[My Flight Surgeon]

Thanks for the question Doug. Your body changes most of the food you eat into glucose (a form of sugar). Insulin, a hormone produced by the pancreas, allows glucose to enter all the cells of your body and be used as energy. Diabetes is a disease that occurs when a person’s body doesn’t make enough insulin or can’t use insulin properly. When you have diabetes, the sugar builds up in your blood instead of moving into the cells. Some, but not all, of the excess sugar is carried out of your body (through urine), and the energy is wasted.

There are two types of diabetes. Type 1 occurs when the body doesn’t produce any insulin. People with type 2 diabetes either don’t produce enough insulin or their cells ignore the insulin. Nearly 95% of people with diabetes have type 2.

The problem is diabetes causes many other health problems. These include:
Blindness. Diabetes can damage the small blood vessels in the retina. It is the leading cause of blindness in people ages 20 to 74.
Heart disease. People with diabetes are 2 to 4 times more likely to have heart disease and damage to the blood vessels in the heart. This increases their risk of heart attack and stroke.
Nerve and blood vessel damage. Damage to blood vessels in the legs can limit the supply of blood to the nerves in the legs and feet. This can make it difficult to feel injuries (such as foot sores). Damage to the blood vessels can also put you at risk for infections and sores that don’t heal. In severe cases, parts of the foot or lower leg may have to be amputated (removed).
Kidney disease. Diabetes can damage the small blood vessels in the kidneys, which then can’t filter out the body’s waste. In some people, the kidneys stop working completely. These people require dialysis or a kidney transplant. Dialysis is a treatment that eliminates wastes in the blood.

Treatment
Diabetes can be controlled with diet, oral medications and/or insulin. If one controls their diabetes, complications can often be prevented. The way to stay healthy with diabetes is control your blood sugar level. You can do this by eating right, exercising, maintaining a healthy weight and, if needed, taking oral medicines or insulin.
Eat a healthy diet. The recommended diet for many people who have diabetes is very similar to that suggested for people who don't have diabetes. It's important to eat at least 3 meals per day and never skip a meal.
Exercise. Exercising will help your body use insulin and lower your blood sugar level.
Maintain a healthy weight. Losing excess weight and maintaining a healthy body weight will help you in 2 ways. First, it helps insulin work better in your body. Second, it will lower your blood pressure and decrease your risk for heart disease.
Take your medicine. If your diabetes can’t be controlled through diet, exercise and weight control, your doctor may recommend medicine or insulin. Oral medicines (taken by mouth) can make your body produce more insulin or help your body use the insulin it makes more efficiently. Some people need to add insulin to their bodies. Always take medicines exactly as your doctor tells you to.

Now related to aviation, the FAA states 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. So these folks will maintain a lean body weight, exercise regularly and watch their diets very carefully. What he FAA asks of the pilot is to essentially adhere to the treatment guidelines of the American Diabetic Association.

For pilots with Type 2 diabetes requiring oral medications (type 1 requires insulin therapy) the FAA says An applicant with a diagnosis of diabetes mellitus controlled by use of a medication may be considered by the FAA for an Authorization of a Special Issuance of a Medical Certificate. Following initiation of medication treatment, a 60-day period must elapse prior to certification to assure stabilization, adequate control, and the absence of side effects or complications from the medication. The initial decision is made by the FAA in OKC but if the pilot meets the FAA’s criteria for disease control, the AME may issue subsequent certificates and forward the supporting documentation to the FAA for review. (This is the new AME Assisted Special Issuance (AASI) the FAA instituted to facilitate keeping pilots in the air. The medical criteria are included in this link http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/diabetes_med/ . I have several captains who are type 2 diabetics and fly on a Special Issuance with no problems.

For those with type 1 or 2 diabetes that is treated with insulin, the FAA has established a policy that permits the special issuance medical certification of insulin treated applicants for third class medical certification. You cannot obtain a First or Second class medical if you take insulin! The FAA states Consideration will be given only to those individuals who have been clinically stable on their current treatment regimen for a period of 6-months or more. Consideration is not being given for first or second class certification. Individuals certificated under this policy will be required to provide substantial documentation regarding their history of treatment, accidents related to their disease, and current medical status. If certificated, they will be required to adhere to stringent monitoring requirements and are prohibited from operating aircraft outside the United States. These monitoring criteria are extremely rigid and would be difficult to follow for all but the most dedicated pilot. The link to initial evaluation, monitoring and subsequent evaluation is included here http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/diabetes_insulin/ .

Now to Doug’s question (LONG ANSWER to a short question ), diabetes tends to be hereditary, especially type 2. The best advice I have is to maintain a lean body weight (DROP THE WEIGHT), exercise on a regular basis and eat a health conscious diet. The diet should be well-balanced and probably not exceed 2000 calories a day. The “precursors to type 2” testing may have been a serum insulin level. There is no screening test that I am aware of that can tell you if you will become a diabetic. If the serum insulin is high, it may indicate one has glucose intolerance or “metabolic syndrome” and that can be a pre-diabetic condition. There are diabetic who are not overweight but the majority of type 2 diabetics we see are too heavy.

One last comment about diabetes, about 3% of the US population has been diagnosed with diabetes and they utilize 15% of healthcare resources. So you can see, the complications of the disease are very costly.

*comments from FAA documents are in italics