Newly diabetic - what do I need for a 3rd class?

[Newly Diabetic]

A large chunk of my family is diabetic so I suppose the upside is that I've already seen most of the bad outcomes plus what happens when managed properly (though meds & tech have come a long way since the early 90s). About 2 months ago I was diagnosed as diabetic following several high fasting glucose test (~126-150) several weeks apart and an above normal a1c. My last a1c (before treatment) was 7.6. I'd say the pain and fear of a urological issue that has been resolved added to it, but that now feels like a cop out.

I haven't flown or applied for a medical in years for fiscal reasons. I've recently started metformin along with a series of classes and monitoring. My understanding is that it will take another week or 2 for the meds to build up then do its job consistently.

I've searched these forums and the faa site. I guess I need an SI and it has to go through the ACMD the first time followed by an annual renewal. I believe these are the things I need:

1) 2 "good" a1c readings 90 days apart. Last one within 30 days of application.
2) No recent hospitalizations for hypo or hyperglycemia
3) A letter from the doc saying it's controlled and no nerve damage, etc.

The Questions:
1) What is a1c that they are looking for? My WAG is 6.5.
2) Will I need an eye doc visit for the annual renewal?
3) Other than a1c and fasting glucose what reads/test do I need?

Sidenote:
Turns out my liver hates me. I seem to suffer from the "liver dump". Do any of the other diabetics here feel like their liver is holding their body hostage?

 

[RJM62]

< snip >

2) Will I need an eye doc visit for the annual renewal?

I don't know if it's required, but you'd be foolish not to get one. A thorough eye exam can be had for less than a hundred bucks by a good optometrist. My current optometrist gives my eyeballs an examination that rivals the ones the docs in the military did.

Sidenote:
Turns out my liver hates me. I seem to suffer from the "liver dump". Do any of the other diabetics here feel like their liver is holding their body hostage?

Yep. I find that exercise helps a lot, as does munching on peanuts throughout the day. My biggest sugar dumps happen at night, though. My levels are fine all throughout the day, but high in the mornings. But all I have to do is walk a couple of laps around the house, and they fall right in line.

There's a name for this phenomenon, but I forget it offhand...

-Rich

 

[comanchepilot]

The first thing you need to do is SEARCH these forums.

Once you have the easily found information - then ask your questions once you have the answers -

Shorthand? For an easy approval

90 days down min.
A1c under 7
No insulin [this is possible but requires more effort and a CFI involved]
No hypoglycemias [meaning no events where you go down from low blood sugar]
You will need blood tests - but all of those will be revealed in the search. . . as well as certain certifications -

Find yourself a good endocrinologist -

www.aeromedicaldoc.com is your friend forever in this -

 

[AggieMike88]

A1C needs to be in the "well controlled range". 6's are desired, 7's are tolerated, 8's will be issued but with a talking too and warning, 9.0 and higher is right out.

Doctor's letter needs to say:

• Dx'd with Diabetes on _____. A1C reported as being _____ (include lab results with submission)
• Was put on _____ medication (dosage and frequency). Medication is well tolerated and no adverse side effects.
• Exam conducted for following complications, but none found - Neuro (including peripheral nerves), Nephro (kidneys), Cardio, Optho (eyes)

And as Joe said, your grounded for 60 days while medication takes hold and you go back for a fresh A1C to show what improvement the medication achieved.

I've included a template that Dr. Bruce gave me a long time ago.


+1 to working directly with Dr. Bruce Chien (www.aeromedicaldoc.com) including going out to Peoria to get the medical done. Joe did that and walked out of Bruce's office with fresh SI and medical in hand. I chose not to go to Peoria and got deferred to OKC. 7 weeks I sat waiting for the FAA letter. (and I was lucky, reports were going around the average wait was 12-14 weeks. And still is).


Now... if you can be REALLY good with your control, you can avoid the SI and be part of the pre-diabetes crowd. But that requires documentation of an A1C of 6.5 or less, a fasting blood sugar of 125 mg/dl or less, and if you're taking diabetes medication, only metformin is permitted. This is under something started in April of this year known as CACI (Conditions Aviation Medical Examiners Can Issue).

The worksheet for the Diabetes Type 2 CACI can be found at this link

 

[AggieMike88]

The Questions:
1) What is a1c that they are looking for? My WAG is 6.5.

See my reply above

2) Will I need an eye doc visit for the annual renewal?

Only if your primary doc isn't comfortable doing a simple exam looking at your retina. My original doc wasn't happy with doing the status letters or eye exam, so I did go to a lenscrafters old school examiner (no computerized stuff) and asked for an 8500-7 to be filled out. And I "fired" the primary doctor.

New doctor is happy that I have flying as a motivator to keep DM2 in check. And very willing to do all exams and have status letter ready by next day.

3) Other than a1c and fasting glucose what reads/test do I need?

It's not uncommon for you to be put on a statin (like pravastatin) or ACE inhibitor (like lisonpril) as a preventative measure. If your primary doc put you on these meds, they will need to be mentioned.

What was your reported blood pressure? If within the green arc, no worries. But if in yellow arc, some additional stuff is worth getting now to save time.

Sidenote:
Turns out my liver hates me. I seem to suffer from the "liver dump". Do any of the other diabetics here feel like their liver is holding their body hostage?

If you're talking about mornings, this isn't too unusual. The liver is a storehouse of glucose for both emergencies (fight or flight) and to keep you going when you aren't eating (such as sleeping). One way to keep things level is to eat an appropriate snack before bed (something that is lower glycemic, takes a while to digest, and has a healthy balance of protien, fat, fiber, etc). Check with your diabetes educator and/or nutritionist for more help with that.

Sometimes certain foods do better as bedtime snacks. Lately, eating 2 or 3 small dill pickles has seen a noted drop in fingertip mg/dl tests before breakfast.

 

[asgcpa]

I WAS a Type II diabetic and would STRONGLY recommend you email Dr. Bruce Chien bbchien@comcast.net for a consult. Do this before you complete Medxpress and follow his advice prior to doing anything else. He is on vacation now for another week or so. Good luck!

 

[asgcpa]

If you need to discuss my experiences you can PM me.

 

[bbchien]

Oral agent controlled diabetes on metformin is fairly simply special issued. You need:

Letter from the doc saying you have no evidence of Neuropathy, Retinopathy, CV disease, nor nephropathy.

HbA1c less than 8, practically. The statutory denial is 9.0.

Your AME needs to get these together, send them in, call to get approval, and if he's any good can issue it in the office. Annually you repeat, but only every other year, do you examine.

If I've got your post right, you have oral agent controlled diabetes. The part you are citing, is about insulin requiring diabetes. That certification is a BIG deal. I have done 26 of those initial issuances, right out of the office, but it's taken some years to get good at that one.

****

Even better, if on Metformin alone (NOTHING else for glucose control) and you have a HbA1c of 6.5 or less, AND a fasting glucose of 125 or less, the AME can issue you without an SI for two years. This changed on June 8. Most but not all AMEs have gotten the memo.

 

[AggieMike88]

Annually you repeat, but only every _other_ year, do you examine.

Minor edit for the omitted word.

 

[bbchien]

THANKS, Mike.

 

[Newly Diabetic]

Thanks to everyone for clarifying things.

I've decided to postpone a medical and such until mid 2014. My a1c went from 7.6 at diagnosis to 8.1 about 2.5 months after I started taking Metformin. Further more my readings are all over the place more so than before. Seems that it makes my appetite wildly unpredictable from nothing to eat everything. Not to mention the fact that I'm still trying to figure out how to eliminate the "exercise spike" without overeating.

Guess I'll "fix myself" then circle back to the certification stuff.

 

[AggieMike88]

Health first, fly later is always a good way to go.

 

[Also a diabetic]

I WAS a Type II diabetic and would STRONGLY recommend you email Dr. Bruce Chien bbchien@comcast.net for a consult. Do this before you complete Medxpress and follow his advice prior to doing anything else. He is on vacation now for another week or so. Good luck!

WAS a diabetic? I thought once a diabetic always a diabetic, that you could control it to some extent with diet and exercise, but it's not something you overcome.

 

[asgcpa]

WAS a diabetic? I thought once a diabetic always a diabetic, that you could control it to some extent with diet and exercise, but it's not something you overcome.

I had gastric bypass surgery in August 2012. A1C while on insulin and metformin prior to surgery was 8.1. A1C immediately dropped after surgery, to 6.7 30 days later. The doc took me off metformin immediately after surgery and reduced insulin dose ; and was taken totally off insulin 2 weeks later. A1C last blood draw in August 2013 was 5.4.