Newly diabetic - what's next

[Longtime POA New Diabetic]

This year has been full of surprises, but this was not one I expected at all.

Long story short, I was injured last month and require surgery to repair. That alone will have me grounded for the next few months, ok no big deal. I only fly recreationally at the moment, although have operated commercially in the past and hoped to do so again in the future.

In the pre-op physical, we discovered my blood sugar and A1C were very high, unbeknownst to me. Yeah I could stand to lose a few pounds, but am an active guy and was not experiencing any symptoms at the time. Surgery has been postponed while we work to get this under control. I immediately cut out carbs and sugars and adopted a suitable diet and was started on metformin. The doctors also want me on Ozempic, but not until after surgery. Exercise is difficult at this time due to the injury, but I also can't stand sitting around so I am moving best I can. In just three weeks I've dropped my blood sugar into the 150s and A1C almost 2 full points. I know I will forever be tagged as a Type 2 Diabetic for life, but feel fully confident I can manage it with diet alone eventually.

My question is in regards to flying and my medical. I have two years left on my current 3rd class medical. I do wish to be able to potentially go back to a 1st or 2nd Class medical to resume commercial flying in the future.

What actions, if any, do I need to take prior to my next medical?

What records will I need ultimately need to show the FAA?

 

[Brad W]

I know I will forever be tagged as a Type 2 Diabetic for life,

I can't answer your direct FAA related questions and concerns, but I'm sure those that can will be a long shortly

I don't know you, but I'm convinced that you can too! I even believe that you can reverse it!!!

I'm not sure if I've watched this particular video or not... it's juts a random example I found in a google search
but I know that I've read and watched many accounts like this. It doesn't necessarily have to be "forever".
I went on a deep-dive about 3-1/2 years ago into metabolic health and went carnivore. I was chasing it for other reasons (GERD), but I was broaching into what they are calling "pre-diabtes" these days.... My dad was type 2 and he was never the best about managing his diet...so that was also a lens that I was looking through when I was reading all of those medical journal studies, listening to lectures by MD's and college professors, reading books, and all the rest.
Anyway, I'm convinced that traditional Western medicine did my dad no favors....

 

[AvNavCom]

If you control it by diet:

"Applicants with a diagnosis of diabetes mellitus controlled by diet alone are considered eligible for all classes of medical certificates under the medical standards, provided they have no evidence of associated disqualifying cardiovascular, neurological, renal, or ophthalmological disease. Specialized examinations need not be performed unless indicated by history or clinical findings."

If you require meds for sustained control, it will be an SI. Full information linked here.

As always, a consult with an AME is advisable once your PCM says you're stable, to ensure you get the right stuff done for your particular situation.

 

[bbchien]

What happens next depends on what your HbA1c actually was. Since you didn't say, I can't help much.
Above 9.0 and there is no doc on the planet who is going to let you try to control by diet alone.
At 8.0 you still have some non pharma options. But anyone taking the position that at 9.0 you can do it by diet and exercise...well the State Board of Medicine is going to be interested in you.....

Remember, when you do get it under control you CAN get off the meds....

 

[murphey]

I've kept my A1C between 6.2 and 6.4 for the past many years on low dose Metformin and no longer binging on pints of Ben & Jerry's. I've substantially limited carbs but not eliminated them. A couch potato is more active than I am. (I had to tell my now-former Dr that I was diabetic - he never once tested A1C despite knowing I had family history). I could bring it down by more exercise and diet changes but as my current Dr points out, my numbers have remained rock solid steady for over 10 years, so he's not worried.

 

[Lachlan]

In just three weeks I've dropped my blood sugar into the 150s and A1C almost 2 full points. I know I will forever be tagged as a Type 2 Diabetic for life, but feel fully confident I can manage it with diet alone eventually.

By lowering your A1c 2% in three weeks, you'll be tagged as something else besides only a T2D. That's just not a reasonable timeframe for a 2% change.

 

[Kenny Phillips]

By lowering your A1c 2% in three weeks, you'll be tagged as something else besides only a T2D. That's just not a reasonable timeframe for a 2% change.

Yeah, something is up; I made a drastic change in diet and exercise, and dropped mine about one point in three months, and blood sugar to just over 100, and my doctor was quite pleased.

 

[bbchien]

...which is because the HbA1c (% of glycosylated hemoglobin) is created at the time the red cell is manufactured and reflects the blood glucose as the newly created red cell leaves the bone marrow. The red cell lasts in the circulation about 90 days.....

 

[Mark K]

One possibility for the discrepancy is if you are using a CGM, like a freestyle libre. It will report out an "eA1c," which is like an A1c, but not exactly. As Doc Bruce noted, a traditional A1c averages 3 months of readings. The continuous glucose monitor will give you an estimated A1c, but it's based on the data you have. If you've only been wearing the meter for two weeks, then it only has 2 weeks of data to estimate an A1c. So you get a traditional blood test and say, it's 9%, you get religion, aggressively modify your diet and lifestyle, slap a CGM on, and it can spit out an eA1c of 7% after 2,3, or 4 weeks.

As noted, it is not physiologically possible to drop your standard blood drawn A1c 2% in 2 weeks. (Well, maybe...The highest I've seen in practice was around 16% at discovery, IIRC. You put that person on insulin and maybe, if you checked after 2 weeks, you might see that drop. Hard to exactly say. Please don't be that patient...)

Also, I know there is a thread of, "meds are bad, do it with lifestyle if you're a real man" here. But, it's not really the right way of looking at it. High sugars are toxic to the pancreas, and it creates a vicious circle where those high sugars provide negative feedback impairing the ability of the pancreas to naturally control the pancreas.

So you want to do everything possible to lower your sugars in a prompt fashion. Which means meaningful lifestyle change-increased physical activity, and proper nutrition. Which for most folks is calorie restriction as well as modification of the type of calories. And a medication simultaneously, like metformin or a glp1 like Monjauro or Ozempic.

From 25 years of clinical practice, I no longer recommend "just do diet and lifestyle," for most patients except in very motivated patients just barely meeting criteria for dm2 who are philosophically opposed to meds.

The problem isn't that I want to "push medicines." Rather, in any given set of 100 people I diagnose with DM2, despite my encouragement, advice, referral for nutritional support, lifestyle coaching, 90% will come back in follow up 10 pounds heavier and telling me their exercise is something like, "I walk at work." You know, their sedentary office job work...Sigh. They have all sorts of reasons why they are not doing the things they had to do...

So I know that non medicine recommendations will delay control of the sugars in 90% of patients. If a patient proves my stats wrong, yeah, sure they can taper down on the meds if they want. It may not work, but they can try... I have had folks with DM2 successfully go into a remission with normalized A1c's for years. But this is uncommon and takes a high degree of motivation and behavior change.

PS all of this pertains to type 2 DM, and is only general medical advice, see your doctor, yada, yada, standard disclaimer about this not being specific medical advice...

 

[Brad W]

The red cell lasts in the circulation about 90 days.....

a traditional A1c averages 3 months of readings

red cells could live less than 90 days, or even significantly more than 90 days, right?

it is not physiologically possible to drop your standard blood drawn A1c 2% in 2 weeks.

Is there a scenario where the lifespan for a red cell is significantly less than 90 days? and couldn't that lead to a much faster than normal change/improvement in A1C over time? (I'm not implying that this would be good, just asking if it's possible)

and if this is the case, where would that show up in the typical lab panels?

 

[Brad W]

oh, and I don't believe the OP said that his A1C dropped 2%....just skimming it, looks like he wrote 2 points....

 

[bbchien]

red cells could live less than 90 days, or even significantly more than 90 days, right?


Is there a scenario where the lifespan for a red cell is significantly less than 90 days? and couldn't that lead to a much faster than normal change/improvement in A1C over time? (I'm not implying that this would be good, just asking if it's possible)

and if this is the case, where would that show up in the typical lab panels?

You'd have to do a hemolysis workup- lots expensive tests. The cell life is shorter in thallesemia minor, however, and in sickle cell disease.
B

 

[Mark K]

Hi Brad,
Yes, you're right there are odd scenarios where you can actually get a drop in A1c. For example, you get a blood transfusion. Those transfused cells will have normal amounts of sugar stuck to them, and you would get an artificially low reading. Or, you can have a disorder of increased destruction of red blood cells, such as a hemolytic anemia. So yes, it's possible, but there would have to be some unusual explanation.

 

[Longtime POA New Diabetic]

Sorry for the delay getting back on this thread, I was having trouble replying on my cell phone and had to get to my computer.

FWIW, I have been a long time member of POA, many of you may know me but I am posting anonymously because I'm just not sure about announcing this prognosis to the world yet. Only my doctors and immediate family know.

I will try to respond to the various questions that were posed.

At my initial lab, my glucose was 520, and my A1C was 12.0. Again I had no symptoms and was caught quite off guard, as was the doctor, although I do have family history of diabetes so the risk factor was there.

I was immediately started on 500mg metformin twice a day, which a week later was doubled after I transitioned to a diabetic clinic. The immediate goal is getting things under control to have surgery. I am not trying to do this on diet alone and accept medication is necessary, although my long term goal is to get things under control with diet and lifestyle changes, which my doctor thinks is entirely possible.

Here I am three weeks later, I am monitoring my glucose 5-6 times a day (finger prick, not CGM), strategically before and after meals, and am averaging 130-140 throughout the day. I just had another A1C run this afternoon and it was 10.3, so yes a reduction of 1.7 in three weeks.

Diet wise, many years ago I adopted the Keto diet and strictly adhered to it for several years, losing about 60 lbs in the process. I have strayed from strict Keto over the last several years, although did retain a few of the habits. I regained a little weight, but not much and honestly thought I was healthy at that. I have returned to a very low carb diet since the very day of my first lab work, which I credit to getting my glucose number better under control in combination with the metformin. The first week my numbers were in the 200s, the next week 150-200, this week 130-140.

If there are other questions I missed, please let me know.

My questions remain though, where does this leave me in regards to flying and my medical currently? I am self grounded due to my injury and will be for the next several months, so no big rush to get back in the air. Also do I need to do anything regarding my med and the FAA prior to my next medical? And what should I expect at my next medical?

Thank you my friends for your responses.

 

[Mark K]

Well, since you are newly DM2 and on meds, you're grounded and will need an SI. See here below what you need. 12 to 10.3 in three weeks is really good. The guide notes 9% as an initial goal, but for most folks you want this significantly lower To see the full effect you should check 3 months from the initial diagnosis.

So you have to demonstrate A1c control, a review from your doctor that there are no other complications-get eye exam updated and let your eye care practitioner you are newly diabetic and to look for evidence of any diabetes related eye changes. Your doc will also likely order some blood and urine kidney tests to screen for early kidney damage. And then you need a good exam/progress report noting no evidence of neuropathy or cardiovascular issues. I'll defer to Dr. Chien on the actual details of the package you want to present to your AME.

DM2 is eminently treatable but it does require commitment and lifestyle change, and, sometimes the acceptance that long term medications will be necessary. In some folks the pancreas can regain enough function that one will not need meds, but in many folks, the damage to the pancreas is done. Even the best lifestyle will not bring a pancreatic Lazarus from the dead, so to speak. Also, using meds may take some of the stress off the pancreas over the long term, actually preserving pancreatic function, thereby reducing or delaying your long term chance of needing insulin.

https://www.faa.gov/ame_guide/dec_cons/disease_prot/diabetes_med

 

[Brad W]

If you're going to eventually try to get low carb...like seriously low, I'd suggest a book written by that doctor in the youtube video I linked earlier (Ketocontinuum) There were a few good points in it that I wish that I'd known when I did the transition to "10g or fewer carbs per day". The so-called "keto flu", GI issues, etc... I believe that had I'd known some of what she teaches it would have gone a lot smoother for me.

 

[Lindberg]

Diet wise, many years ago I adopted the Keto diet and strictly adhered to it for several years, losing about 60 lbs in the process. I have strayed from strict Keto over the last several years, although did retain a few of the habits. I regained a little weight, but not much and honestly thought I was healthy at that. I have returned to a very low carb diet since the very day of my first lab work, which I credit to getting my glucose number better under control in combination with the metformin. The first week my numbers were in the 200s, the next week 150-200, this week 130-140.

Since you're anon, do you mind quantifying "a little weight"? Personally, I was very unpleasantly surprised at the large difference going from a 23.5 BMI to a 24.7 BMI* (less than 10# in my case) made to all my results. As someone with an a1c that's genetically a little higher than I like, I do worry about the tipping point.

* Nevermind the standalone value of BMI, it's a useful metric for comparison.

 

[ETN Flyer]

I'm a 4 yr T2 diabetic (46yo), discovered during routine physical with A1c of about 14.0 at the time, no real symptoms other than feeling exhausted. The GP immediately put me on a 2-week insulin regiment and referred me to his diabetic PAs. First appointment, insulin brought fasting sugar down to acceptable non-insulin range and PA prescribed her typical cocktail of oral meds, with a stern 'lose weight' look in her eye. Fast forward through the next 12-18 months of seeing her every 3 and A1c stayed about 7-8, not ideal and she keeps saying diet and exercise. My wife finally pushed me to see an endocrinologist. First appointment with the endo, she laughs at my prescription list and says, "I haven't prescribed these in 10 years!" This isn't ancient history guys, it was 1/1/24. She totally changes my orals, adds Mounjaro and I'm now 6.2-6.3 A1c every 6 months, lost 50 lbs, feel amazing, can get exercise now, and got my 2nd class SI issued in March of this year. The SI requirement is a single page worksheet completed by my endocrinologist at every 6 mo check-in and handed to my AME every year, truly easy-peasy (google FAA diabetic worksheet). The initial review was about 90 days from exam to OKC approval. Biggest word of advice is to SEE AN ENDOCRINOLOGIST! The PA that I was assigned by my GP was only required 40 hours of continuing education per year to add 'diabetic specialist' to her certifications and it showed (not throwing stones at any PAs, just my state's requirement). I did tons of research to get all my paperwork in order for the AME, along with an email to Dr. B (Thanks Dr. B!!!). Happy to answer any questions you may have, feel free to PM me!

 

[4RNB]

DM is such a devastating problem that thread drift is acceptable to me. Flying comes second, I'd consult an AME as many people suggest for many problems.
Yes- see the specialist! It is so important it drew a wallflower into forum participation!

I've never heard that DM was "toxic" to a pancreas, though it sure is related. The big impact long term is the microvascular changes. I don't know the physiology, just the effect. Blindness-perhaps from hemorrhage, which can be fixed if you are properly tied into the system with good DM and vision care. Kidney failure and the need to be connected to a machine every night or 3x week-overall a faster treadmill to being buried. Heart. Feet-perhaps you only lose a few inches at a time (because doctors get paid for doing stuff) before your knees are finally gone and your wounds take forever to heal. Your virility robbed... Hypertension always seemed to be a comorbidity also.

With your pre diagnosis numbers, my money is betting you had symptoms but were not aware.

Your 130-140 averages are better but they are not good. <120 is normal.

If it happened to me I'd be on the diet and exercise man up bandwagon.

 

[Longtime POA New Diabetic]

Well, since you are newly DM2 and on meds, you're grounded and will need an SI. See here below what you need. 12 to 10.3 in three weeks is really good. The guide notes 9% as an initial goal, but for most folks you want this significantly lower To see the full effect you should check 3 months from the initial diagnosis.

So you have to demonstrate A1c control, a review from your doctor that there are no other complications-get eye exam updated and let your eye care practitioner you are newly diabetic and to look for evidence of any diabetes related eye changes. Your doc will also likely order some blood and urine kidney tests to screen for early kidney damage. And then you need a good exam/progress report noting no evidence of neuropathy or cardiovascular issues. I'll defer to Dr. Chien on the actual details of the package you want to present to your AME.

DM2 is eminently treatable but it does require commitment and lifestyle change, and, sometimes the acceptance that long term medications will be necessary. In some folks the pancreas can regain enough function that one will not need meds, but in many folks, the damage to the pancreas is done. Even the best lifestyle will not bring a pancreatic Lazarus from the dead, so to speak. Also, using meds may take some of the stress off the pancreas over the long term, actually preserving pancreatic function, thereby reducing or delaying your long term chance of needing insulin.

https://www.faa.gov/ame_guide/dec_cons/disease_prot/diabetes_med

Thank you Mark! That is exactly the information I was looking for.

I feel like I am being seen by every doctor under the sun lately. GP, Endocrinologist, Ophthalmologist, Orthopedic, nutritionist, etc.

So far other than the high glucose and high A1C, no other complications found so far. The eye doctor said she was actually surprised, given my A1C, that there was zero sign of any issues. I've worn glasses most of my adult life and my prescription has barely changed from what its been for the last 5 years. All other labs have come back just fine. They have done tests for nerve damage on my feet and hands and found no evidence of issue there either.

An A1C of 12 corresponds to an average glucose of 298, still way too high, but much lower than the 500 we initially found. One hypothesis is the 500 was a recent spike likely pushed higher due to my injury, being laid up, and the steroids and pain medication they gave me which all list increased blood glucose as a potential side effect. More than one doctor has said the injury may have been a god send. The diabetes may have been caught before any serious long term damage has been done beyond the T2D diagnosis. Now it is just to managing and monitoring my T2D and learning to live with it.

For what its worth, my BS today has been around 120 nearly all day. Yes still elevated above normal, but given where it came from just a few weeks ago, good progress.

Since you're anon, do you mind quantifying "a little weight"? Personally, I was very unpleasantly surprised at the large difference going from a 23.5 BMI to a 24.7 BMI* (less than 10# in my case) made to all my results. As someone with an a1c that's genetically a little higher than I like, I do worry about the tipping point.

* Nevermind the standalone value of BMI, it's a useful metric for comparison.

At my heaviest, probably about 10-12 years ago, I was 235 lbs. After a year or more of Keto, I was down to 170, my high school weight. At just under 6' tall, that is about as normal as I get for my build. Since dropping off of Keto about 5 years ago, my weight has slowly crept back up to around 200. I guess I was in denial, but I convinced myself that 200 was still way better than 235, and I was maintaining it pretty easily, my waist size was stable at 34 inches, and I was otherwise healthy and able to do everything I wanted to. This diagnosis has certainly been a wake up call, unfortunately maybe just a little too late.

Thank you again everyone for your responses. I'll admit my 2026 has been a bit heavy. Since January 1 I've dealt with moving, trying to help my elderly parents through several crisis of their own, three completely unrelated injuries, two ER visits, an upcoming surgery, and this T2D diagnosis. I never even set a goal for flying yet this year, but it might be just to go look at the airplane at some point. Fortunately my partner in the plane is keeping the dust off of it.

 

[Lindberg]

Thank you again everyone for your responses. I'll admit my 2026 has been a bit heavy. Since January 1 I've dealt with moving, trying to help my elderly parents through several crisis of their own, three completely unrelated injuries, two ER visits, an upcoming surgery, and this T2D diagnosis.

If you haven't already, you might want to look into the link between stress and type 2 diabetes. It is significant. And a big component of it is corticosteroid levels.

 

[Longtime POA New Diabetic]

Thought I would post an update on my situation.

I did manage to have the surgery to repair my injury and am well on the mend. Probably another 6-8 weeks I could start thinking about flying again. I'll be honest, I'm still unsure how to go about starting that process even though I have the FAA link above. Part of this is selecting a new AME, mine retired! I did visit the ophthalmologist and had a clean bill of health, and have a quarterly follow up with the endocrinologist next month. I am curious to find out my A1C at that appointment.

As far as the diabetes goes, I am maintaining an average glucose of between 100-120 with low carb diet and medication (Metformin and Ozempic). In the two months since diagnosis I've lost about 20 lbs. I hope to lose another 20 and get my average glucose under 100, and keep both there.

 

[Half Fast]

Probably another 6-8 weeks I could start thinking about flying again. I'll be honest, I'm still unsure how to go about starting that process even though I have the FAA link above.

Well, given what you wrote,.....

I only fly recreationally at the moment, although have operated commercially in the past and hoped to do so again in the future.

I have two years left on my current 3rd class medical. I do wish to be able to potentially go back to a 1st or 2nd Class medical to resume commercial flying in the future.

In the near term, if you only want to fly recreationally and if you're willing to put off commercial flying for a while, Basic Med would seem to be an option. Diabetes is not one of the conditions that requires a one-time SI prior to Basic Med. If your doctors are okay with it, that would let you get back in the air while you sort out a path back to a class 1 or 2 medical.

 

[lsaway]

I am curious to find out my A1C at that appointment.

If you don't want to wait until your next appointment, I use a lab service that cost $14.80 for A1c. It is available in the USA but excluding MA, MD, NJ, NY, RI. You don't need to get your own doctor's order because they include the order. You just go to any Labcorp location for the blood draw and you get the results the next day. The results are FYI because there is no insurance billing codes & they don't send them to your doctor where they get into your medical records. www.ownyourlabs. com

 

[Longtime POA New Diabetic]

Well, given what you wrote,.....

In the near term, if you only want to fly recreationally and if you're willing to put off commercial flying for a while, Basic Med would seem to be an option. Diabetes is not one of the conditions that requires a one-time SI prior to Basic Med. If your doctors are okay with it, that would let you get back in the air while you sort out a path back to a class 1 or 2 medical.

Is that right? I didn't think Basic Med was an option for me at this particular point! I will have to look into it.

That is why I love this forum and have been a member for so long!

 

[Half Fast]

Is that right? I didn't think Basic Med was an option for me at this particular point! I will have to look into it.

That is why I love this forum and have been a member for so long!

You said you have two years left on your medical, so I assume it's never been revoked. Here's the list of conditions that require a one-time SI prior to Basic Med:

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

• A mental health disorder, limited to an established medical history or clinical diagnosis of—
  • A psychosis, defined as a case in which an individual —
  • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
  • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
• A bipolar disorder; or
• A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations
• A neurological disorder, limited to an established medical history or clinical diagnosis of any of the following:
• Epilepsy;
• Disturbance of consciousness without satisfactory medical explanation of the cause; or
• A transient loss of control of nervous system functions without satisfactory medical explanation of the cause.
• A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
• Myocardial infarction;
• Coronary heart disease that has required treatment;
• Cardiac valve replacement; or
• Heart replacement.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Diabetes ain't nowhere on that list! Approving you for Basic Med is up to the physician's judgement, and of course you have to ground yourself if you know you can't fly safely. If you and your docs consider your condition well controlled and decide you're safe to fly, then Basic is available to you.

If you still want to go back to a Class 1 or 2, it's going to take some time and consultations with an AME and some data gathering, maybe some testing or monitoring, to get you there. You could be flying on Basic while you do all that. Just don't submit anything to the FAA that could result in your medical being revoked or a new application being denied. Get all your ducks in a row first.

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med

 

[FrequentPilot]

Disclaimer: This is not medical advice. This is a casual conversation.

We would need to know your A1C (since that's the 3 month snapshot) before saying anything concrete. Based on what you said, was your previous A1C 9.2? Is your current A1C 7.2? Like Dr. Chien, I can only speak theoretically, given the information available.

Prediabetes (A1C of 5.7-6.4) is typically reversable with diet and exercise alone. Diabetes can also be reversed with diet and exercise to an extent as well, but the higher the number, the lower the likelihood as it becomes very difficult to do so. The likelihood also depends on other factors like smoking history, obesity, etc.

Theoretically, if your A1C is really high, you could either ignore your doctor's advice or find some quack who tells you to just manage it with diet and exercise. However, in this case, your AME will likely ask about your current A1C. Regardless of class, if your A1C is high and you don't take medication to control it, your AME will likely feel uncomfortable issuing you a license and defer you. Then the FAA denies your application because your diabetes is too uncontrolled and you could lose consciousness or develop a serious symptom in flight and kill somebody. This is the FAA's way of saying "take your meds!" All of this can be avoided, by simply starting the medication in conjunction with a good diet and exercise. Regardless of whether, you're in remission or not by your next FAA exam, if you're taking medication and your A1C is under control and you can prove that to your AME, the AME will likely be willing to grant you a medical (assuming that you recover from your surgery without complications). In this case, I don't think the FAA will ever bother you or request anything from you. Your AME will likely continue asking you to check your A1C to prevent relapses.

The FAA has a sheet that contains the observation times for each class of diabetes drugs, I encourage you to look it up. Unsurprisingly, Metformin is the MVP, I'm not sure why Ozempic is your doc's first choice, unless obesity is a factor in this case.

In closing, if you really went from an A1C of 9.2 to 7.2 with just diet and exercise alone, that's really impressive. Mediations may be avoidable if you're at 7.2 and continuing to go down, but keep in mind that a glucose of 150+ is still diabetes. Albeit this considered well-controlled diabetes, but this would likely necessitate medication if that number stops dropping. For now, focus on staying healthy, keeping that A1C in check by dieting, exercising, monitoring your daily glucose, and starting to take medication if needed, and enjoying life!

 

[4RNB]

CGM?

 

[midwestpa24]

I have decided to go ahead and post under my usual screenname. I am Longtime POA New Diabetic.

I had my three month check-up with the endocrinologist this morning and it went well. My A1C this morning was 5.2 (down from 12.0 at initial finding). I've also lost about 30 pounds in the last three months through diet, exercise, and medications (Metformin and Ozempic). My doctor has directed me to drop the Metformin and dial the Ozempic back to the minimum dose.

Doctor also filled out and signed the FAA's Diabetes or Hyperglycemia on Medications Status Report.

I have intended to go BasicMed for now, but have had trouble finding a doc in the area to do it. I'm still working on that.

My question today for today is this. Since I have the A1C under control and the report filled out and signed, do I go ahead and visit an AME to start the SI process? So I go in as a consult first, before submitting a formal application? This will be a new to me AME, since my previous AME has retired. In the past I held a 2nd Class with the only restriction is wearing glasses, no other complications.

 

[AvNavCom]

Are you doing flying which exceeds BasicMed limitations? If not, is it worth considering just sticking with BasicMed and not worrying about the SI?

 

[SkyHog]

This is yet another example of the FAA having no business being in the medical game. Type 2 diabetes should not be grounding nor require a special issuance.

Go BasicMed and tell the FAA to shove their antiquated and clueless medical program up their Oklahoma City, corn fed ass.

Edit: if it fits the profile, don't forget Sport Pilot is also an option - then you do not even need the exam.

 

[midwestpa24]

As easy as it is to say screw it and go BasicMed, I do want to keep a 2nd class to keep the door open for the occasional commercial operation that comes my way. BasicMed could get me in the air for now, but it almost seems like it would be easier to get the SI now than try to find a local doc willing to sign off Basicmed.

 

[WDD]

My A1C this morning was 5.2 (down from 12.0 at initial finding). I've also lost about 30 pounds in the last three months through diet, exercise, and medications

Wow! Well done!

Sounds like you've decided on 2nd class - good luck. The only thing I can offer is to get a consult first, don't give them your number, don't have them activate your application.

If you ever decide to do Basic Med, just go to a Doc in a Box that does DOT physicals.

 

[Cap'n Jack]

This is yet another example of the FAA having no business being in the medical game. Type 2 diabetes should not be grounding nor require a special issuance.

Perhaps. I know someone who drank water like a fish and had to pee all to often. I realize gatorade bottle or little johns help, but I think it depends on the symptoms. OTOH, those symptoms tend to make someone self-ground anyway.

 

[bbchien]

I have decided to go ahead and post under my usual screenname. I am Longtime POA New Diabetic.

I had my three month check-up with the endocrinologist this morning and it went well. My A1C this morning was 5.2 (down from 12.0 at initial finding). I've also lost about 30 pounds in the last three months through diet, exercise, and medications (Metformin and Ozempic). My doctor has directed me to drop the Metformin and dial the Ozempic back to the minimum dose.

Doctor also filled out and signed the FAA's Diabetes or Hyperglycemia on Medications Status Report.

I have intended to go BasicMed for now, but have had trouble finding a doc in the area to do it. I'm still working on that.

My question today for today is this. Since I have the A1C under control and the report filled out and signed, do I go ahead and visit an AME to start the SI process? So I go in as a consult first, before submitting a formal application? This will be a new to me AME, since my previous AME has retired. In the past I held a 2nd Class with the only restriction is wearing glasses, no other complications.

Get the doc's last office visit record (not the "aftervisit summary"). Get the DM (Oral) or "DMO" worksheet also in front of an AME. A good one will take your MedXpress PDF print (from the completed applciation" button and call it in and get aprroval. Then and only then does he type in the code to make it go live, and you walk out with the one year certificate. This one's pretty simple.

 

[TCABM]

As easy as it is to say screw it and go BasicMed, I do want to keep a 2nd class to keep the door open for the occasional commercial operation that comes my way. BasicMed could get me in the air for now, but it almost seems like it would be easier to get the SI now than try to find a local doc willing to sign off Basicmed.

DOT doc in a box if your PCP/PCM is unwilling for some reason. Have you had a conversation with your PCP/PCM?

Consider it a stop gap while you find an AME to consult with who will tell you what to bring in when you come back for the next visit. After they see what you have and tell you what’s missing in the documentation, you fix that then finally come back with good documentation and a MedXpresss application.

Don’t give him the number to open the MedXpresss application until after they’ve reviewed your paper copy, your documentation, and shown you in the AME guide why they can and will issue in office.

 

[Kenny Phillips]

Perhaps. I know someone who drank water like a fish and had to pee all to often. I realize gatorade bottle or little johns help, but I think it depends on the symptoms. OTOH, those symptoms tend to make someone self-ground anyway.

The voracious thirst indicates the diabetes wasn't well controlled.

 

[Cap'n Jack]

The voracious thirst indicates the diabetes wasn't well controlled.

That's correct. But what I think would be debilitating when flying a small plane is that the guy had to use the bathroom all the time to get rid of all the water. After treatment, the situation greatly improved. However, I understand some of the reason the FAA would want some evidence it is truly controlled.

 

[Lindberg]

That's correct. But what I think would be debilitating when flying a small plane is that the guy had to use the bathroom all the time to get rid of all the water. After treatment, the situation greatly improved. However, I understand some of the reason the FAA would want some evidence it is truly controlled.

The blindness, neuropathy, organ failures, and vascular disease from uncontrolled diabetes can also be debilitating.

 

[bflynn]

This year has been full of surprises, but this was not one I expected at all.

Long story short, I was injured last month and require surgery to repair. That alone will have me grounded for the next few months, ok no big deal. I only fly recreationally at the moment, although have operated commercially in the past and hoped to do so again in the future.

In the pre-op physical, we discovered my blood sugar and A1C were very high, unbeknownst to me. Yeah I could stand to lose a few pounds, but am an active guy and was not experiencing any symptoms at the time. Surgery has been postponed while we work to get this under control. I immediately cut out carbs and sugars and adopted a suitable diet and was started on metformin. The doctors also want me on Ozempic, but not until after surgery. Exercise is difficult at this time due to the injury, but I also can't stand sitting around so I am moving best I can. In just three weeks I've dropped my blood sugar into the 150s and A1C almost 2 full points. I know I will forever be tagged as a Type 2 Diabetic for life, but feel fully confident I can manage it with diet alone eventually.

My question is in regards to flying and my medical. I have two years left on my current 3rd class medical. I do wish to be able to potentially go back to a 1st or 2nd Class medical to resume commercial flying in the future.

What actions, if any, do I need to take prior to my next medical?

What records will I need ultimately need to show the FAA?

Consider your diet. Most people with T2 diabetes eat their way into it. It's possible to eat your way out of it too. Switch to eating low carb