Diabetes mellitus, Type 2, medication controlled.

[My Flight Surgeon]

This is another in the series of condition for which the FAA grants Special Issuance certificates.

As with all other conditions, the FAA will want to review the entire medical record. Your AME or http://www.faaspecialissuance.com can assist you in preparing your records for submission.

The topic today is Diabetes mellitus, Type 2, medication controlled.

Diabetes mellitus is a chronic disease that requires long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. It is a disproportionately expensive disease; patients diagnosed with diabetes accounted for 6.2% of the US population in 2002, or 18.2 million people. In that year, the per capita cost of healthcare for people with diabetes was $13,243 for people with diabetes and $2560 for people without diabetes.
Type 2 diabetes is characterized by peripheral insulin resistance with an insulin-secretory defect that varies in severity. For type 2 diabetes to develop, both defects must exist: All overweight individuals have insulin resistance, but only those with an inability to increase beta-cell production of insulin develop diabetes. About 90% of patients who develop type 2 diabetes are obese. Because patients with type 2 diabetes retain the ability to secrete some endogenous insulin, those who are taking insulin do not develop diabetic ketoacidosis if they stop taking it for some reason. Therefore, they are considered to require insulin but not to depend on insulin. Moreover, patients with type 2 diabetes often do not need treatment with oral anti-diabetic medication or insulin if they lose weight.
Having type 2 diabetes increases your risk for many serious complications. Some complications of type 2 diabetes include: heart disease (cardiovascular disease), blindness (retinopathy), nerve damage (neuropathy), and kidney damage (nephropathy).

The goal in the treatment of diabetes is to bring the fasting blood glucose down to normal (100 mg/dL), and the hemoglobin A1c down under 6.5. Good control limits the complications of diabetes. Most of the current medications used to manage diabetes are “approved” by the FAA.


FAA Special Issuance
The initial Authorization determination will be made on the basis of a report from the treating physician. For favorable consideration, the report must contain a statement regarding the medication used, dosage, the absence or presence of side effects and clinically significant hypoglycemic episodes, and an indication of satisfactory control of the diabetes. The results of an A1C hemoglobin determination within the past 30 days must be included. Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying but the disease(s) must be carefully evaluated to determine any added risk to aviation safety. At a minimum, followup evaluation by the treating physician of the applicant's diabetes status is required annually for all classes of medical certificates.

The applicant should be informed of the potential for hypoglycemic reactions and cautioned to remain under close medical surveillance by his or her treating physician. The applicant should also be advised that should their medication be changed or the dosage modified, the applicant should not perform airman duties until the applicant and treating physician has concluded that the condition is:

• under control;
• stable;
• presents no risk to aviation safety; and
• consults with the Examiner who issued the certificate, AMCD or the Regional Flight Surgeon.

An applicant who uses insulin for the treatment of his or her diabetes may only be considered for an Authorization for a third-class airman medical certificate.

[IWExcelsiorE]

So Doctor, this means you can't have a commercial license if your a diabetic?

[My Flight Surgeon]

No, it means you have to have the diabetes well controlled on medication (not insulin).

[IWExcelsiorE]

I see. Diabetes is common on my father's side. I keep thinking "what if i get become a diabetic"?...