Out of curiosity (Dr Bruce! Dr Bruce!)

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Is it even possible, in theory, under the right set of circumstances, for a type I diabetic to hold a class 2 medical? I have an itch to try and figure out if maybe. Specifically, I am interested in one because of the infamous Mangiamele - I fly myself to meetings sometimes, and there is an emerging need to bring someone along with me to some of them, which I have recently learned is apparently not kosher according to the FAA chief counsel. While not a real issue to this point, we are now seriously considering acquiring a corporate aircraft for this purpose, and it sort of hinges on this question to some degree.

I hold a class 3 already.
 
Thank you.

I went and looked but can't find the thread. Dr Bruce?
 
gismo said:
Bruce, the second link (search) doesn't work for me.

And WRT class I or II medicals with type 1 diabetes I wonder if the emerging technologies like continuous glucose monitoring (there's even a non-pucturing version coming) and ultimately the artificial pancreas will help open this door.
Click to expand...

My wife is Type 1 so I have quite a bit of anecdotal experience...

She does a good job of testing, taking her Humalog (short term) as well as Levemir (long acting) yet she still has has her "low" moments. Not so low as to be a medical emergency, but low enough that she recognizes that she's low and sucks on some candy, etc, on her way to testing. If that happened on short final (VFR) or "on the approach" (IFR) I'm not sure how she would do. She'd be soaking wet and shivering and near exhaustion....but I think she'd get it done. (Hey, she is my wife, after all!)

So, do I think she should be issued a Class III medical? No :(

Mike
 
mbundy said:
My wife is Type 1 so I have quite a bit of anecdotal experience...

She does a good job of testing, taking her Humalog (short term) as well as Levemir (long acting) yet she still has has her "low" moments. Not so low as to be a medical emergency, but low enough that she recognizes that she's low and sucks on some candy, etc, on her way to testing. If that happened on short final (VFR) or "on the approach" (IFR) I'm not sure how she would do. She'd be soaking wet and shivering and near exhaustion....but I think she'd get it done. (Hey, she is my wife, after all!)

So, do I think she should be issued a Class III medical? No :(

Mike
Click to expand...
Are you comfortable with her driving a car? My daughter is diabetic and uses an infusion pump. She has been managing her blood sugar well since she started taking insulin when she was 12. She never gets low enough to be unsafe driving a car (or pilot an airplane should she decide to do that). I think the pump does help with that because with it she doesn't need to use long term insulin and therefore can make dosing adjustments with nearly immediate response. She does keep some carbo-boosting food handy as well as carrying a glucogen pen (which she's never had to use).
 
There was also a pilot who flew over the north pole who was flying for Diabetes recognition. (Was on this year's Flying Wild Alaska.)

But this was a question about a 2nd Class or higher and flying Commercially. Not about a 3rd Class. There are obviously some 3rd Class holders already.
 
mbundy said:
My wife is Type 1 so I have quite a bit of anecdotal experience...

She does a good job of testing, taking her Humalog (short term) as well as Levemir (long acting) yet she still has has her "low" moments. Not so low as to be a medical emergency, but low enough that she recognizes that she's low and sucks on some candy, etc, on her way to testing. If that happened on short final (VFR) or "on the approach" (IFR) I'm not sure how she would do. She'd be soaking wet and shivering and near exhaustion....but I think she'd get it done. (Hey, she is my wife, after all!)

So, do I think she should be issued a Class III medical? No :(

Mike
Click to expand...

That's why FAA standards don't necessary mesh with tight glycemic control. Any endocrinologist worth his/her stethoscope would tell you a fingerstick glucose of 250 mg/dl is not good control. But to conduct a flight as PIC, it's perfectly acceptable.

That's why the type 1 diabetic pilot is required to check glucose before flight, during flight and prior to landing.

It's all about not only "control", but also about lability of symptoms, ability to recognize signs of hypoglycemia, and absence of debilitating symptoms.

As a type 1 diabetic for 45 years, I speak from experience. I practice emergency medicine for a living. If I based my opinion of whether type 1 diabetics should hold any level of FAA medical certificate on the patients I see, the answer would be a resounding NO. But it's a skewed sample, and most certainly does NOT reflect all the well-controlled diabetics who never, ever find their way to an emergency department.

I have absolutely no doubt as to my ability to safely operate an aircraft as a type 1 diabetic. But I also know the risks and limitations, know exactly what I have to do to function safely, and do it. I'm no more a "danger" to you or anyone else based on my medical history than if I were non diabetic.

(For what it's worth, I would be perfectly safe operating on a second class as well, but probably won't happen in my lifetime.)
 
gismo said:
Bruce, the second link (search) doesn't work for me.

And WRT class I or II medicals with type 1 diabetes I wonder if the emerging technologies like continuous glucose monitoring (there's even a non-pucturing version coming) and ultimately the artificial pancreas will help open this door.
Click to expand...

Precisely why I'm asking.

I HAVE a CGM. It has completely solved the problem of lows because of the trending alarms; I KNOW (with absolute certainty) when I am about to go low, 15-20 minutes before it happens, which is plenty of time to pre-correct (that is, injest fast-acting carbs) before it happens. I don't need to prick a finger, I don't need to even do anything; the device is right there and I am so attuned mentally to its alarm that I never ever miss it. Heck, I click the little "show BG" button every 10 minutes or so anyway when I'm flying, just a force of habit.

So the entire risk of low while flying - the real risk attached to being a type 1 pilot - is gone completely.

That was part of my class 3 medical too.

So maybe a class 2 IS possible with something like this?
 
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The problem here is liability. Medtronic will not, for example, connect its already proven interface between its CGM to its subQ pump. The miniature artificial exocrine pancreas has been here for ~4 years, it can't be sent to market because of liability.

FAA is pretty cautious of this as well.
 
bbchien said:
The problem here is liability. Medtronic will not, for example, connect its already proven interface between its CGM to its subQ pump. The miniature artificial exocrine pancreas has been here for ~4 years, it can't be sent to market because of liability.

FAA is pretty cautious of this as well.
Click to expand...
According to my daughter's endocrinologist some patients have been using a minimally closed loop system (CGM tied to a pump) for a year or two but that might just be clinical trials. I believe the only "automatic" pump adjustment of the current system is dialing back the insulin dosage during sleep/rest times to limit a detected drop in blood sugar. I assume the most serious issue is the potential for insulin shock if a pump was mis-directed to up the dosage but FWIW, that was a big concern with the initial approval for pumps in general. It doesn't seem to me that highly tested software and triple redundant hardware would be much if any less reliable than an actual human pancreas.
 
gismo said:
According to my daughter's endocrinologist some patients have been using a minimally closed loop system (CGM tied to a pump) for a year or two but that might just be clinical trials. I believe the only "automatic" pump adjustment of the current system is dialing back the insulin dosage during sleep/rest times to limit a detected drop in blood sugar. I assume the most serious issue is the potential for insulin shock if a pump was mis-directed to up the dosage but FWIW, that was a big concern with the initial approval for pumps in general. It doesn't seem to me that highly tested software and triple redundant hardware would be much if any less reliable than an actual human pancreas.
Click to expand...
An attorney can't sue a pancreas if something goes wrong but you can be certain that the company that makes the artificial variety will end up in court if a bad outcome occurs. That is bound to happen even if the device works flawlessly as designed.
 
bbchien said:
The problem here is liability. Medtronic will not, for example, connect its already proven interface between its CGM to its subQ pump. The miniature artificial exocrine pancreas has been here for ~4 years, it can't be sent to market because of liability.

FAA is pretty cautious of this as well.
Click to expand...

Sure, I would be too.

But that's not what I'm saying. I am not using a pump. I am using a real time monitor, which replaces my finger pricks, and also happens to provide trending analysis and very reliable alarms. It doesn't dose me at all, but it does, with certainty, remove the chance of my going into hypoglycemic coma while piloting.
 
...which is why the situation is "stagnant" as it is. From a legal viewpoint, the machines are as reliable as we will allow them to get.
 
bbchien said:
...which is why the situation is "stagnant" as it is. From a legal viewpoint, the machines are as reliable as we will allow them to get.
Click to expand...


Yep, the basis of the problem lies within Wall Street. They aren't going to risk their money no matter how beneficial.
 
Henning said:
Yep, the basis of the problem lies within Wall Street. They aren't going to risk their money no matter how beneficial.
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Why should any company sell something for a couple hundred or even a few thousand bucks profit only to risk millions in liability payouts for each device sold?
 
Gary F said:
Why should any company sell something for a couple hundred or even a few thousand bucks profit only to risk millions in liability payouts for each device sold?
Click to expand...

They shouldn't. And I say that as one who could directly benefit from the technology. But until there is some sort of tort reform or liability limits in this country, it ain't gonna happen. :mad:
 
Henning said:
Yep, the basis of the problem lies within Wall Street. They aren't going to risk their money no matter how beneficial.
Click to expand...

Usually that type of logjam is busted by an uber-rich person with the disease who would gain from the device...

Rich people only listen to rich people. Pretty typical.

"You know, if we could get some of these laws changed, we could make a fortune selling this thing I'm wearing, Bob..."
 
Does anybody here believe that a device can be made that cannot malfunction under any circumstance? The devices are closed loop electronic systems and the human body has it's own set of quirks. There is no such thing as an acceptable risk/benefit ratio in our legal system. Any bad outcome must be obscenely "compensated".
http://www.youtube.com/watch?v=R_XwVIVKbds

http://www.youtube.com/watch?v=9HLrqOuKj4w

http://www.youtube.com/watch?v=V49_Af3HOks


http://www.youtube.com/watch?v=X6yHXofu4mg

http://www.youtube.com/watch?v=ZUSyymOnqD0&feature=related

http://www.youtube.com/watch?v=W1KdJTQFCwQ&feature=related
 
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