What do I do now?

[Unregistered]

About two weeks ago I was diagnosed as diabetic. (I haven't flown since.) My Doctor just issued me a blood glucose tester with instructions to check my blood sugar 4 times a day. It seems to be relatively stable and only a little high. He has indicated that he thinks that I can be controlled with diet and exercise. As I understand the requirements, I'll be considered as meeting the requirements if the Doc is correct, although the situation changes if I have to go on medication.

So do I continue to fly until such time as medication is prescribed or my medical renewal comes due? What do I need to present to the AME next time around? Is there anything I need to do with OKC before the exam?

 

[poadeleted20]

Do not fly until you get a good answer from Dr. Chien, the AOPA medical help desk, or an AME you know and trust. My initial read (and I am not an AME or a physician) is that you no longer meet the standards for a third class medical, and are grounded pending a special issuance. I may be wrong, but you don't want to find out the hard way that I'm right since in addition to a possible FAR violation, you may find your insurance (or that of anyone whose plane you fly as a renter or borrower) is invalidated.

 

[dwh]

Ron is correct. I am a current diabetic flying on a special issuance third class. there will be a list of test that the FAA will require and it will be at least 6 months before you can apply for the SI ticket. Then expect to wait at least 12 weeks. The FAA will require a letter from your treating physician stating that your A1c results are for the last couple of tests. Please be aware that the A1c test for a period of 3 months time. The closer to that number being under 7.0 the better you will be. You will also need an eye exam from an opthamologist on a yearly basis even though you may not now need glasses to see. This disease can cause blindness by causing the blood vesels in your eyes to rupture. Now is one of those times that it is a time to truely learn what you are dealing with because it does not go away. The six months will give you time to learn all that you can and of things to be aware of. By all means make use of the resources provided to you by the AOPA as thy can provide a list of tests that will be required, Dr Chein is alos a great resource to drww information from in the owrking of the medical people at the FAA. Also by all means please keep your Doctor infromed of the requirements that the FAA makes on you it will be easier to get what you need when you need it. Use any resource that you can get your hands on including other diabetics to help you understand the condition. Each case i not the same but each will provide you insight. Please feel free to contact me as well.

 

[EdFred]

§ 67.313 General medical condition.

The general medical standards for a third-class airman medical certificate are:

(a) No established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (emphasis mine)

I read that to say if you are not taking anything to help with the condition because you don't need it you don't need an SI. I know someone with diabetes, and I am pretty sure they have no SI on their medical. But I didn't even stay at a Holiday Inn express last night.

 

[poadeleted20]

Ed:

Read on...

(b) No other organic, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. [emphasis added]

The laundry list of those conditions is not part of the reg, but issued directly to AME's as part of their manual. If you go there, you'll find more details. For the various forms and degrees of diabetes, see http://www.faa.gov/avr/aam/Game/Version_2/03amemanual/WEB/Chapter%203/3.48.htm#sec_3_47_diabetes. Note the limitations on issuing for diabetes mellitus controlled by diet ("If no glycosuria and normal glycosylated hemoglobin A1C"), the only form of diabetes for which issuance is authorized without headquarters involvement. As I said, you need to get proper AME advice before flying after being diagnosed with "diabetes."

 

[bbchien]

So do I continue to fly until such time as medication is prescribed or my medical renewal comes due? What do I need to present to the AME next time around? Is there anything I need to do with OKC before the exam?

If you are controlled without medications you are not grounded. However, to not take medications in the hope of avoiding special issuance is the WORST thing you can do for your total health.

There are special issuances for pill controlled diabetes, and for insulin controlled diabetes. The pill controlled SI is not a big deal. I routinely get them apporved over the phone if the proper documentation is had, sent, and gotten before the FAA initial MD reviewer. the key is that your Hemoglobin A1c, which is the moving average of your 90 day's glucose control, is 7 or less It can be gotten with the value above 7, but it's not a quick issuance). You will need to go to an opthalmologist with a form 8500-7 so he can attest to your abesence of opthalmologic disease (you can have your family doc say that, but the issuance goes a LOT faster with an Opthalmolgists' letter- my experience). A Cardiovascular evaluation which includes a statement of your cardiovascular risk factors, the absence of detectable CV disease (just about all MDs saying this are going to want the EKG) will be needed. A statement from you doc saying no neurological, or renal disease is required. The annual recert is not a big deal- a hemoglobin A1c and a letter summarizing the continued absence of CV, neuro, Renal/and opthalmologic disease from your family doc will do, IF the A1c remains below 7. There is a mandatory 60 day stabilization period on the meds before issuance. The A1c has to be within 30 days of the issuance, although I have seen some slack cut on this one.

For insulin dependent diabetes, it's much tighter, includes all of the above and a pre-flight and in-flight glucometer protocol (with a recording glucometer which is looked at 3 monthy by YOUR doc). Dale H. was kind enough to post and is your beste resource on the practicalities of the inflight protocol. If it turns out that way, tell me and I'll point you to the protocol for insulin dependent diabetes- it is a lot tougher. There are about 1,800 airmen flying third class with this issuance.

Do NOT sell the airplane. Lose all possible weight and get to aerobic exercise! Gather all the data, and get in contact with an AME 90 days before you are due. Find an AME who will take your documentation, forward it to the Regional FS, discuss it with him (or to OKC, discuss it with THEM) PRIOR to you AME visit. Keep all original copies and send the documentation to the AME, to the Regional Flight Surgeon or OKC, with you name and SSN on EVERY page.

Lastly, email me before you send ANYTHING. Do not jeopardize sport pilot. PS the "olols" for hypertension are prohibited with any medication for diabetes. Tell you family doc!

 

[Unregistered]

Thanks All (and especially you, Dr. C).

You may be sure that I will not try to avoid going on medication just to avoid the SI. Though I may discuss things in detail (even question him) wigh my MD, I will ultimately follow his medical advice to the letter. His field is Family Practice rather than Endocrinology, he is the frist in many years to manage to keep my wife's diabetes under reasonable control, and she has been on injected insulin for longer than I can remember. If I do have to go on meds for the diabetes I will have to discuss the BP medication with him as I am on Atenolol.

For now, if I am interperting correctly, I can continue to fly unless I have to go on medication for the diabetes. Correct?

 

[bbchien]

Thanks All (and especially you, Dr. C).

For now, if I am interperting correctly, I can continue to fly unless I have to go on medication for the diabetes. Correct?

You are in self certification mode until your first medication of any type for diabetes (see, there is a protocol for Diabetes Mellitus, diet and exercise control, which requires no special issuance).

However, you will be held to the standard of what was reasonable for you to do. If your sugars are so high that your vision gets blurry, self ground. If your sugars are so high that you are constantly urinating (an effect of the osmolarity of glucose) and sipping water to keep up, self ground. And on and on it goes.
Get it dealt with! Live long enough to fly long (and prosper!).

Bruce

 

[bbchien]

Certification with Change in diabetic regimen

Attention everybody. I seem to recall answering an inquitry about a month ago for which I can't remember the detailed situation. It centered around a diabetic flyer (insulin requiring) changing from shots to the insulin subQ pump and whether he was grounded.

IIRC I answered that continuing to fly was between you and your 3 monthly monitoring physician- but in preparing for the Tampa Expo lectures, I see a line in item B(1) on page 187 of the current (2004) AME guide which says "For documentation of diabetes management...change in treatment regimen....With any of these occurences, the indivvidual must cease flying until cleared by the FAA."

In the case of changing to a pump, which is a BETTER option for many, until you have stabilized and you and your physician have advised FAA you are grounded.

Sigh.