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-   -   FAA approves insulin-dependent for Class I (https://www.airlinepilotforums.com/pilot-health/125122-faa-approves-insulin-dependent-class-i.html)

SonicFlyer 10-31-2019 07:33 PM

FAA approves insulin-dependent for Class I
 
The Federal Aviation Administration is set to allow pilots with insulin-treated diabetes to apply to fly commercial airliners, according to a Department of Transportation official who spoke with CNN.

The new protocol, which could be announced as early as next week, will allow pilots with insulin-treated diabetes to apply for a first- or second-class medical certificate, which is required to fly commercially.


https://www.cnn.com/2019/10/31/polit...tes/index.html

AirBear 11-01-2019 10:06 PM

We'll have to see what the restrictions are. When they talked about this around 2012 it was going to be hourly blood testing, 2 pilot cockpits only, and limited to flying in the 48 states. Continuous Glucose Monitors will probably make hourly testing unnecessary, you'll just have to scan the embedded sensor before takeoff, hourly during flight and before landing. I suspect the FAA medical bureaucrats are going to be hard asses about this since it's being forced down their throats due to pending lawsuits from diabetic pilots. A Diabetic Pilot on insulin will need near perfect blood sugar control to be approved. I'm also curious what types of insulin they'll approve. There's short acting taken just before eating a meal, and then long acting taken either once every 24 hours or a 12 hour insulin taken before eating breakfast.

Excargodog 11-02-2019 06:11 AM

Actually I believe the thing pushing this is that medical science is increasingly recommending using insulin for even type 2 diabetics who strictly speaking aren’t insulin dependent (At least insulin dependent from some external source) at all.

https://www.mdedge.com/ccjm/article/...tart-which-use

AirBear 11-02-2019 11:36 AM

Thanks for posting that link. I'm in exactly that situation so I found it very interesting. I was diagnosed with T2 diabetes 15 years ago (strong family history of it). I've been unable to get my A1C below the diabetic threshold of 7.0, although I've come close. My Diabetes Doc has said that after 15 years my pancreas is running on empty, you can only squeeze it chemically for so long. Unless I show a marked improvement in A1C I'll be starting insulin after my next visit in late November. I wear a Continuous Glucose Monitor which enables me to print out comprehensive charts on my sugar levels, based that those the Doc plans to put me on short acting mealtime insulin. That type would be a major PITA to use while flying as it needs to be temp controlled once the multi-use injector pen is used, and refrigerated until it's opened. That's why I'm doubtful the FAA will approve pilots on that type of insulin. Now an insulin pump might be a different story, I'm not sure how much care and feeding those things need.

Quote:

Originally Posted by Excargodog (Post 2916624)
Actually I believe the thing pushing this is that medical science is increasingly recommending using insulin for even type 2 diabetics who strictly speaking aren’t insulin dependent (At least insulin dependent from some external source) at all.

https://www.mdedge.com/ccjm/article/...tart-which-use


Excargodog 11-02-2019 02:21 PM

Quote:

Originally Posted by AirBear (Post 2916754)
Thanks for posting that link. I'm in exactly that situation so I found it very interesting. I was diagnosed with T2 diabetes 15 years ago (strong family history of it). I've been unable to get my A1C below the diabetic threshold of 7.0, although I've come close. My Diabetes Doc has said that after 15 years my pancreas is running on empty, you can only squeeze it chemically for so long. Unless I show a marked improvement in A1C I'll be starting insulin after my next visit in late November. I wear a Continuous Glucose Monitor which enables me to print out comprehensive charts on my sugar levels, based that those the Doc plans to put me on short acting mealtime insulin. That type would be a major PITA to use while flying as it needs to be temp controlled once the multi-use injector pen is used, and refrigerated until it's opened. That's why I'm doubtful the FAA will approve pilots on that type of insulin. Now an insulin pump might be a different story, I'm not sure how much care and feeding those things need.

That’s not necessarily the best way to treat type 2 with insulin. If your doctor’s an endocrinologist and you have confidence in him, go with that. But you might at least discuss this with him:


Quote:

The “treat-to-target” clinical trials established that the addition of basal insulin to existing oral glucose-lowering therapy achieves good glycemic control in the majority of patients with type 2 diabetes (27–29). According to the ADA/EASD algorithm for the management of type 2 diabetes, insulin could be initiated with either once-daily NPH insulin or a long-acting insulin analog
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811456/


Quote:

Often, people with type 2 diabetes start using insulin with one long-acting shot at night, such as insulin glargine (Lantus) or insulin detemir (Levemir). Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.

https://www.mayoclinic.org/diseases-...t/drc-20351199

As I said, talk it over with your doc and maybe your AME, but a smaller dose of long acting backed up by oral agents might be an easier sell to the FAA.

AirBear 11-02-2019 05:38 PM

My Doc is a very experienced Endo. I wear a CGM so always have plenty of charts to show him, that's how he knows I need to be on mealtime insulin. We just need to damp down those spikes at mealtime. A long lasting insulin might take me too low during the night. And I don't really want to go back to my job, I have a great disability plan and being home 24/7 lets me get plenty of incline trainer time in.

atpcliff 11-02-2019 09:58 PM

Canada has allowed Type I to fly as commercial pilots for a while. I don't know what they require in Canada for Type I differently than "normal" pilots...

My Type I son is trying to get his licenses in the US, and then move to Canada to fly professionally. So far, it has been months waiting for the FAA to approve his Class III flight physical so he can start training.

AirBear 11-03-2019 10:41 AM

I finally found the 2014/15 study the American Diabetic Association did on insulin dependent pilots. I'll post the link below to the PDF. I thought I remembered geographic restrictions but don't see that in the report. No telling how many of the suggested restrictions in this report will make it into the new procedures.

http://www.pilotswithdiabetes.com/pd...age_pilots.pdf

AirBear 11-03-2019 10:46 AM

Quote:

Originally Posted by atpcliff (Post 2916957)
Canada has allowed Type I to fly as commercial pilots for a while. I don't know what they require in Canada for Type I differently than "normal" pilots...

My Type I son is trying to get his licenses in the US, and then move to Canada to fly professionally. So far, it has been months waiting for the FAA to approve his Class III flight physical so he can start training.

There's a Facebook Group your son might want to join if he hasn't already, it's called "Flying with Diabetes":

https://www.facebook.com/groups/301356476613317/

AirBear 11-06-2019 04:52 PM

Saw an article today, the writer said their source within the FAA told them the new protocols for Insulin Dependent Pilots will be published on Thursday, Nov. 7th in the Federal Register and on the FAA Website. Also, a new guide for AME's will be out. We'll see if it actually happens.


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