If you’re considering becoming a pilot, you’re probably already aware that alongside the challenging examinations you need to pass, you also need to undergo a thorough health assessment and receive a medical certificate before you can operate an aircraft.
But you may be wondering about certain health conditions, and how these could affect the process.
If you have diabetes, you’ll probably be aware that there are 2 types: insulin-dependent (Type I) and non-insulin-dependent (Type II.) Diabetes is one of the FAA’s 15 disqualifying medical conditions. However, this doesn’t mean you can’t fly at all.
The FAA has several categories of Special Issuance for well-controlled diabetics, including both type I and type II, which we’ll be looking at during the course of this article.
So, can you be a pilot with type 2 diabetes?
The answer is ‘possibly.’
Diabetics who aren’t dependent on insulin (so type II diabetics) may be considered eligible for all classes of medical certificates if they are able to control their blood sugar through their diet and exercise, without the assistance of medication.
This is provided they have no evidence of other disqualifying illnesses that are associated with their diabetes, such as disqualifying heart, circulatory, kidney, or neurological conditions, eye diseases, or other complications.
Type 2 diabetics do not need any additional specific testing unless this is indicated in their medical history or examination. So as long as their diabetes is controlled through diet and exercise alone, no Special Issuance is required.
Can I be a pilot with type 1 diabetes?
For type 1 diabetics things are a little more complex.
For diabetics who rely on insulin, up until 2019, only a Class III Special Issuance was allowed.
Even with today’s medical advancements, it’s still very difficult to perfectly regulate a diabetic’s blood sugars, especially to avoid hypoglycemia, and for this reason, the FAA only allowed Class III certifications for insulin-dependent diabetics - meaning they’re eligible to fly private and recreational operations or fly as a student pilot, flight instructor and as a sport pilot.
However, according to Aviation Medical Services, not every insulin-dependent diabetic will get a favorable review from the FAA, only those who have a history of demonstrating excellent control of their diabetes, are meticulous with their insulin and dietary management, have no episodes of hypoglycemia and have no other significant medical issues that may impact their condition.
The FAA also has rules concerning the checking of blood sugars prior to and during flight, and prior to landing, which can get a little complicated. However, there are currently about 300 or so insulin-dependent diabetics flying in the U.S., so the system seems to work relatively well.
Can I get a Class 1 medical with diabetes?
As we said above, for many years, the FAA did not extend Special Issuance consideration to insulin-treated pilots, so first and second-class medical certificates were simply not an option for type I diabetics, only type II.
Things started to change in April 2015 however, when the FAA revised its position to state that it would provide consideration "on a case by case basis" for pilots applying for first and second-class certifications, however, it didn’t actually grant any certificates.
Then, on November 7, 2019, the FAA published a notice in the Federal Register announcing a new protocol for evaluating those with insulin-treated diabetes applying for first and second-class medical certificates.
This process is still very much reliant on a case-by-case assessment of those with diabetes, however, this is thought to be the most medically and legally appropriate approach to considering whether or not a person is in a fit state to fly an aircraft.
However, the U.S. is not at all the first country to make these changes.
Since 2001, Canada has been allowing some pilots with insulin-treated diabetes to fly commercial flights, while in 2012, the UK also made a similar move, approving a protocol that allowed pilots with insulin-treated diabetes to engage in airline transport and commercial operations.
Traditionally, those with diabetes - particularly the insulin-dependent variety - would not be able to become commercial pilots, however, there have been numerous changes in recent years, and now pilots with type I or type II diabetes can potentially become pilots so long as they don’t have any other disqualifying conditions.
The granting of medical certificates is done on a case-by-case basis, and both type I and type II diabetics need to prove that they have good control over their condition, whether it be through their insulin treatment or diet and exercise regime.
However, the good news is that if you’re a diabetic, it’s not the end of the road, and you could still become a pilot yet.