glucose 125 or less).

I suspect that glipizide may seriously complicate matters because it can cause hypoglycemia.

I don't know how seriously it complicates things, but I do know that any anti-diabetic medication other than metformin means a Special Issuance.

But I'm not a doc or an AME, just a diabetic. Call Dr. Bruce.

...and if you're on something other than metformin, don't fly until you do.

 

[groundpoundn2000]

UPDATE!

First thank you all for the replies and knowledge. I have went out on a limb and decided to try and beat this condition. I figure the Doc's are confused so why not .. Today is day 2 of putting an hour on the treadmill and becoming a vegan...I'm sure it will get harder and the exercise will go down a bit but the numbers don't lie and if it means i get my wings back, then its vegan life until my wings fall off.. I plan on walking into the docs office in 30 days, several pounds lighter and setting my meds on the counter... Just wondering if i show 30 days of great numbers with out meds, could i be set free?...

Woke up yesterday with a B/S 187 afternoon was 126

This morning was an een 100!! All no Insulin or pills... Very excited...

 

[pilot_dude]

It's not a Special Issuance if you are pre-diabetic and not on anything other than metformin (i.e., you meet all the parameters on the pre-diabetic worksheet in the AME's Guide, mainly no problems, 1AC 6.5 or less, and glucose 125 or less).

Just to prevent any confusion, it's an A1C which is short for Hemoglobin A1C or HbA1C

 

[pilot_dude]

UPDATE!

First thank you all for the replies and knowledge. I have went out on a limb and decided to try and beat this condition. I figure the Doc's are confused so why not .. Today is day 2 of putting an hour on the treadmill and becoming a vegan...I'm sure it will get harder and the exercise will go down a bit but the numbers don't lie and if it means i get my wings back, then its vegan life until my wings fall off.. I plan on walking into the docs office in 30 days, several pounds lighter and setting my meds on the counter... Just wondering if i show 30 days of great numbers with out meds, could i be set free?...

Woke up yesterday with a B/S 187 afternoon was 126

This morning was an een 100!! All no Insulin or pills... Very excited...

Congratulations on finding a method to control your glucose levels!
Mark the date, wait three months then get an A1C. That will be the deciding objective methodology if you're truly successful.

 

[asgcpa]

UPDATE!

First thank you all for the replies and knowledge. I have went out on a limb and decided to try and beat this condition. I figure the Doc's are confused so why not .. Today is day 2 of putting an hour on the treadmill and becoming a vegan...I'm sure it will get harder and the exercise will go down a bit but the numbers don't lie and if it means i get my wings back, then its vegan life until my wings fall off.. I plan on walking into the docs office in 30 days, several pounds lighter and setting my meds on the counter... Just wondering if i show 30 days of great numbers with out meds, could i be set free?...

Woke up yesterday with a B/S 187 afternoon was 126

This morning was an een 100!! All no Insulin or pills... Very excited...

Thats great. I hope it works for you.

In my case, I was a Type II on a daily dosage of 112 units of Lantis and 1,000mg of Metformin. I had a gastric bypass, lost 100 pounds in 7 months (now 130). Three days after the surgery they reduced the Lantis, and eliminated Metformin. 3 weeks later I was off of Lantis and all diabetes drugs. I saw Dr Chien 7 months later for my medical. I was down 100 pounds at the time. My A1c was 5.6 at the time of my medical with Dr. Chien, and as I said, I was off all medications for about 7 months at the time of my aviation exam. My A1c was stable for the prior 5 months (iI was down to 5.7 two months after my surgery). I was not issued a SI for the diabetes, but again, Dr Chien is one of the best in the aviation medical field, and apparently is/was a leader in the diabetes related AME. I would talk directly to him and do a consultation. His website is http://home.comcast.net/~bbchien/site/.


Good luck.