Diabetes and 3rd Class Medical

[FallingApart]

Just been diagnosed with Diabetes. Haven't completed the full work up yet. My PC doc says most likely its type 2. But, my blood sugar was high enough that he called me back in right away and prescribed a low dose of long acting insulin just to get it down for now.

I think I remember reading somewhere that the FAA changed the rules on insulin dependance. And, that I can still get a 3rd class even if I stay on injectable insulin. Is that right?

I looked up the prescribed drug, Lantus, on the AOPA drug database, and does say its OK with a diebetes workup.

Anyone have any experience with this?

 

[AggieMike88]

Diabetes Type 2, insulin treated, is a special issuance situation.

For more info, see this page from the AME guide and read about non-CGM and CGM options.

https://www.faa.gov/about/office_or.../offices/aam/ame/guide/dec_cons/disease_prot/

 

[rk911]

before you take the physical be sure you can pass the physical. a denial will eliminate not only a private certificate but also the sport certificate. don't guess. don't assume. make sure.

 

[AggieMike88]

In addition to what @rk911 said above, DO NOT let your desire to aviate overstep your need to get and keep your diabetes in control.

We like to say as a mantra, “Health First, Fly Later.”

Diabetes, when not kept under control, causes so much havoc on other systems in your body. Eyes, heart, kidneys, nerve endings, and more.

Follow your primary doctors guidance and make the appropriate changes of lifestyle, diet, and exercise to get that A1C back into normal ranges.

Once that is done and stable for many months (at least 3, but 6 is better), then consult with an AME about obtaining your medical.

The wait is optional, but doing so increases your chances of issuance because you can demonstrate that the changes you did as a result of the diagnosis are working and are stable.

But the big take away is, Health First, Fly Later.

 

[bbchien]

IDDM-1 third class is a lengthy but doable SI.
Lantus, is a form of insulin. Even if you have type 2, the Special issuance is entitled, "Diabetes mellitus requiring the use of insulin" (whether type 1 or type 2).

....the new frontier is IDDM-1 insulin, First class

Here's what he needs:

A record of 3rd monthly care (endocrine) in which they express “good control”. That means 8.0 HbA1cs quarterly or below.


Letter from the doc saying:


No episodes of hypoglycemia that require outside care, in the past year

NO more than on in the past 5 years.

Statement from the Doc: that you have no known nephropathy, neuropathy or cardiovascular nor neurovacular disease.

Dilated eye exam by a board cert. Ophthalmolgist within 90 days priro to application “no diabetic retinopathy” or if there is some, reaslonably normla Humphrye 24-2 or 30-2 visual fields.


Statement by the doc that you have become well educated as to the physiology of diabetes and make good treatment decisions.

Letter from a CFI in which he notes that you can do a fingerstick glucose while in control of the aircraft and not lose control.

 

[flyingron]

I should echo something that Bruce has pointed out in the past. Those high A1cs are progressively damaging your organs. Don't let the FAA policy make you unhealthy. I've got a stepson who was diagnosed with Type I at an early age. During some of his misspent young adulthood, he allowed himself to get really messed up. Vision problems, failed kidneys, and loss of a leg among other problems ensued before he was even 40.

 

[FallingApart]

Well, Friday the doc prescribed a very small dose of a long acting insulin. He said the goal was to get my blood sugar level under 200.

I quit eating all processed food and put myself on a low carb diet eating eggs, chicken, mixed greens, broccoli, cheese, avacado, almonds and cashews.

It took me 4 days. But today, my blood sugar was under 93 before breakfast, and stayed under 140 all day.

In fact, when I checked 2 hours after breakfast, it was 120. So, I treated myself to a banana before taking insulin and going for a walk.

After 4 days, I think I can live like this OK. Would like an occasional glass of wine or slice of pizza. But, Oh well.

I just hope the doc feels I can maintain this with just diet and exercise (no drugs). I really don't want to go that route.

I'm wondering if maybe its possible I have some kind of temporary diabetes. Is that a thing with 60 year old men?

 

[flyingron]

Your profile isn't uncommon for a late-onset (type II). Get your weight down and eat sensibly. The blood glucose is a number you use to address your behavior, but again, your overall health is determined by the A1c number which gives an idea of how long your blood glucose has been at damaging levels.

 

[MacFly]

Well, Friday the doc prescribed a very small dose of a long acting insulin. He said the goal was to get my blood sugar level under 200.

I quit eating all processed food and put myself on a low carb diet eating eggs, chicken, mixed greens, broccoli, cheese, avacado, almonds and cashews.

It took me 4 days. But today, my blood sugar was under 93 before breakfast, and stayed under 140 all day.

In fact, when I checked 2 hours after breakfast, it was 120. So, I treated myself to a banana before taking insulin and going for a walk.

After 4 days, I think I can live like this OK. Would like an occasional glass of wine or slice of pizza. But, Oh well.

I just hope the doc feels I can maintain this with just diet and exercise (no drugs). I really don't want to go that route.

I'm wondering if maybe its possible I have some kind of temporary diabetes. Is that a thing with 60 year old men?

No, you're likely a Type II diabetic. Your path now is to manage your blood sugar. Diet, exercise, WEIGHT LOSS....and medication of one type or another to address the issue. Some diabetics doing all those thing diligently can get their blood sugar under good enough control that no meds are required at all.

Fasting blood sugar isn't as important as hemoglobin A1c to judge the extent of the disease and the effectiveness of treatment. Your AME will certainly want to know that number.

 

[AggieMike88]

As MacFly and @flyingron point out, your A1C is the guiding number on how well your managing your blood sugar levels. Your general target number is 6.5 or a tad less.

A1C isn't a quickly changed number, it has a 90-day look back. So if you were good on your diet and exercise for a small number of days during that time, you may see a reduction in your value, but not as much progress as you may want.

But if 80 days of the 90 you were diligent and only "cheated" in moderation for a widely spaced out 10 days of the 90, you will see some good progress. Just mind the grams and % of carbs and sugars in those cheat foods and don't go too crazy.

There is a home A1C test called A1C Now that you can use to monitor your progress. A box of 4 tests is less expensive for many people than a visit to their blood draw laboratory.

There are many good educational resources out there for dealing with diabetes. I hope you will avail yourself of them as needed.

BY the way, if you get to and can keep your A1C in the 6.0-7.0% range, the FAA is "comfortable" with that and won't hassle you when you renew your medical. But if you are renewing while in the 8's or 9's, then they give you stern looks and talk to you about how you are not exhibiting adequate control.