Diabetes and the Student Pilot

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Student pilot wanna-be here.

After a routine visit to general practice doc, I got bad news this week that I have contracted diabetes. I was informed by a phone call from the doc and haven't seen the lab results, but he did mention one of the indicators was really high at 12 when it should be something like 7 or below. My looking about the internet has me thinking he was referring to A1C,but I am not sure.

I inquired about control via diet and exercise alone. Doc said no, that oral medication is needed and he would phone in the prescription (don't know which med yet). I'll be getting that tonight. We set an appointment to go over labs and construct a treatment routine for next week.

I did a search on both the red board and AviationMedicine.com to find out more information about diabetes and getting the student and 3rd class certificate.

From the red board, I found this post by Dr. Bruce:
Bruce Chien said:
the SI for pill controlled diabetes is quite simple.

2 months groundiing.
Hemoglobin A1c just piror to certifiying - and it needs be better, but 8.3 won't stop the show. If you however want to fly for a few more years, get it down to 7. As the test measures glycosylated hemoglobin and the cells last 90 days, your's will probably equilibrate at 7.5. Do better.
Letter from your Family doc: No Retinopathy, no Coronary disease, neuropathy or kidney disease. Most docs will do a serum creatinine, and dip the urine, to make the latter statement.
Exam and all the info are sent to OK City PO box 26200 Ok City 73125-0080 with your name and dob on each upper right hand corner. SEND CERTIFIED.

After the return receipt is received, give it three days and start calling 405-954-4821 on three nonconsequitive days. You'll get the SI in about four weeks.
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From this, I got the target I need to be getting my A1c down to. And what the family doc needs to confirm. Also the two months grounding.

This was (of course) right inline with the other sites I visited.

So I get what's needed, and will work with the family doc on a good plan for the diet and exercise and make sure the medication is started and doing it's thing.

So all of that for background to this question.

I comprehend the 60-day grounding while you give the medication a chance to work and bring the A1C to the desired point. And I know that until I reach my 60 day anniversary with taking the meds, the AME won't be able to work up my medical. But I don't mind the wait.

While the the grounding aimed at the solo pilot who is diagnosed after they have the certificate, what about someone like me as a student pilot? Since the CFI is there and PIC, am I permitted to train during this 60 day period?

Or am I S-O-L until the 60 days elapse and the family doc is satisfied the meds are working?

It sucks that I just got all of the financials that I worked hard to obtain in order to start the training, only to be tripped up by this. But, sae la vie, and I would rather catch this now and work to get healthy than miss it and become a flying menace to myself and others.

Any and all info is apprecaited.
 
you can take as many lessons as you want while you are waiting for your special issuance. In fact it would probably be good to do so, for your mental health.

sorry to hear about the diabetes but #1 is to take care of yourself. my grandpa is dealing with a load of health problems now because he basically ignored his diabetes for about 15 years.
 
What Tony said. You can fly without a medical as long as you're not a required crew member. For a student pilot that means not solo.

60 days might not be long enough to get your A1c from 12 to under 7. As I understand it it's a measure of the glucose in the red blood cells, so it's like a 90 day history.

Be sure to check your blood glucose regularly, and exercise. Exercise uses different pathways to burn sugars and really helps control this insidious disease.

Joe
 
You can get the student certificate without the medical and even solo as long as the plane your flying meets the LSA standards. As long as your CFI is sub part H, your time will count toward the PPl also. Just don't go to the AME until you are sure you can pass the exam.
 
maddog52 said:
You can get the student certificate without the medical and even solo as long as the plane your flying meets the LSA standards. As long as your CFI is sub part H, your time will count toward the PPl also. Just don't go to the AME until you are sure you can pass the exam.
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I was thinking part 61 not LSA. I guess he would need his Dr's opinion that it's OK.

I'd like to hear Dr. Bruce's opinion on this, but that might be medical advice rather than certification.

Joe
 
Thanks for the info guys.

I might have overstated on the A1c of 12. I'll admit it was a guess since I didn't write it down when the doc and I spoke on the phone. Probably should have. When I was at Walmart picking up the prescription, I spotted a home A1c test and read the box. 12 is the top of the scale. So until I meet with the doc (next Wednesday) I won't know the actual number.

The box did show that between 6 and 7 you've got the glucose level in control.

Prescription is Metformin, 1000mg, take twice daily with food.

Areeda said:
60 days might not be long enough to get your A1c from 12 to under 7. As I understand it it's a measure of the glucose in the red blood cells, so it's like a 90 day history.

Be sure to check your blood glucose regularly, and exercise. Exercise uses different pathways to burn sugars and really helps control this insidious disease.
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You are likely correct that it's gonna take a long time to get the A1c close to 7. But from what I have found on the different boards where Dr. Bruce has commented and the FAA.gov page, it's about proving to the FAA that my levels are being managed well and headed down. Here is a link to the FAA page on the subject. They don't mention a required level. Just that I prove it's being managed and there are no detrimental effects from the medicine or having the disease. It appears that, like any other SI, it's a matter of providing the right documentation that disease or disorder is being controlled properly and the physicians watching over me are satisfied with my progress.

And thanks for advice to check my levels regularly. I did pick up one of the meters aind test strips when I filled the prescription. Plus I did some Googling and found a diabetes education service at a nearby hospital (teaches you more about monitoring and nutrition/exercise). I do plan on asking my doc for the appropriate orders/referral to this group.

tonycondon said:
you can take as many lessons as you want while you are waiting for your special issuance. In fact it would probably be good to do so, for your mental health.
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Thanks Tony, that's good to know. And I agree that it would be a good uplift to spirits to fly and see that I'm making progress. And I do plan on finding an instructor who's good to go under Part 61, for several reasons in addition to what we are discussing here.

So the next step is to start getting regular with the med, begin educating myself on nutrition, up the exercise, and get on board with the doctor's orders.

Thank you for the information and support. I greatly appreciate it.
 
Unregistered said:
Thanks for the info guys.
<snip>

Prescription is Metformin, 1000mg, take twice daily with food.

<snip>
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To help you maximize your available aviation funds you should know that Metformin is available at Walmart on their $4 generic list. No insurance required. Our local grocery store chain, Ingles, sells it for $3. $3 or $4 for 60 tabs is not too bad :smile:

Bruce
 
Gmaper said:
To help you maximize your available aviation funds you should know that Metformin is available at Walmart on their $4 generic list. No insurance required. Our local grocery store chain, Ingles, sells it for $3. $3 or $4 for 60 tabs is not too bad :smile:

Bruce
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Thank you. Walmart is where I filled the script. And you are correct, it was $4.00 even (no sales tax.

What knocked me on my heals on the dollars was the cost of the test strips. The Bayer Contour meter was just $19.00, but the strips were $28 for 25 strips. I've already identified online sources that are half that. In any case, I definitely need to find out about coverage/reimbursement from my insurance.

So now we start day 2. Metformin taken, breakfast was water, Banana, Apple, 1 oz of almonds, and a slice of whole grain wheat toast.

As they say, one day at a time. And to comply with Tony's prescription for metal spirits, I'll try to knock out another chapter of study toward my written tonight.
 
Areeda said:
I was thinking part 61 not LSA. I guess he would need his Dr's opinion that it's OK.

I'd like to hear Dr. Bruce's opinion on this, but that might be medical advice rather than certification.

Joe
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What exactly about a student pilot in an LSA is not covered by part 61? Just trying to make sure the OP knows all his options.
 
maddog52 said:
What exactly about a student pilot in an LSA is not covered by part 61? Just trying to make sure the OP knows all his options.
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My ignorance of LSA is showing, sorry.

I was referring to solo under rules that require a medical.

If he/she flies under self certification, it still doesn't mean "do what you want". Rather it means that he/she and a private physician make the fitness of flight decision.

Joe
 
For the purposes of this thread, my desire is to earn full PPL privileges.

I am aware and have had conversations with the AME about "don't go official on the medical until you're sure of approval" since once denied by OKC, you're locked out of all flying.

The AME (a specialist in "difficult cases" and well liked/recommended in pilot community in these parts) was very understanding and offered to do a consult and review before we commit to paper and filing. So if it turns out to be a no to PPL, we'll still leave the sport pilot window open.

But I'm going to work hard to do what I can to get the PPL. Gives me a real good reason to do right with med and nutrition, and wear out the treads on my sneakers.
 
A type II diabetes on meds SI is not difficult once you get it under control. There are a lot of us.

Don't worry. Do your lessons, follow your doctor's orders and be patient.

Joe
 
Areeda said:
I was thinking part 61 not LSA. I guess he would need his Dr's opinion that it's OK.
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That's correct, but with an HbA1c of 12, and a blood glucose of who-knows-what, you'd have to discuss with your physician the chances of having a diabetic event while flying. As the Federal Air Surgeon said about this situation...
You should consult your private physician to determine whether you have a medical deficiency that would interfere with the safe performance of sport piloting duties. You may exercise sport pilot privileges provided you are in good health, your medical condition is under control, you adhere to your physician’s recommended treatment, and you feel satisfied that you are able to conduct safe flight operations.
...
Certain medical information that may be helpful for pilots can be found in our Pilot Safety Brochures.
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As for the Metformin, the AOPA database says that to be legal to fly with this stuff, you need a diabetes evaluation and status report with no side effects. Also, after reading what it says about Metformin (a generic for Glucophage) at http://www.drugs.com/metformin.html, I don't think you'd want to be PIC even in a LSA while on this stuff until you've been on it long enough to be absolutely sure you're not going to experience any side effects and your condition is so stable you don't have to worry about a high/low blood sugar level developing in flight -- and that may take some time. Note that the FAA thinks there's a big difference between low-grade diabetes controllable with diet and exercise versus when medication and testing several times a day is required for control.
 
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Thank you for your input Ron.

As I said, I was total guessing at an A1c of 12. I did purchase a A1c home test kit today and will see what it says.

As far as glucose levels, when I tested for first time just after taking the Metformin last night (Wednesday) it was pretty high (360). By this evening (Thursday) repeat testing, even with meals, is showing me down to 240 after taking 3 tablets. So I'm headed in the right direction for sure with the medication. (100-150 is the healthy level)

And I totally agree with what you said about not wanting to be PIC of even a paper airplane until my doc is happy that the med plus improved nutrition and exercise has got this beast under control.

And as I said, I'm fully willing to be patient for 60 days (or more) before going official with the AME. Heck, I've waited for more than 40 years... 60 days should be a snap!

(and thank you for the drug fact link... I was going to look this up for myself, but you've provided a good place to get started)
 
Please call your doctor's office and discuss measuring and recording your blood glucose levels.

The number he/she wants to know is the FASTING glucose level, so I take mine in the morning before I eat.

The numbers after eating have some interest but they are very hard to interpret.

Oh and depending somewhat on the test 120 is usually the top of the normal range for fasting glucose levels.

You can do it, but it takes time and EXERCISE (damn it).

Joe
 
Sorry I missed this for so long. Yes, you can do everythign but solo, until you have the SI. Just be aware, that you actually will do BETTER with good control (use your $$s wisely) as your VISION will be better. What happens when the sugar runs high, you actually have a higher "oslmolarity" in your blood (lower concentration of water) and that sucks water out of the vitreous (the gel between the lens and the retina). The refractive properties change, particularly when your A1c is above 9.

I'd also wait until the last reasonable moment to get the A1c drawn. It reflects the moving average of the previous 90 days' control, and will be lower later as your control improves.

9.0 is a showstopper.
8.0 is a grudging SI
7.0 is what it takes.

So the elements are, HbA1c in preceeding 60 days, letter from your doc testifying that you have no neuro, cardiac, renal or ocular manifestations of Diabetes (which is why you want the HbA1c down), and have not had hypoglycemic loss of consciousness.

Warning: go to a good AME. This one can be issued telephonically and you CAN walk out PIC it all the items are in order.
 
Thank you Dr. Bruce for the additional information. Especially the details on the A1c levels. I will also ask for copies of the lab results of this week for my records. This way I have my own copy of the "baseline" to compare future results to.

When I go to my doc this Wednesday, I'll have on my list of discussion items his planned schedule of A1c checks. I will also make sure I clearly communicate my desire to fly so that doc understands my goal and reason for requests to hit 7.0 and write-ups to take to the AME.

And if I need to wait until it's in the 7.0-7.5 range then that's what I will do.

A good "difficult case" AME in my area has been found and contacted for information. His office supplied much the same about the HbA1c and letter from treating doc saying all is working as planned and no bad stuff.

And thank you for confirming the "you can do everything but solo".


A question. You said.
Just be aware, that you actually will do BETTER with good control (use your $$s wisely) as your VISION will be better.
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Was the "use your dollars wisely" speaking to my training dollars? Vision has been okay, especially distance. Drugstore "cheaters" are used for long reading sessions (20 minutes or higher). But I get what you're saying that as control over my diabetes improves, so will vision. And I think you're saying so will my flying skills (especially landings) since that is very much sight based.


Thank you again for the good info (and support) from all. This is helping my spirits for sure.
 
Now that I've just started rolling on medication, exercise (60 minute walk yesterday!) and better diet, is it reasonable to expect a notable drop in the various tests once 60 days have elapsed? At least enough to say treatment is working and I'm headed in the right direction?

Through various sources on the net, I'm finding the normal non-diabetic HbA1c range is 6.0 and below. With the prescribed treatment, is it possible for a Type II to reach that?


(Oh, and I sure mention that now that I've gotten over the shock of this news, I am actually glad the GP Doc caught this now. I was getting ready to head to the AME for my exam in 3 weeks. It would have been a major bummer to be on record for the exam and my urine analysis to come back waving the red flag. Now we can address this, get it under control, THEN make my way to the AME.)
 
Unregistered said:
Through various sources on the net, I'm finding the normal non-diabetic HbA1c range is 6.0 and below. With the prescribed treatment, is it possible for a Type II to reach that?
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Not diabetic myself though all but 3 people over 25 years old on my mom's side have the insulin dependent kind. I won't say it's impossible, but it'll probably take a while to fine tune it down to 6. I've seen some family members get A1c down to 6.7 and 6.3. Just remember that even "normal" people w/ poor diets can get up to 8.

(drift)
I know you've heard it before a thousand times already, but please oh please manage it well. You'd be surprised at how many other conditions from head to toe can arise if not controlled.
 
To give you an idea about how the HbA1c number moves, wasy you're in terrible control with a Hb A1c of 10%.

If you started to suddenly have normal blood sugars (Hb A1c of 5.8) all the time, at 45 days you'd have a value of 7.9. At 60 days, 7.4. At 75 days, 6.5. It's linear.

The % glycosolated hemoglobin (Hb A1c) is stable and retired after about 90 day's service and reflects, in the red cell, the prevalence of sugar at the time the cell was manufactured.
 
Thanks Dr. Bruce...

When I visit with my Doc, I'll pay special attention to any HbA1c testing schedule he proposes. Hopefully it will be something like every 30 days. If at 60 days, I'm running similar to your example, that will make waiting out the 90 days that much simpler in order to have a good value for the AME.

But I'm also encouraged not to try to rush anything. Just like it's not good to rush primary training. I'm ready to take the time necessary to establish and maintain the necessary control and test levels.
 
Unregistered said:
Thank you. Walmart is where I filled the script. And you are correct, it was $4.00 even (no sales tax.

What knocked me on my heals on the dollars was the cost of the test strips. The Bayer Contour meter was just $19.00, but the strips were $28 for 25 strips. I've already identified online sources that are half that. In any case, I definitely need to find out about coverage/reimbursement from my insurance.

So now we start day 2. Metformin taken, breakfast was water, Banana, Apple, 1 oz of almonds, and a slice of whole grain wheat toast.

As they say, one day at a time. And to comply with Tony's prescription for metal spirits, I'll try to knock out another chapter of study toward my written tonight.
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I was in the same boat as you a year ago. My fasting Glucose Level was 240+ and my hBa1c 11.8. I started metformin, and with diet and exercise, I now have my Hba1c down to 5.7 (last lab work).

In the mean time I jumped thorough all of the hoops and got my medical back, and a 6 year authorization. Hang in there, work with you doc, get it the diabetis under control, then get you medical.
 
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