Dare to Dream: Flying Solo with Diabetes by Douglas Cairns
The FAA and a U.S. Pilot's License
Diabetes Control Requirements
Not many people know that its possible to be a private airplane pilot with insulin-dependent diabetes. A remarkably sensible and effective scheme was introduced in 1997 in the U.S. requiring a pilot to meet the normal requirements of FAA Class II Medical (for private flying) and also demonstrate that overall diabetes control is good, with no diabetes-related complications. He or she must have had good diabetes education and developed the ability to self-manage diabetes well.
For good diabetes control, there must be an absence of any recent unexplained hypoglycemic events (i.e. incapacitation) within the last year, and no debilitating diabetes complications, such as damage to the eyes or kidneys or nerves in your legs. Your A1C should reflect good diabetes control as well. Once the medical certificate has been awarded, you must have check-ups every three months and additional annual medical to confirm continued good diabetes control. These include a report on A1C, daily blood sugar test results, and confirmation of no hypoglycemic events.
When I first applied, the medical reporting requirements seemed daunting. However, Dr. K, the Bangkok-based FAA-designated medical examiner, helped me through what was required. Overall it took seven months to dig out old medical records from the U.K. and supply new reports. Once the regular three-month check-ups were established, I found it an extremely good system. If anything was going wrong with your diabetes control, it would be detected early.
When I sent my medical records and reports to the FAA, I was nervous about the outcome. While I knew that I was well controlled, I didn't want to assume anything. The Medical arrived in the middle of 2000. It was one of the best letters I have ever received.
In-Flight Blood Sugar Control Requirements
So how does the U.S. system ensure safety (primarily avoiding going too low) when flying with diabetes? The FAA sets blood sugar testing requirements: Test within 30 minutes of takeoff, each hour into flight, and 30 minutes before landing. The results need to fall within a range of 100-300 mg/dl (5.5-16.5 mmol/l). This compares to a non-diabetic range of 72-126 mg/dl (4.0 - 7.0 mmol/l) and allows a good buffer of safety between 100 and having symptoms of being hypo.
It is a wide, workable range. If the result is above 300, you must land as soon as practicable and bring sugars down into the required range before flying again. (So far I have not gone above 300 when flying.) If your preflight test is above 300, you need to administer insulin and/or wait for sugars to fall within range. If a test during flying is below 100, you must ingest 20 g of carbohydrate and bring your sugars back up. (There is no requirement to land if your level is below 100, however.) If testing is difficult to out due to flying requirements, such as flying in bad weather, you must eat 20 g carbohydrate and then test when it's convenient. You do not need to send your test results to the FAA after every flight. We are left alone to follow the pre-flight and in-flight testing requirements.
The FAA recently carried out a statistical study of 265 pilots with type 1 diabetes in 1999 and concluded that they were no more likely to suffer an incident or accident with diabetes when flying than any other pilot. After nearly four years of using this system, and flying over 1,200 hours, including a challenging round the world flight, and recently a 12-hour world speed record across the U.S., I find this system both safe and practical. It is an extremely good way to fly safely with type 1 diabetes.
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