Diabetes guidelines for flying

[RJM62]

I have Type-2 diabetes that I've managed for years with diet and exercise. Over the past six months or so, however, my glucose control has become less tight. My FBS, postprandial, and A1C levels have been creeping up, with my last A1C at 7.1.

A few days ago I was going to fly a trike with a friend, as I've been seriously thinking about taking it up. It wouldn't be an "official" lesson because he's not a CFI, but I would be doing the flying. But when I took my morning FBS, it was 205. I'd been out with friend the night before, and we stopped at a Chinese noodle house right before I went home. I think the noodles were what did it.

In any case, 205 is way high compared to my average, but even the average has been creeping up around the 140 neighborhood. I tested again half an hour later, and it was at 200. I canceled the flight. Subsequent tests throughout the day were lower each time, and steadied at around 140 by nighttime. Since then, my morning FBS has hovered in the 140 neighborhood -- still too high, I know. But not so high that my doctor insists that I go on medication.

Rather, my doc gave me one month to shed some more pounds and do some more exercise to try to reign in the glucose. If I can't, then he's putting me on metformin. It's not the end of the world, I know. But the doc and I agree that diet and exercise is the better way to go as long as I can do it.

Now here's my question:

The problem I have is that I feel fine. I don't feel any different when my numbers are high. No drowsiness, no dizziness, no excessive peeing... nothing.

So... what do I base my go / no-go decision upon?

The other day, when I tested 205, I just said to myself, "That's too high," and grounded myself. But I had no real basis for that other than that, well, it seemed too high.

I fly under the SP rule, and my doc's not a pilot (nor an AME). He told me that if my levels are more than 20 or so points more than what I expected (or if they are abnormally low), or if I'm feeling any symptoms at all, I should self-ground. Fine, but I'm wondering if any of the docs here can offer anything more specific.

Thanks in advance,

-Rich

 

[TMetzinger]

You've described the reason this disease is so insidious - many people can have NO symptoms at all even while diabetes is causing damage to their bodies.

My mom didn't know she had a problem until she lost her vision - while she was driving. It was gradual enough that she pulled over safely, but could have been worse. And her vision came back.

I think you did the right thing being conservative. And I get the impression that as we age we are more likely to need the aid of medication - my grandfather and mom both were on meds by their late 60s but Grandpa died at 99 due to an infection after a colostomy, and Mom is doing fine in her 70s.

So - to repeat advice others have given on the subject - do what you have to to manage the disease. Don't be a "no medicines" hero if meds will make you healthier. The FAA Air Surgeon is fine with oral medications and has in my opinion really turned the attitude around to help people find ways to keep flying.

Best wishes,

 

[RJM62]

You've described the reason this disease is so insidious - many people can have NO symptoms at all even while diabetes is causing damage to their bodies.

My mom didn't know she had a problem until she lost her vision - while she was driving. It was gradual enough that she pulled over safely, but could have been worse. And her vision came back.

I think you did the right thing being conservative. And I get the impression that as we age we are more likely to need the aid of medication - my grandfather and mom both were on meds by their late 60s but Grandpa died at 99 due to an infection after a colostomy, and Mom is doing fine in her 70s.

So - to repeat advice others have given on the subject - do what you have to to manage the disease. Don't be a "no medicines" hero if meds will make you healthier. The FAA Air Surgeon is fine with oral medications and has in my opinion really turned the attitude around to help people find ways to keep flying.

Best wishes,

Thanks, Tim.

My reasons for wanting to delay the meds have nothing to do with flying, actually. It's that my doc and everything I've read about the subject since I was diagnosed seem to agree that diet and exercise are the preferred treatment, as long as they remain effective. But my doc tells me that an A1c of 7.0 is the threshold above which he believes medication is necessary, because the benefits of medical intervention below 7.0 are less certain.

In any case, he wants my FBS readings to be consistently in the 120 - 130 range within 30 days, and my next A1C to be below 7.0. He believes that if I lose more weight (which is very hard to do since I quit smoking last year), I can delay the need for medications for possibly several more years, which is what he thinks is the best course of action. But failing that, he'll be putting me on metformin, which will ground me until it's clear that I'm stable on the meds. So be it. Health comes first.

-Rich

 

[AggieMike88]

For some encouraging action and results, head over to the AOPA Red Board and read the posts by ComanchePilot.

He got nailed with DM2 in May of this year but got really serious about gaining and keeping control. It's a real success story worth reading.

 

[bbchien]

We got Comanche Pilot re-certified just 64 days after he started the meds. He was super-serious.

 

[AggieMike88]

He still is. And a good role model for the rest of us.

 

[RJM62]

Thanks for the encouragement.

I've been more conscientiously following my diet and exercising more, and the numbers have been looking better. FBS was 142 this morning, postprandials have been in the 130 - 150 neighborhood.

I also bought a new meter and calibrated it. The one I had got mediocre reviews for accuracy from Consumer Reports, so I bought a better-rated one and calibrated it. The numbers were about the same, but the strips are about half the price, so it was a good purchase anyway.

Going on the medications doesn't scare me. I have a family history of diabetes 2 on both sides, so I figure it's kind of inevitable that I'll be going on medication at some point.

But I also know that I am still overweight, despite having lost quite a bit over the past few years; and I know that I'd been slacking off on the diet and exercise recently. I had pretty tight control for quite a while when I was doing all the right things, but the truth is I got lazy.

One thing that I noticed that struck me as odd: If I take my FBS the moment I wake up, it's a lot higher than it will be half an hour later. One day last week, for example, it was 185 when I rolled out of bed, but 150 half an hour later. The next day, it was 170 immediately upon prying my eyes open, and 145 half an hour later.

I haven't had the opportunity to ask the doc about that peculiarity yet, but I wonder if it has something to do with the cup of coffee in the morning. Caffeine stimulates insulin production, someone told me. I guess I should wait half an hour before having the coffee, and test again without the caffeine.

Or possibly my late-night snacking (nuts, cheese, etc.) is a bit too much or a bit too close to bed time.

In any case, thanks again for the input and encouragement. I do appreciate it.

-Rich

 

[AggieMike88]

When I went in for my DM2 education course, they explained the morning phenomenon as your liver dumping a store of glucose into your bloodstream to assist with getting you moving in the morning. Since it's been 10 to 12 hours since the prior meal, your system feels like a large bolus is needed.

The dietician suggested a small, simple snack before retiring for the night can help reduce the spike. One graham cracker square with a small spoon of peanut butter was one example.

Try cutting your snack size smaller.

And realize why you have the crave to snack after the main meal. For me, it's to have something sweetish. But 2 pieces of Eclipse sugar free gum has served to solve that.

 

[RJM62]

When I went in for my DM2 education course, they explained the morning phenomenon as your liver dumping a store of glucose into your bloodstream to assist with getting you moving in the morning. Since it's been 10 to 12 hours since the prior meal, your system feels like a large bolus is needed.

The dietician suggested a small, simple snack before retiring for the night can help reduce the spike. One graham cracker square with a small spoon of peanut butter was one example.

Try cutting your snack size smaller.

And realize why you have the crave to snack after the main meal. For me, it's to have something sweetish. But 2 pieces of Eclipse sugar free gum has served to solve that.

Thanks. That's very helpful. I don't recall that having been explained in the course, nor have I noticed it before, but it does make sense.

I think I need to either take another class or consult with a dietitian. The class I took was a one-day thing on a Saturday, and there's only so much you can cover in a day.

Thanks again,

Rich

 

[AggieMike88]

Do keep sugar free gum handy, especially something with a strong flavor that you enjoy.

I don't know the mechanism of it, but I get occasional urges to eat something, but I'm not hungry. This led to uncontrolled snacking and those problems.

Now, the taste of the gum, plus the chewing motion somehow satisfies the craving. And 10 calories for 2 bits of gum is waaaaayyyy better than 300+ calories for stuff I didn't need to eat.


Another angle I'm trying to reduce calorie intake across the mid day is to not take an eating lunch per se (I still take a break, but take a walk versus eat) is to make a lunch out of 1.5 oz (by weight) of plain Cheerios and a medim banana, no milk. Focus on eating it over an hour's time. Fills me up, makes me feel like I'm finger fooding, and it's just 256 cal; 2g fat; 48 net carbs; 5g protien. The protien is a bit low so I'm investigating a partial serving of one of the powder suppliment drinks (think Met-Rx) for that.


My own experimentation is showing that I can do well on reduced calorie (say 1500-1800) diet. I feel okay and if I'm excercising, I don't have the ups and downs with energy and mood. Just keep working with portion control, multiple small feedings during day versus 2 or 3 massive ones, and try to add 5 more minutes to each excercise period.

This weekend I'm going to get a copy of something that describes the Mediterranean diet. Several pilots over on the Red Board have stated success with that program.

Additional motivation: The less of you, the more useful load in your aircraft for fuel or another travelling companion!

 

[RJM62]

Do keep sugar free gum handy, especially something with a strong flavor that you enjoy.

I don't know the mechanism of it, but I get occasional urges to eat something, but I'm not hungry. This led to uncontrolled snacking and those problems.

Now, the taste of the gum, plus the chewing motion somehow satisfies the craving. And 10 calories for 2 bits of gum is waaaaayyyy better than 300+ calories for stuff I didn't need to eat.


Another angle I'm trying to reduce calorie intake across the mid day is to not take an eating lunch per se (I still take a break, but take a walk versus eat) is to make a lunch out of 1.5 oz (by weight) of plain Cheerios and a medim banana, no milk. Focus on eating it over an hour's time. Fills me up, makes me feel like I'm finger fooding, and it's just 256 cal; 2g fat; 48 net carbs; 5g protien. The protien is a bit low so I'm investigating a partial serving of one of the powder suppliment drinks (think Met-Rx) for that.


My own experimentation is showing that I can do well on reduced calorie (say 1500-1800) diet. I feel okay and if I'm excercising, I don't have the ups and downs with energy and mood. Just keep working with portion control, multiple small feedings during day versus 2 or 3 massive ones, and try to add 5 more minutes to each excercise period.

This weekend I'm going to get a copy of something that describes the Mediterranean diet. Several pilots over on the Red Board have stated success with that program.

Additional motivation: The less of you, the more useful load in your aircraft for fuel or another travelling companion!

Roger that, especially in LSA.

Oddly enough, I've never cared for sweets. Even as a kid, I never particularly liked candy. You'd more likely find me munching on hot cherry peppers than a Snickers bar. I started drinking my coffee black, with no sugar, when I was about 12, and I still do. So avoiding sugar (as in actual sugar) is the easy part of this for me.

But it's kind of strange the way my body reacts to various foods. I love bread and pasta, but I can only handle them if they're whole grain and I don't go overboard. I also like mashed potatoes and white rice, but either of them will raise my glucose astronomically, so I have to avoid them. Brown rice hardly affects my glucose at all, though. Oddest of all, ice cream doesn't seem to affect it very much. I avoid it anyway, but mainly for weight reasons.

I've never been much of a gum chewer, although I do chew Nicorettes since I quit smoking... maybe it's time to wean myself off those, as well, and try ordinary sugarless gum.

Thanks again,

Rich