by Dr. Bill Blank, M.D., Senior AME
@August 2020 All rights reserved.
Published in Midwest Flyer – August/September 2020 issue
The FAA has come a long way since I first became an Aviation Medical Examiner (AME). Then diabetics could not be certified. Recently the FAA announced it would certify insulin-dependent diabetics at the first and second-class levels. They had been doing so for third-class medicals since 1996.
Diabetes is characterized by a high blood-glucose level. Most of our energy comes from our body using glucose. Insulin, a hormone produced by the pancreas, permits glucose to enter our cells and be utilized. Type I diabetics do not make insulin and require treatment with it. Type I usually appears in childhood. Type II diabetics, either don’t make enough insulin, or do not utilize it effectively and are generally treated with oral medications. Type II, previously called “adult onset diabetes,” is occurring more frequently. This is related to the increase in obesity in our population.
We often think of diabetes in terms of the blood sugar level in our bodies. Treatment is based on trying to normalize the blood-sugar level and minimize fluctuations. We do this because elevated blood-sugar levels damage the small arteries going to various body organs interfering with the transport of oxygen to these tissues. This can result in diabetic eye disease (retinopathy), kidney disease, peripheral neuropathy (nerve damage), and heart disease. Diabetes, thus becomes a circulatory disease. With good blood sugar control, many of these complications can be minimized and/or delayed.
The FAA is mandated to establish a required level of safety for the national airspace system. An additional goal is to certify as many airmen as can be done safely. The certification policy for diabetics has evolved over time with these principles in mind.
An AME can issue a certificate for diabetes controlled by diet and exercise. A status report from the treating physician, and the results of a hemoglobin A1C level done within the last 90 days, are needed. If you have been diagnosed with “pre-diabetes,” your AME can still issue you a medical certificate, provided an FAA Pre-Diabetes Worksheet has been completed by your treating physician. Diabetes requiring treatment with oral medications or insulin requires Special-Issuance Certification. Further details can be found on the FAA or AOPA websites.
The major inflight risk for diabetics taking insulin is hypoglycemia or low blood sugar. This can lead to confusion and loss of consciousness. A technologic advancement called “continuous glucose monitoring” notifies the airman, in advance in real time, of predicted episodes of low or high blood sugar levels, giving the airman time to respond and prevent them from occurring. This development has given the FAA confidence to certify some insulin-dependent diabetics at the first and second-class levels. The FAA has done a good job of developing policies for safely certifying as many diabetics as possible.
Basic Med: You may not realize it, but Basic Med is celebrating its third anniversary this year. And as far as I can tell, there has not been a significant spike in aircraft accidents among Basic Med Certificate holders. The FAA is gathering statistics on Basic Med and is mandated to report the results to Congress within 5 years of the adoption of the program. Unless fatal accident numbers skyrocket, I think Basic Med is here to stay.
EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985.
Dr. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Dr. Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII) and has given over 1200 hours of aerobatic instruction. In addition, Dr. Blank was an airshow performer through the 2014 season and held a Statement of Aerobatic Competency (SAC) since 1987.
DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.