Soon I'll need to be on Insulin ...

[schomburg]

I am a Type II diabetic, not currently insulin dependent. with a Class III medical and FAA Special Issuance. Age 72, Private ASEL, fresh instrument rating (12/2004), lean and fit, employed as a medical DSP engineer.

Over the past six months, my blood glucose levels have risen despite meds and an aggressive long-term aerobic exercise program, 3-4 times weekly for 10+ years. My last HbA1c was at 8.4 following a respiratory virus that kept me away from the gym for a month. I am essentially maxed out on the usual NIDDM oral meds.

My endocrinologist, whom I trust highly, is recommending that I begin insulin treatment 'soon'. My current medical certificate expires on 31 May 2005, and I will probably begin insulin usage shortly thereafter. I'm not opposed to this, as it will protect me against future diabetic health deterioration

I have read the insulin-related certification articles and regulations on the usual general aviation and Federal websites, and have the following query:

While staying entirely within the rules, which is the better strategy for me to follow: ??

[1] Attempt to renew the Class III certificate as usual, risking possible disqualification at the physical exam, -OR-
[2] Skip this next physical, let the certificate expire, get established on insulin, wait the six months, and then apply for an insulin-dependent Class III Special Issuance.

Also, does anyone know the odds of getting the requested "insulin SI" ?
And, should I seek out an AME with any special qualifications to help me with this? (I live near Portland, Oregon.)

I really will appreciate any input on this ...

Dick Schomburg
Hillsboro, Oregon

 

[bbchien]

I am a Type II diabetic, not currently insulin dependent. with a Class III medical and FAA Special Issuance. Age 72, Private ASEL, fresh instrument rating (12/2004), lean and fit, employed as a medical DSP engineer.

My last HbA1c was at 8.4 following a respiratory virus that kept me away from the gym for a month. I am essentially maxed out on the usual NIDDM oral meds.

Dick, here's what you do. Look up the following link. Do everything on it- got to http://www.faa.gov/avr/aam/game/Version_2/03AMEMANUAL/PROTOCOLS/DIABETES_INSULIN.htm
and download, print the document.

Basically FAA will allow a third class for an individual with insulin dependent diabetes who can show he does not have retinopathy, nephropathy, and isn't getting too low and passes out. You have to essentially also pass the coronary disease workup. Sounds like a lot, but Dale Herzberg on the AOPA board got through this and is actively flying.

In the 90 days preceeding your certificate expiring, you will need:
HbA1c less than 7 (it can be 7-9, but 7 gets you in the door quickly).
Normal Stress treadmill to as close to 100% of your age Vmax (227-72=155 rate), going 9 minutes on the "Bruce" protocol.
LDL/HDL/Cholesterol, Creatinine
8500-7 filled out by the opthalmologist "no diabetic retinopathy"; the form is downloadable at the link provided here.
Current status assessment by your endocrine treating doc- "no episodes of coma, well controlled, no detectable endorgan disease" (see the document).
A recording glucometer and following the protocol before and during flight noted in the FAA document.

There are now about 1700 third class airmen flying on this special. If you have a good AME he will look at everything you have, send it down to OKC (fax will do) and then but the federal doc to review it on his Xerox document imager (takes 3 weeks to get in system) and give approval for office issue. But if you have a regular AME you need to go 90 days before and submit it all for deferral and regular channels.

PLEASE be aware that if you plan to use sport pilot, a deferral or a denial disqualifies from Sport Pilot as well, as "FAA has reason to know...." I would suggest gathering all the information and going to the AME 90 days prior to your expiration, for a "consultation". If the AME thinks you are going to get issued, then come back and do the application...or however he wants to manage it. If he thinks you will get Special Issuance denied (coronary problem, eye problem, kidney problem) then say, "Thank You" and go out the door without writing on anything- and take your records, too.

Please be advised that if you go through the usual deferral/denial/special channel this will take 120 days even if you have all the stuff. This one is worth travelling to an AME who does a lot of special issuances.

Having a high average glucose will maximally damage your prospects for future good quality of life survival and I suspect your primary care doc is correct.

 

[RobertGerace]

If you have a good AME...

Dick,

Don't mess around. I have a AWESOME AME. His name is Dr. Bruce Chien. I suspect he thinks it is silly that I fly 3 hours to Peoria for my medical, but "Lemme tell ya ma story, man..."

I learned there are two kinds of AME's out there. One is on the hunt for people to disqualify and he doesn't care if you fly or not. The other is sympathetic and will consult with you up front to tell you what you need to do in advance of your medical so he won't HAVE to defer it.

...just like in his post above...

 

[CaptainChuck]

Get Dr. Bernstein's Diabetes Soultion.

Cut out the carbs - most of them anyway.

Instead of goig from orals to shots, you likely will be able to go off the orals.
Worked for me.

 

[bbchien]

Chuck, he's already thin....and he's older than you, too...

 

[schomburg]

Thanks, all, for helping!

Would have said that sooner, but this has been a "weekend from Hell" with a painful molar, now thankfully gone. Amazing what a modern dentist can do, supported by the right tools and potions. It was a zero-pain procedure, not even a twinge!

Again, thanks, and I'll post my insulin-certification experience as I go thru it.

Dick

 

[poadeleted3]

Thanks, all, for helping!

Would have said that sooner, but this has been a "weekend from Hell" with a painful molar, now thankfully gone. Amazing what a modern dentist can do, supported by the right tools and potions. It was a zero-pain procedure, not even a twinge!

Again, thanks, and I'll post my insulin-certification experience as I go thru it.

Dick

Lucky you!! They went to take one of my molars out, and couldn't get my tooth numbed. Dude eventually told me to hold on, and pulled it. Probably emptied their waiting room with my hollering LOL.