Type II Diabetes Treatment Plan

[Unregistered]

I recently went in for a baseline physical (I'm a 40 year old male, 6'2", 238 lbs) and found:
BP 136/74
Pulse 60
EKG normal
And the following abnormal results from a metabolic and lipid panel (fasting):
Glucose at 144
Triglycerides at 260
An A1C wasn't performed with my metabolic panel, so I'll be sure to get one next time.
So, assuming that a follow up test confirms the high glucose, I'm going to officially be a type II diabetic.

Since I currently hold a valid medical good for another 22 months, I've done research on AOPA. As I understand it, if the doctor has me using diet and exercise to control the problem, then I can continue to fly, and have to report the diagnosis and present an A1C showing good control and a statement that I'm free of the various "pathys" associated with diabetes at my next medical renewal. If the A1C is below 9 my AME can renew the medical at that time.

If I go on oral meds for control, then my current medical is invalid, and in 60 days I can take the same paperwork to my AME for a special issuance, that will eventually result in a certificate and letter and then hopefully as long as my status doesn't change I can renew with my AME afterwards.

So, after all that background, I'd like your opinion on my plan for next steps.

I want to tell my doctor that I'd prefer to try reduced calories and increased exercise if my A1c is below 9, and re-evaluate in 6 months, by which time I should have dropped around 20 pounds or more. If my A1c is higher, then perhaps I should go on oral meds as well.

My mother was diagnosed the same way in her early 50s, and she took Glucontrol for about a year, and by then had lost enough weight that she didn't need it any more (12 years ago), so I'm hopeful that I can manage this and only be on meds for a short period, if at all.

All advice welcome, thanks very much.

 

[bbchien]

I recently went in for a baseline physical (I'm a 40 year old male, 6'2", 238 lbs) and found:
BP 136/74
Pulse 60
EKG normal
And the following abnormal results from a metabolic and lipid panel (fasting):
Glucose at 144
Triglycerides at 260
An A1C wasn't performed with my metabolic panel, so I'll be sure to get one next time.
So, assuming that a follow up test confirms the high glucose, I'm going to officially be a type II diabetic.

Since I currently hold a valid medical good for another 22 months, I've done research on AOPA. As I understand it, if the doctor has me using diet and exercise to control the problem, then I can continue to fly, and have to report the diagnosis and present an A1C showing good control and a statement that I'm free of the various "pathys" associated with diabetes at my next medical renewal. If the A1C is below 9 my AME can renew the medical at that time.

If I go on oral meds for control, then my current medical is invalid, and in 60 days I can take the same paperwork to my AME for a special issuance, that will eventually result in a certificate and letter and then hopefully as long as my status doesn't change I can renew with my AME afterwards.

So, after all that background, I'd like your opinion on my plan for next steps.

I want to tell my doctor that I'd prefer to try reduced calories and increased exercise if my A1c is below 9, and re-evaluate in 6 months, by which time I should have dropped around 20 pounds or more. If my A1c is higher, then perhaps I should go on oral meds as well.

My mother was diagnosed the same way in her early 50s, and she took Glucontrol for about a year, and by then had lost enough weight that she didn't need it any more (12 years ago), so I'm hopeful that I can manage this and only be on meds for a short period, if at all.

All advice welcome, thanks very much.

Same guy as at AOPA. If you A1c is above 9, you're being silly. Your retinas kidneys heart and nerves are taking a real pounding. Get on the metformin, the SI is very easy, I have it on speed-dial.

Below 9 you have a bit more time. But don't dilly dally, even at 9 you are taking a pounding every minute of every night with that overnight glucose in the 120s. Control will get your Triglycerides down, which over time are just LETHAL.

After you get the weight off and are off the pill, you will get a letter of eligibility from FAA putting you back into the regular issuance pool.

 

[TMetzinger]

After you get the weight off and are off the pill, you will get a letter of eligibility from FAA putting you back into the regular issuance pool.

I learned something new! I didn't know that a person could go back to the regular issuance pool once he was off oral meds. I assume he still has to report the diagnosis and bring a status letter?

 

[bbchien]

I learned something new! I didn't know that a person could go back to the regular issuance pool once he was off oral meds. I assume he still has to report the diagnosis and bring a status letter?

No. He gets a letter of eligibility, and a warning. That letter essentialy says "you no longer have the disease"....ecuase you don't have it. The warning says, if it comes back you need to self ground and obtain an SI.

 

[TMetzinger]

Now I'm confused. When does he get this magic letter? When he goes for his SI renewal and reports that he's no longer taking the meds and shows a normal A1c (and everything else)?

Does the FAA pronounce a cure when the person is not taking meds and the A1c is within normal limits, or as long as it's less than 9?

I guess I understood that someone not taking meds but diagnosed had to bring an A1C and status report for every renewal, to show that the A1c was below 9 and there was no significant nerve, vascular, or retinal damage. Will that person get a similar letter when his bloodwork is normal again?

 

[bbchien]

Now I'm confused. When does he get this magic letter? When he goes for his SI renewal and reports that he's no longer taking the meds and shows a normal A1c (and everything else)?

Does the FAA pronounce a cure when the person is not taking meds and the A1c is within normal limits, or as long as it's less than 9?

I guess I understood that someone not taking meds but diagnosed had to bring an A1C and status report for every renewal, to show that the A1c was below 9 and there was no significant nerve, vascular, or retinal damage. Will that person get a similar letter when his bloodwork is normal again?

Diet controlled diabetes mellitus is not a special issuance, it is a normal issuance. HE gets the letter when he submits a letter form his doc saying that he has been off 90 days, had diet controlled DM, Hb A1c in the decent range 7-8 (not great). The warning letter it pretty detailed as to when the airman's jig is up.

I don't know of any community based doc who will tolerate a 9. Few who will tolerate an 8. Many will take 7.0 off meds.

 

[TMetzinger]

OK, I understand that. Now, it's 6 months after he got the letter. No symptoms, treating physician is happy. When he goes to renew his 1st class medical, does he still check the box for Diabetes and mark it "previously reported, no change"? Or does he leave the box blank? Does he need to bring a status letter from his treating physician, or does the FAA trust that if he's lying the urine test for glucose will catch him?

Put another way, I don't see why a person diagnosed with diet controlled DM has to bring a status report for every normal renewal, but a person who was on oral meds at one time but is now controlling with diet wouldn't need to bring the status report for every normal renewal.

Hope this is clear - it's late.

 

[bbchien]

OK, I understand that. Now, it's 6 months after he got the letter. No symptoms, treating physician is happy. When he goes to renew his 1st class medical, does he still check the box for Diabetes and mark it "previously reported, no change"? Or does he leave the box blank? Does he need to bring a status letter from his treating physician, or does the FAA trust that if he's lying the urine test for glucose will catch him?

Put another way, I don't see why a person diagnosed with diet controlled DM has to bring a status report for every normal renewal, but a person who was on oral meds at one time but is now controlling with diet wouldn't need to bring the status report for every normal renewal.

Hope this is clear - it's late.

The reason is the threat of hypoglycemia, which isn't there w/o Metformin. You have it backwards- they guy on the pills has to bring a current status, the guy controlled with diet alone does not have to. That's the threshold for FAA concern.

Back on diet control: He brings the letter of eligibility with him, to the AME and is issued (No current status report). He reports "previously reported, see letter of eligibility". It he's getting too high and omits, the urine will tell the story....eventually, or the eyes (and if that's what tells the story, he gets grounded fully).

 

[TMetzinger]

The reason is the threat of hypoglycemia, which isn't there w/o Metformin. You have it backwards- they guy on the pills has to bring a current status, the guy controlled with diet alone does not have to. That's the threshold for FAA concern.

Back on diet control: He brings the letter of eligibility with him, to the AME and is issued (No current status report). He reports "previously reported, see letter of eligibility". It he's getting too high and omits, the urine will tell the story....eventually, or the eyes (and if that's what tells the story, he gets grounded fully).

OK - that's the part that AOPA must have had wrong - they state that someone with a diagnosis of diet controlled DM must bring a status letter and A1c to every medical:

"The aviation medical examiner may issue a certificate for diet-controlled diabetes, if you have the supporting documentation. You will need a current status report from your treating doctor that also mentions the absence of significant medical or surgical complications including cardiac, peripherovascular, renal, neurological, or ophthalmologic disease. Also needed is current blood work that shows a hemoglobin A1C level no higher than 9 percent. The FAA requires the actual laboratory report, not just a statement from your treating physician."