Certified letter from Oklahoma City

Jeffythequick

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Jeffythequick
i was out with the family and my neighbor called and said I got a certified letter that she wasn't allowed to sign for.

Getting home, I found out that it's from OKC. Since I have to wait until Monday to find out what's in it, I figured I'd come here for some hope. (Yeah, I know...)

So, my situation is that this is my first attempt at class 3 medical, and I am T1 diabetic, in good control, have notes from my doctors for all of the things on my 8500-8.

What are the possibilities of what can be in a certified letter from the FAA for a first time applicant?
 
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Not know why certified
Either they want more data
You've been denied
Or it's a special issuance approval for you to take to an AME so he can issue the medical
 
Not know why certified
Either they want more data
You've been denied
Or it's a special issuance approval for you to take to an AME so he can issue the medical

I ran a 5K race today, and I was pacing with this guy that asked if I was OK after the race was over, and found out that he's an AME that works where I do, and he told me that my company will pay for the cost for the AME (nice to know for the future). Anyway, I told him that I was wondering how the process went, and he said that, at best, I'd get a Special Issuance approval. It's just been a while since I saw the AME (that I paid for), so I was wondering what happens next...
 
I've never received my SI by certified mail. Usually it is a request for more info that requires proof of delivery to start the clock on your response. A denial will come by certified mail, also.

I'm betting they want more info or testing.
 
An SI just comes in with the regular mail. Never got a denial, but it probably comes in the regular mail, too. A request for more info will have a deadline, so it is probably a special delivery to prevent someone from saying they never got it.
 
When I received a request for more info, it came in two copies - one registered and one standard mail. Both identical letters.


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I received a certified letter once, when they were requesting more current test results than I had sent in. I scheduled the exam and resubmitted the results, then they sent me the SI.
 
Jeffy, did your doc's material specifically discuss diet and dosage?

Specifically mention you are educated and make good treatmentt decisions?
Specifically note you have had no hypoglycemias (that needed outside intervention) in The last year and at most one in the past five years?
Specifically note no known CV disease, no nephrologic or neurologic complications?
Did you send in a current ophthalmologists's exam and if there is retinopathy, send Humphrey 24-2 or 30-2 formal visual fields (and NOT the pseudo-welch- humphrey from an Optometrist)?
And if U are 40, an adequate stress treadmill?

How about a letter from your CFI noting that you have been seen to test your fingerstick and keep control of the aircraft (the dexterity" requirement?

If you are missing any one of these it is either a demand letter or a denial....


DID your AME know these requirements and inform you/ hep you gather? This is one of the most detailed specials....and no T gets to be uncrossed....

Dr B
 
Jeffy, did your doc's material specifically discuss diet and dosage?

Specifically mention you are educated and make good treatmentt decisions?
Yes, please see below.
Specifically note you have had no hypoglycemias (that needed outside intervention) in The last year and at most one in the past five years?
Looking at http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/guide.pdf and the protocol for Insulin-Treated Diabetes Mellitus - Type 1 & Type II, I am on the edge of item #1, where, in 2011, I did have a few assisted low blood sugar episodes. My last one was in 2014, and there was an incident in 2013 where paramedics were called at my work, but my blood sugar was fine (75 - I know that lots of people like to call 75 "low", but in taking data from my children and wife, their blood sugar is consistently in the 70's and 80's, so that's what I consider "normal"... Plus, I can think and operate normally in the 70's, and did.)
Specifically note no known CV disease, no nephrologic or neurologic complications?
Yes, highlighted below.
Did you send in a current ophthalmologists's exam and if there is retinopathy, send Humphrey 24-2 or 30-2 formal visual fields (and NOT the pseudo-welch- humphrey from an Optometrist)?
And if U are 40, an adequate stress treadmill?
Yes, I did. It was my annual Ophthalmology exam I get every year, and it was submitted. I'm not sure how to answer the Humphrey question, but her diagnosis was, for the first time in 44 years with the disease, is that I have "slight retinopathy".
How about a letter from your CFI noting that you have been seen to test your fingerstick and keep control of the aircraft (the dexterity" requirement?
I haven't gone to a CFI yet, as I am taking the advice of the FAA on this one before spending $1000's of dollars on a fruitless adventure (from the Guide for Aviation Medical Examiners from the FAA, 2/24/16, p.226):
NOTE: Student pilots may wish to ensure they are eligible for medical certification prior to beginning or resuming flight instruction or training. In order to serve as a pilot in command, you must have a valid medical certificate for the type of operation performed.

I do use a Continuous Glucose Monitor (actually, 2... one stand alone, and the other built into my Insulin Pump... my wife can check my blood sugar remotely from the one that goes through my iPhone - Yay Dexcom!!!) for indicating whether my blood sugar is falling/climbing, and use finger sticks to determine dosage for my insulin pump. I asked the AME if that is acceptable, and he said that it was, in his experience.
If you are missing any one of these it is either a demand letter or a denial....
Well, at least I know what will be in the letter on Monday... :O
DID your AME know these requirements and inform you/ hep you gather? This is one of the most detailed specials....and no T gets to be uncrossed....

Dr B
Thank you, Dr. Bruce, for your reply/questions... I've answered them in line... (Here is the letter from my endocrinologist, I changed the name/birthday):
I am the endocrinologist treating Jeffythequick, date of birth February 30, 1845, for type 1 diabetes. Per FAA guidelines, he needs a letter from his treating physician to get a pilot's license.

His last two hemoglobin A1c measurements were 6.7 on January 4, 2016, and 6.8 on June 23, 2015. Jeff is on an insulin pump and eats a reasonable diet. He does not have cerebrovascular, cardiovascular, peripheral vascular disease or diabetic neuropathy.

His last documented ophthalmologic exam showed no retinopathy dated April 18, 2013. He is due for a repeat exam, assuming that he has not had one outside of my organization recently.

He has been educated in diabetes and its control and understands the actions that should be taken if complications such as hypoglycemia should arise. He has the ability and the willingness to properly monitor and manage his diabetes.

He is capable of using his glucometer and making decisions based on the results.

He has not had an exercise stress test due to the lack of any clinical indication for such a test. We will provide a baseline ECG once that is performed, but certainly he does not meet any clinical criteria for consideration of stress testing.

I know this is a wall of text, and I'll keep people informed here. I hope that others can learn from my experience.
 
I ran a 5K race today, and I was pacing with this guy that asked if I was OK after the race was over, and found out that he's an AME that works where I do, and he told me that my company will pay for the cost for the AME (nice to know for the future). Anyway, I told him that I was wondering how the process went, and he said that, at best, I'd get a Special Issuance approval. It's just been a while since I saw the AME (that I paid for), so I was wondering what happens next...

Lol, why did he ask if you were OK?
 
Well, my item 2 makes it not look good for the application....you might not consider 75 low but you have two events that required outside assists within 5 years.

Why did you apply, knowing that?
:(
 
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I never got a certified letter from the FAA telling me that I am a good boy and they are proud of me.... Hopefully they are just wanting more information.
 
Well, my item 2 makes it not look good for the application....you might not consider 75 low but you have two events that required outside assists within 5 years.

Why did you apply, knowing that?
:(
The 75 one, in my opinion, doesn't count, as they didn't do any assistance (giving me any medication/transportation to a hospital) which has been done in other paramedic visits that I have had. I'd like to explain:

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 which resulted in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness). (Guide for AME, PROTOCOL FOR INSULIN-TREATED DIABETES MELLITUS - TYPE I & TYPE II, Section A.1)

I had a low blood sugar situation earlier that I corrected myself, and when a co-worker saw that I had taken the glucose tabs, knew I was diabetic, and called the paramedics (where I work has their own paramedics) because they thought I was going to pass out, based on their previous experience with a family member (their words were, "If I see a diabetic taking glucose, I call for help, and let them sort it out. My Aunt Edna almost died..."). The paramedics came, they tested my blood sugar, and did nothing (they asked what happened, and I told them my blood sugar was going down, so I took 4 glucose tabs and was waiting for it to come back up, which takes about 15-20 minutes), and since I was responsive, they waited for about 10 minutes. When my blood sugar went to 96, they saw that it was going up, and left. I talked to the AME prior to submitting to MedXpress, and he did not ask about item #1 (From the AME guide, your item #2). I used him as my sole authority on what to do, and have since found the AME guide on the FAA site (actually, last night, after your post, I dug into FAA.GOV further).

As for your second question, I find that as I get older, most of the regrets I have are from not doing something, rather than doing something. If I am denied, I'm out $100, and know what to work on for the next attempt at getting a PPL. If that is the reason for the denial, then it will be 2 years, and then I'll attempt again. In the meantime, I'm pretty sure there are plenty of CFI that will teach me what I want to and need to know, and then, when I get the Class 3 Medical, the solo and check ride will be that much easier. We may disagree on that incident, but I do respect your evaluation on it with the limited information that I gave in the previous post.

That section C of the Guide is good, and I am using as requirements for driving as well, as I have for the last 31 years.
 
i anticipate your letter will ask for further information. let us know
 
i anticipate your letter will ask for further information. let us know
Will do. Like I put in the reply from Dr. Bruce, I put the detailed info in there so that others can learn from me (and my learning path on this journey...).

I guess it's that "either be a good example, or be a good example of what not to do..." thing. ;)
 
The 75 one, in my opinion, doesn't count, as they didn't do any assistance (giving me any medication/transportation to a hospital) which has been done in other paramedic visits that I have had. I'd like to explain:

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 which resulted in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness). (Guide for AME, PROTOCOL FOR INSULIN-TREATED DIABETES MELLITUS - TYPE I & TYPE II, Section A.1)

I had a low blood sugar situation earlier that I corrected myself, and when a co-worker saw that I had taken the glucose tabs, knew I was diabetic, and called the paramedics (where I work has their own paramedics) because they thought I was going to pass out, based on their previous experience with a family member (their words were, "If I see a diabetic taking glucose, I call for help, and let them sort it out. My Aunt Edna almost died..."). The paramedics came, they tested my blood sugar, and did nothing (they asked what happened, and I told them my blood sugar was going down, so I took 4 glucose tabs and was waiting for it to come back up, which takes about 15-20 minutes), and since I was responsive, they waited for about 10 minutes. When my blood sugar went to 96, they saw that it was going up, and left. I talked to the AME prior to submitting to MedXpress, and he did not ask about item #1 (From the AME guide, your item #2). I used him as my sole authority on what to do, and have since found the AME guide on the FAA site (actually, last night, after your post, I dug into FAA.GOV further).

As for your second question, I find that as I get older, most of the regrets I have are from not doing something, rather than doing something. If I am denied, I'm out $100, and know what to work on for the next attempt at getting a PPL. If that is the reason for the denial, then it will be 2 years, and then I'll attempt again. In the meantime, I'm pretty sure there are plenty of CFI that will teach me what I want to and need to know, and then, when I get the Class 3 Medical, the solo and check ride will be that much easier. We may disagree on that incident, but I do respect your evaluation on it with the limited information that I gave in the previous post.

That section C of the Guide is good, and I am using as requirements for driving as well, as I have for the last 31 years.
Well I sure hope that's not the issue. You are, to the agency, how you appear on paper... sigh. Sounds like you CAN DO THIS.
 
OK, so it was what I thought it would be...

The request for more information, including:

CPAP request, which I can get an average of 6 hours/night with 75% (I used Sleepyhead, and I am at 6:02 hours at 91% usage. (I get up at 3am to get ready for work, so here it is:
DetailsMost RecentLast WeekLast 30 DaysLast 6 MonthsLast Year
CPAP Usage
Average Hours per Night05:5607:4107:2506:3106:02
Compliance100%100%97%97%91%


Each day, it goes up in Avg hour/night, but this will work. It seems that once I get past July (that was the one that brought it down), it'll skyrocket, but I'm good now, so I'm good, so I'll go with what I have now.
:) The letter from my Sleep doctor
o_O the last sleep study info
:) the signed airman compliance with CPAP treatment
:( and the diabetic evaluation checklist
The reason for the :( is the date of the 2011 information, which is wrong. I called the County, and it turns out that it was 7/2012, coupled with the one in 2014, so I have a year to wait on that. I will give the FAA Air Surgeon all of the facts on the one that Dr. Bruce and I discussed, and if/when I am denied, I will ask for an appeal, and see where it goes from there.
A.1: :) Date of initiation of insulin (must for on insulin for 6 months or more - 44 years
A.2: :( No recurrent (two or more) episodes of assisted low blood sugar recovery
A.3: :eek: 2 A1c measurements (I have seen on here >6 is :(, but not sure for T1D or T2D.
A.4: :) Insulin type and dosage (Insulin pump - I can give the insulin:carb ratios and insulin:blood sugar ratios, if needed. I don't have a set dose/day, as part of my control, it varies on diet, exercise, and blood sugar.
A.5 :) No vascular diseases or neuropathy
A.6 :) I'm diabetic educated
A.7 :) I can walk and chew gum, and I can test my blood sugar and fly my simulator (I've driven and tested too, but only when there is no traffic near me) at the same time, plus, with the CGM, it tracks pretty closely.
A.8 :) No other significant history/medications

B. :confused: All medical records? Accident and incident records pertinent to their history of diabetes. 44 years of medical records? How do I do that, when over half of the doctors I have gone to are dead? The accident (there is one, as I have only had a motorcycle accident and diabetes wasn't an issue, as my blood sugar was 168. Being 20 and immortal was more of a contributing factor than anything else. Oh yeah, don't wear sunglasses at night, no matter what Corey Hart says...)

C. :) Confirmation by an Ophthalmologist that I'm good.
D. :eek: If >40, maximal graded stress test.

So... a couple of questions:
1. If I am denied, can I still do the Sport route, or is that out too with a denial?
2. Can I still do the student route until I get the medical? I know I will pay for the teacher in the air, but I'd like to at least give it a go. The worst thing is that I learn to fly an airplane with a CFI next to me, and then when I can get the Class 3 medical, I'll be set to continue on.
3. If I am denied, how long do I have to wait until I try again (making sure I'm all good with the A.2 issue?

Thank you all for your insight, especially you, Dr. Bruce.

Jeffy
 
An A1c of 6.5 or below accompanied by an fbs of 125 and less, and Type 2 pill controlled will get you in the CACI for Type 2. But I believe all Type 1's are SI's due to the different nature of the beast.

Type 2's will be SI'd up through A1c of 9.0, but if you're running that high, you have more to worry about health wise than getting the FAA's approval to fly. Dr. Bruce once told me, 6.5-7.5 would get me a general counseling about proper control, 7.5-8.0 would be approved with a stern warning, and 8.0+ would not be a pleasant conversation. And he's right since if you're running that high, you're doing significant damage to lots of internal systems.

And bonus points to you for the Corey Hart reference... But maybe now you can switch it to a Timbuk3 one.
 
A denial takes out Sport Pilot options. Dr Bruce can answer best on when you can reapply. I do not know of any limitations on minimum time between applications.
 
1. If I am denied, can I still do the Sport route, or is that out too with a denial?

A denial takes out Sport Pilot options. Dr Bruce can answer best on when you can reapply. I do not know of any limitations on minimum time between applications.

As Bill said, Sport is out with a denial, but you're good to go on Gliders, including powered gliders.
 
An A1c of 6.5 or below accompanied by an fbs of 125 and less, and Type 2 pill controlled will get you in the CACI for Type 2. But I believe all Type 1's are SI's due to the different nature of the beast.

Type 2's will be SI'd up through A1c of 9.0, but if you're running that high, you have more to worry about health wise than getting the FAA's approval to fly. Dr. Bruce once told me, 6.5-7.5 would get me a general counseling about proper control, 7.5-8.0 would be approved with a stern warning, and 8.0+ would not be a pleasant conversation. And he's right since if you're running that high, you're doing significant damage to lots of internal systems.

And bonus points to you for the Corey Hart reference... But maybe now you can switch it to a Timbuk3 one.
That's the goofy thing about T1D's (especially with a pump)... A fasting blood sugar will be... whatever you want it to be. I have a I:BG ratio of 1:25, so if I'm at 150, and I want my FBS to be 75, well, then, 3 units, and I'm there.

Oh well, it looks like I'll be having a CFI next to me. Heck, they probably appreciate the $60/hour plus the time in the air...

$50 thou a year? I couldn't take the pay cut. But hey, it was 1988, and that was a lot of money back then.
 
In any case, Dr. Bruce's fee to review your case is extremely reasonable. And his resulting advice, invaluable.

So if you wish his help in determining what it is the FAA desires so that you have a successful outcome, do it. You won't regret it. But act soon as the deadline clock is ticking and not sending in the requested info on time causes more problems.
 
As Bill said, Sport is out with a denial, but you're good to go on Gliders, including powered gliders.

Some of whose performance characteristics under power are virtually indistinguishable from those of most LSA airplanes.

Ultralights are another option (and a much cheaper, much more hassle-free one at that) if you just want to fly for flying's sake and don't give a rat's about any other useful purpose. The biggest problem is finding dual instruction in something vaguely similar to the ultralight you'll be flying. The SP rule grounded almost all of the fat ultralights. :(

LSA trikes are similar enough to ultralight trikes that they're essentially the same. Well, not the same so much as that the way they are controlled makes the transition more intuitive and natural. I've been told that LSA powered parachutes and gyrocopters also handle very much like their ultralight counterparts.

Three-axis ultralight airplanes, on the other hand, handle quite differently from "real" airplanes, despite having the same controls. But most pilots who transition do manage to survive their first flights.

(I've heard rumors that some fat ultralights are still illegally being used for clandestine ultralight instruction in some remote areas, but of course those are just rumors. :rolleyes: )

Rich
 
...(I've heard rumors that some fat ultralights are still illegally being used for clandestine ultralight instruction in some remote areas, but of course those are just rumors. :rolleyes: )
Is there no way for a fat ultralight to be flown legally, e.g., by a person with an appropriate pilot or instructor certificate?
 
Is there no way for a fat ultralight to be flown legally, e.g., by a person with an appropriate pilot or instructor certificate?
If it is certificated as an E/S-LSA, no problem. And, at one time, long, long ago, you could make the conversion. But that window has since closed.
 
In any case, Dr. Bruce's fee to review your case is extremely reasonable. And his resulting advice, invaluable.

So if you wish his help in determining what it is the FAA desires so that you have a successful outcome, do it. You won't regret it. But act soon as the deadline clock is ticking and not sending in the requested info on time causes more problems.
Yeah, I have most of what they need already. There was some problems with me being the intermediary between what the doctors needed.
 
Is there no way for a fat ultralight to be flown legally, e.g., by a person with an appropriate pilot or instructor certificate?

Nope. Not unless you removed one seat, reduced the fuel capacity back to five gallons, and got the weight back under 254 pounds. But then it would no longer be "fat."

There was a window of opportunity during which they could, in theory, be registered as E-LSA (or in a few cases, as S-LSA without the "E"); but very few came close enough to meeting the ASTM airworthiness standards for LSA that any DAR in his right mind would sign off on them. So most of them were either cannibalized or abandoned.

Those who continue to illegally fly the remaining ones may or may not be taking a big chance, depending mainly on how much they have to lose. Certainly no one who holds or ever hopes to hold any sort of FAA certificate would want to take the chance.

Does the FAA expect them to be scrapped?

I don't think the FAA cares, as long as they are not flown.

Rich
 
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Yeah, I have most of what they need already. There was some problems with me being the intermediary between what the doctors needed.
That might be part of the service Dr. Bruce provides.... Once you give him permission to talk to your physicians, he makes the phone call asking for what's needed in their language
 
asking for what's needed in their language

I don't recall him doing this but he will tell YOU what you need to tell your doctor in their language. Calling doctors would be a big time sink but would be a nice touch.
 
I don't recall him doing this but he will tell YOU what you need to tell your doctor in their language. Calling doctors would be a big time sink but would be a nice touch.
You're likely correct.
 
Nope. Not unless you removed one seat, reduced the fuel capacity back to five gallons, and got the weight back under 254 pounds. But then it would no longer be "fat."

There was a window of opportunity during which they could, in theory, be registered as E-LSA (or in a few cases, as S-LSA without the "E"); but very few came close enough to meeting the ASTM airworthiness standards for LSA that any DAR in his right mind would sign off on them. So most of them were either cannibalized or abandoned.

Those who continue to illegally fly the remaining ones may or may not be taking a big chance, depending mainly on how much they have to lose. Certainly no one who holds or ever hopes to hold any sort of FAA certificate would want to take the chance.



I don't think the FAA cares, as long as they are not flown.

Rich

I'm surprised that they can't even be flown as experimental.

I also wonder how they handled the legal issues in flying the Wright Flyer replica.
 
Jeffy I'm not here to "hold out". But to give you good advice I'd need your FAA blue ribbon medical record. Takes about 2 weeks to get and then I'd be "in the know".

But the one thing I would not do is "appeal without the necessary information" because then you get an Fed. Air Surgeon Denial, which then only he can un-do (which takes months, e.g 6). Remember, you are interpreting what they are demanding.

Sounds mostly like a routine sleep apnea clearance, which I didn't recall being part of the equation. Remember, to the FAA you are the total package.....

Sleep Apnea: Know that they want:
The graph (readacted version attached0 with 75% of bars >6 hours' of use.
The current status letter
The affidavit of use

A7. PROVE it. Letter from CFI!
Date of initiation: I send a whole year's records, which helps with 2 items: >6 month's initiation of insulin, AND no hypoglycemias that required outside inteverntion for the most recent year. The rest is a matter of coaching the endocrine correctly, which was not done.....
 

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I'm surprised that they can't even be flown as experimental.

I also wonder how they handled the legal issues in flying the Wright Flyer replica.

There were many problems with certificating fat ultralights, beginning with the fact that most of them didn't even come close to meeting the ASTM standards, particularly in terms of structural requirements, maneuvering loads, and gust loads. They were delicate craft built for the fairest of fair weather flying. Very few of them could be beefed up sufficiently to meet ASTM standards, even given the increased weight allowance. It would be easier to build a new airframe.

There also were legal Catch-22s. A lot of fat ultralights were commercially built, but as ultralights, meaning that they had no ACs at all, but they did have serial numbers. As long as they were legal (sort of) under the USUA and EAA exemptions, the owners could do whatever they wanted to them within the confines of FAR 103 and the training exemptions. But because they were commercially built, that also meant that they didn't meet the 50 percent build requirement for them to qualify as E-ABs manufactured by the owner; so the owners couldn't legally modify them to ASTM LSA standards even if it were technically feasible to do so. They were not the builders.

Finally, even if it were both legally and technically possible for an owner to do the work necessary to make his or her craft ASTM-compliant, they also had to provide voluminous paperwork proving that it was compliant and setting forth operational and maintenance procedures before a DAR would so much as look at the bird.

The end result was that few fat ultralights were successfully certificated as E-LSA, and even fewer as S-LSA. I don't have any hard numbers, but I personally don't know anyone who succeeded in making the conversion. I suspect that most of the birds were either cannibalized or built-down to meet Part 103 standards for single-place ultralights.

As for the Wright Flyer, I suppose some sort of historical exemption was made. The FAA can issue an AC to a lawn chair if they want to.

Rich
 
Jeffy I'm not here to "hold out". But to give you good advice I'd need your FAA blue ribbon medical record. Takes about 2 weeks to get and then I'd be "in the know".

But the one thing I would not do is "appeal without the necessary information" because then you get an Fed. Air Surgeon Denial, which then only he can un-do (which takes months, e.g 6). Remember, you are interpreting what they are demanding.

Sounds mostly like a routine sleep apnea clearance, which I didn't recall being part of the equation. Remember, to the FAA you are the total package.....

Sleep Apnea: Know that they want:
The graph (readacted version attached0 with 75% of bars >6 hours' of use.
The current status letter
The affidavit of use

A7. PROVE it. Letter from CFI!
Date of initiation: I send a whole year's records, which helps with 2 items: >6 month's initiation of insulin, AND no hypoglycemias that required outside inteverntion for the most recent year. The rest is a matter of coaching the endocrine correctly, which was not done.....

Bruce is too ethical and modest to hold out, so I'll do so on his behalf.

OP presently does not have a medical and also is excluded from SP. His only chance of flying anything other than an ultralight, glider, or free balloon is to get this right; and it's not a DIY sort of project.

Rich
 
I'm surprised that they can't even be flown as experimental.
While experimental gets you around some certification requirements, it doesn't mean "anything goes." Most of the regulations still apply.
 
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