Type 1 Diabetic Pilot in training

S

Semipro

Filing Flight Plan
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Nov 3, 2012
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5
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Phoenix, AZ
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Semipro
Hi all - I am brand new to this great forum, and I have a question regarding my upcoming medical exam. I have done some research on the requirements of a Type 1 diabetic passing a class 3 medical, and I understand that one of the requirements is that I have not had a hypoglycemic event within the last year.

A little background: I am 42, have been a T1D for 17 years, and keep in relatively good control A1c's are usually in the 7's, occasionally I have had a low 8's. No vision or cardio issues, stress tests always come back fine. I am about 12 hours into my private pilot license, and I have about 2-3 months before it is time to solo. I have my class 3 medical exam scheduled for Monday.

16 months ago, my primary care physician changed my insulin regimen to a different type of insulin, and it did not go very well. 11 months ago I had a hypoglycemic episode where my blood sugar dipped while I was sleeping to the point that my wife had to intervene. I changed my regimen back to the same thing I had been using for 5 years, and all is well now.

My question is... Should I wait until 12 months has passed before I go for my medical exam?
 
I'm going to defer to Dr. Bruce Chien about your 12 month question.

But I will ask if ou have gathered up all that you need in terms of documentation for the AME visit such that you know without the shadow of doubt of absolute certainty that you will pass the examination? If not, postpone the exam until you do have all this done and gathered. I know blood lab results and a doctor status letter are part of what you need.

Your mention of cardiac stress tests is raising curiosity on this. There might be some required stuff in this. Again, look to Dr. Bruce for guidance. You do not want to say "oh, that was a while ago, and I think it's no big deal." Cardiac issues are big deals with the FAA and you don't want them starting the poking around. Better to be honest up front and bring the required stuff so you don't get accused for sweeping it under the rug.

Again, seek out Dr. Bruce's counsel on all of this. OWN YOUR MEDICAL and get it done right the first time.

(PS. Not an AME, but a type 2 that has learned a ton from Dr. Bruce and the discussions on these forums)
 
Semipro;

Hopefully you've seen the following from the FAA site. http://www.faa.gov/licenses_certificates/medical_certification/specialissuance/diabetes/

Do you have all of the items mentioned below ready to hand over to the AME?

Insulin-Treated Diabetes

The FAA has established a policy that permits the special issuance medical certification of insulin-treated applicants for third-class medical certification. Consideration will be given only to those individuals who have been clinically stable on their current treatment regimen for a period of 6 months or more. Consideration is not being given for first- or second-class certification.

Individuals certificated under this policy will be required to provide substantial documentation regarding their history of treatment, accidents related to their disease, and current medical status. If certificated, they will be required to adhere to stringent monitoring requirements and are prohibited from operating aircraft outside the United States. The following is a summary of the evaluation protocol and an outline of the conditions that the FAA will apply:

Initial Certification
  • The applicant must have had no recurrent (two or more) episodes of hypoglycemia in the past 5 years and none in the preceding 1 year resulting in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness).
  • The applicant will be required to provide copies of all medical records as well as accident and incident records pertinent to their history of diabetes.
  • A report of a complete medical examination preferably by a physician who specializes in the treatment of diabetes will be required. The report must include, as a minimum:
  • Two measurements of glycated hemoglobin (total A1 or A1c concentration and the laboratory reference range), the first at least 90 days prior to the current measurement.
  • Specific reference to the applicant's insulin dosages and diet.
  • Specific reference to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy.
  • Confirmation by an eye specialist of the absence of clinically significant eye disease.
  • Verification that the applicant has been educated in diabetes and its control and understands the actions that should be taken if complications, especially hypoglycemia, should arise. The examining physician must also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes.
  • If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test.
  • The applicant shall submit a statement from his/her treating physician, aviation medical examiner, or other knowledgeable person attesting to the applicants dexterity and ability to determine blood glucose levels using a recording glucometer).
 
Nothing to read here... Great advice - thank you. I have not yet gathered all of the info that the doctor will need to submit to the FAA, so regardless of the answer on the 12 month issue, I will postpone.
 
Once you have made contact with Dr. Bruce (www.aeromedicaldoc.com), consider using him for your AME exam and initial issuance.

There are many reports airmen using him and leaving his office with the special issuance and their medicals in hand versus waiting months and months during the deferral period that your local AME might have stuck you with.

It will be worth the trip to Peoria.
 
AggieMike88 - On the second post... Yes, I have seen the info on the FAA website. Thanks for ensuring - it was very helpful. As far as the stress tests go, my Primary Care Physician is very thorough. Anyone under his care with diabetes gets a stress test 1x per year.

Anything else you can share about your experience as a diabetic pilot would be very helpful. I will search for your posts, and let you know of questions I have.

Thanks again
 
Fortunately as a type 2, pill control, it's fairly easy to comply. Just keep the A1c in the lower end of the green arc, have my primary doc do an annual exam (with blood work) and provide a status letter, and submit that to the FAA.

With type one, there are additional requirements, such as demonstrating you can do a finger tip test while operating the aircraft in flight, and others. All doable, but the higher standard is there to keep you safe.

Do keep us n the loop as you go forward.
 
PLEASE DO NOT GO ON MONDAY!! PLEASE DO NOT GO ON MONDAY.
GO ONLY AFTER YOU HAVE :

Stress treadmill to 9 minutes and Heart Rate 161.

Letter from your CFI documenting that you have been witnessed while PIC, to take your blood sugar (adequate dexterity).

TWO Hb A1cs, one within 30 days prior to application, one at least 90 days before that.

An opthalmologist's dilated exam "No Diabetic Retinopathy" If any retinopathy, full "Humphrey" formal visual fields on an 8500-7. Not Welch Allyns. HUMPHREY.

Statement from your doc saying that
(1) you are educated in the management of diabetes and make good decisions, that
(2) you have not had any episode of hypoglycemia that required outside help in FIVE YEARS, and in which he makes specific mention of your diet, calories and dosages.
(3) Specific mention that you do not to his knowledge had diabetic nephropathy, neuropathy or Coronary Disease.

Serum Fasting Lipid profile and creatinine.

If you don't have these, and the AME defers, you will get a 30 day demand letter for these. Try gathering the 90 day spread of labs in 30 days--->impossible, means DENIAL.

Start gathering the stuff together. Where are you geographically (approximately)?
I'll beat my drum just a smidge, I have originated nearly 2% of the initial certifications of IDDM, and have gotten the last ~16 on the phone, with the examiner in OKC having the documents in his email.....and issued in the office.
 
Last edited:
He's in Phoenix according to his profile.
 
AggieMike88 said:
He's in Phoenix according to his profile.
Click to expand...

Worth a plane ticket to Peoria! :D Semipro, there a probably a dozen AME's that can get you through this process, BUT if you pick the wrong one you are screwed! Dr Bruce will give you the best shot at passing your medical, get in contact with him via email and book a cheap ticket to visit him in person. It isn't the cheapest way to get a 3rd class, but flying isn't cheap anyway and getting denied won't make it any cheaper!:eek::mad2:
 
A1c's in the 8's are not going to cut it. You need to get control of your blood sugar in order to make it to 52, much less 72. An A1c in the high 7's is lousy control. Just my opinion, but, look it up.
 
Semipro said:
Hi all - I am brand new to this great forum, and I have a question regarding my upcoming medical exam. I have done some research on the requirements of a Type 1 diabetic passing a class 3 medical, and I understand that one of the requirements is that I have not had a hypoglycemic event within the last year.

A little background: I am 42, have been a T1D for 17 years, and keep in relatively good control A1c's are usually in the 7's, occasionally I have had a low 8's. No vision or cardio issues, stress tests always come back fine. I am about 12 hours into my private pilot license, and I have about 2-3 months before it is time to solo. I have my class 3 medical exam scheduled for Monday.

16 months ago, my primary care physician changed my insulin regimen to a different type of insulin, and it did not go very well. 11 months ago I had a hypoglycemic episode where my blood sugar dipped while I was sleeping to the point that my wife had to intervene. I changed my regimen back to the same thing I had been using for 5 years, and all is well now.

My question is... Should I wait until 12 months has passed before I go for my medical exam?
Click to expand...

Jesus dude! Why on earth are you burning good money with flight training when you don't even know if you will EVER be issued a medical... You won't even be able to solo, let alone get you're license. IMO the medical should have been the FIRST thing you did, all of my healthy guys that I train even get their medical before flight training or after their fam flight.
 
DO NOT GO TOMORROW. DO NOT GO TOMORROW. DO NOT GO TOMORROW.

Did I fail to mention:

"DO NOT GO TOMORROW".
 
<chuckle> I think he got it.

Too bad it's not part of the CFI continuing education requirement to become more familiar with the 'difficult medical case' issues. Find out more details earlier on about the student's medical history and then provide better guidance than they do now.

I agree with many folks here that the there are too many stories stories of "oops, too late, bunch of money spent" on 15-25 hours of flight before they must navigate FAA medical and find it's not a simple task.
 
Semipro - In addition to NOT GOING TOMORROW, I would second the recommendation to make your way to Peoria when you have met the requirements outlined above by Dr. Bruce in post #8 and have all documents in hand.

As one of the type 1 diabetics with a third-class issued by Dr. Bruce in his office with telephone approval from OKC (I might have been his first, don't recall for sure), I can say without a doubt if it can be done, he's the man to do it.

In the meantime, you only have another month to go before you're at the 12 month mark from your significant hypoglycemic episode, so use the time to start gathering the above data. AND...your control needs to be better. In addition to being able to obtain medical certification, getting your HgbA1c into the low sevens or below (preferably in the low sixes) will help you live longer. If you're not exercising regularly...start. If you're overweight...even more reason to exercise. Review your food and alcohol intake. If you're not sure what to do, a couple meetings with a dietician wouldn't hurt.

If you're diligent and can meet the requirements listed above, there's no reason you can't get this accomplished. Meanwhile, you can certainly keep training. You just might have to delay your solo a bit, but you can still keep learning.

And if you're an AOPA member, go over to their forums and search the medical forum there, of which Dr. B is the moderator, for plenty of posts on this topic.

Brian
(type 1 DM for 46 years - and PP-ASEL)
 
Brian, thanks for the encouragement posted above.

So we can have a more complete thread on Type 1, can you post your routines for pre-flight, during flight, and post-flight to reduce the risk of a hypoglycemic incident?
 
Mike,

I do follow the FAA requirements for MONITORING AND ACTIONS REQUIRED DURING FLIGHT OPERATIONS, which is incorporated into my special issuance letter, to wit:
To ensure safe flight, the insulin using diabetic airman must carry during flight a recording glucometer; adequate supplies to obtain blood samples; and an amount of rapidly absorbable glucose, in 10 gm portions, appropriate to the planned duration of the flight. The following actions shall be taken in connection with flight operations:

  1. One half hour prior to flight, the airman must measure the blood glucose concentration. If it is less than 100 mg/dl the individual must ingest an appropriate (not less than 10 gm) glucose snack and measure the glucose concentration one half hour later. If the concentration is within 100 -- 300 mg/dl, flight operations may be undertaken. If less than 100, the process must be repeated; if over 300, the flight must be canceled.
  2. One hour into the flight, at each successive hour of flight, and within one half hour prior to landing, the airman must measure their blood glucose concentration. If the concentration is less than 100 mg/dl, a 20 gm glucose snack shall be ingested. If the concentration is 100 -- 300 mg/dl, no action is required. If the concentration is greater that 300 mg/dl, the airman must land at the nearest suitable airport and may not resume flight until the glucose concentration can be maintained in the 100 -- 300 mg/dl range. In respect to determining blood glucose concentrations during flight, the airman must use judgment in deciding whether measuring concentrations or operational demands of the environment (e.g., adverse weather, etc.) should take priority. In cases where it is decided that operational demands take priority, the airman must ingest a 10 gm glucose snack and measure his or her blood glucose level 1 hour later. If measurement is not practical at that time, the airman must ingest a 20 gm glucose snack and land at the nearest suitable airport so that a determination of the blood glucose concentration may be made.
While not always congruous with tight control -- having to ingest a snack to raise my glucose if it's 99 mg/dl would probably send an endocrinologist into cerebral spasms -- I do think the requirements serve to minimize the risk of hypoglycemia in flight.

In addition, I tell folks that consistency with diet and exercise is a must when flying. The morning before a flight is NOT the time to start a new workout routine!

Do I always practice what I preach? Honestly...no. My HgbA1Cs should be lower. At least they're consistent...virtually always 7.1 or 7.2 But they could be better. And exercise? Not my idea of a fun time. But since I decided to become a pilot, it's definitely encouraged better and tighter glycemic control and proper followup. I'll get to the exercise part...eventually! :yes:
 
You guys are a riot... Yes, I got the message - Appt canceled, and I will gather the required info before proceeding.

Dr Bruce - I am in Phoenix, AZ. If there is anyone local that you might recommend, I would prefer to stay close to home, but a flight to Peoria is not out of the question.

You mentioned that the Dr needs to state that I have not had a hypoglycemic episode requiring outside help within 5 years. Is that a recurring episode, or do you think they will deny for a single episode within a 5 year time frame?

Also - what results would you be looking for in regards to the Serum Fasting Lipid profile and creatinine?

Thanks for all the help and encouragement - this is a fantastic message board.
 
Unregistered said:
Jesus dude! Why on earth are you burning good money with flight training when you don't even know if you will EVER be issued a medical... You won't even be able to solo, let alone get you're license. IMO the medical should have been the FIRST thing you did, all of my healthy guys that I train even get their medical before flight training or after their fam flight.
Click to expand...

In hindsight, it would have been a good idea to get my medical first. I just learned of the strict requirements for T1D's, and that is why I am doing this research now. To be honest, this is the first time my condition has ever limited me from doing anything that I wanted to do. So while the regulations make absolute sense, it did come as a surprise to me. I will get through this. It is possible that it will take some extra time, but I will not let my condition dictate what I can and cannot do.

And as far as money burning goes... the money I have "burned" has been well worth the experience to this point. Pilots get to do a very cool thing, and I am thrilled to have the opportunity to get a taste.

Can anyone tell me what percentage of Type 1 diabetics pass their medical?
 
Semipro said:
Can anyone tell me what percentage of Type 1 diabetics pass their medical?
Click to expand...

Unfortunately, that's going to be a challenging thing to answer, because of the variables of the airman (1) being in control to start with and (2) having all of their required documentation set up.

Those that present with negatives on that are going to get denied.

Those that present with positives on that are very likely to pass.

Especially with the top of the AME corps helping them.
 
Semipro said:
You guys are a riot... Yes, I got the message - Appt canceled, and I will gather the required info before proceeding.

Dr Bruce - I am in Phoenix, AZ. If there is anyone local that you might recommend, I would prefer to stay close to home, but a flight to Peoria is not out of the question.
Click to expand...

One thing you might not be aware of yet, is the long wait period between the AME deferring your records and application to OKC and the time you get the medical certificate in the mail.

Last time I recall Dr. Bruce reporting this, it was closing in on 120 days (4 months).

So if the Phoenix doc does not have the knowledge or the pull to do it in office, you're going to get deferred.


When I did my first Class 3 medical exam, I did it in Dallas, and got deferred. But I had the benefit of many email conversations with Dr. Bruce on how to minimize this. Coming to my AME with a complete and organized packet of documentation (which he really appreciated) and the tactic of forwarding same packet to OKC got my certificate in 5 weeks when the deferral period was running 90 days.

So, keep considering going to Peoria. They way Dr. Bruce does it will ensure there is minimal delay if any at all.
 
Semipro said:
You guys are a riot... Yes, I got the message - Appt canceled, and I will gather the required info before proceeding.

Dr Bruce - I am in Phoenix, AZ. If there is anyone local that you might recommend, I would prefer to stay close to home, but a flight to Peoria is not out of the question.

You mentioned that the Dr needs to state that I have not had a hypoglycemic episode requiring outside help within 5 years. Is that a recurring episode, or do you think they will deny for a single episode within a 5 year time frame?

Also - what results would you be looking for in regards to the Serum Fasting Lipid profile and creatinine?

Thanks for all the help and encouragement - this is a fantastic message board.
Click to expand...
From the AME guide- ONE is okay in 5 years, NONE in the past 12 months...so those are the limits to recurrence.

They want a normal creatinine, but if it's up less than 50% above the upper limit of normal for your lab (which rperesents a 33% reduction in kidney function) urine macroglobulins need to be normal.

Lipid profile only has to be "reasonable". No Triglycerides of 700 nor Cholesterol of 450, etc.
 
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