Type 1 diabetic class 1 medical

[Iceburg1]

Hello everyone

I am a type 1 diabetic been for 19 years I'm now 20 my question is now that type 1 diabetics can optain class 1 medicals do you know of any one who has done it?

I ask because I will soon start flight training and if I think I can go commercial one day ill do my ppl but if I can't ill go NPPL (m) so how likely is it will airline want to employ a type one over someone with no conditions?

Thanks and happy flying

[Dash8driver1312]

First, let me say good luck following your dreams, the sky is an awesome place to be.

We have one captain on our books who became diabetic. He is filling an office position and trying to get cleared back in, at least as a sim pilot. The problem as you rightly say in your case is that yours is pre-existing. I think it will be very tough for you competing against other applicants without diabetes. Recruiting staff are not famous for taking risks...

[Bearcat]

Op......airlines taking on a pilot is very uncommon with type 1......1 can lead to 2. As long as you know what you chances are and are wide open to the obstacles that lay ahead......otherwise best of luck and fair play to you.

[west lakes]

1 can lead to 2.


Other way round, Type 1 is Insulin Dependant

[Bearcat]

Apologies....you get my gist.

[Denti]

As far as i know anyone who is insulin dependent cannot get a class I medical and although I'm not completely sure I think a class II is out of the question as well. A LAPL might be achievable in those European countries that do not require an EASA medical for it.

Took me three months to get my medical back when I was diagnosed with diabetes and the main part of it was proving that I cannot go into hypoglycemia, even with a doubled dose of my meds (metformin), without eating and very heavy exercise. And even so I now have quite a lot restrictions on both my license and medical.

[TheDudeAbides]

Anybody know if the uk are issuing class 1 medicals for type 1 insulin dependent diabetes? From their website it looks like they are. Is there an agreement with EASA as according to easa part-med, type 1 diabetics are "unfit to fly".

Thanks

[wondering]

Out of 'Acceptable Means of Compliance and Guidance Material to Part-MED1':

AMC1 MED.B.025 Metabolic and endocrine systems

(g) Diabetes mellitus

Subject to good control of blood sugar with no hypoglycaemic episodes:

(1) applicants with diabetes mellitus not requiring medication may be assessed as fit;

(2) the use of antidiabetic medications that are not likely to cause hypoglycaemia may be acceptable for a fit assessment with a multi-pilot limitation.


@Denti,

do you have an OML restriction?

[Denti]

Yes, i have an OML restriction which weirdly enough showed up on my brand new EASA license as well, not only on the medical.

However, my medical was issued on the basis of JAR-FCL 3 just a few days before EASA PART MED came into force. Otherwise i still would be grounded as the current authority doesn't have the capacity to issue a special approval medical in less than half a year. AMCs were much faster during the JAR-FCL time.

[UpDiddlyUpUp]

Folks, see CAA to issue medical certificates to pilots and air traffic controllers with insulin-treated diabetes | CAA Newsroom | About the CAA (http://www.caa.co.uk/application.aspx?catid=14&pagetype=65&appid=7&mode=detail&nid=2161)

In short, yes you can hold a Class 1 medical if you have Type 1. If you need more info see http:Pilots with Diabetes : private flying - Australia (http://www.pilotswithdiabetes.com) or PM me.

[spitfire747]

I work for a big orange European airline.

My FO the other day briefed me that he was a Type I Diabetic who injects insulin. He had to prick his finger and do a blood test every 20 minutes and at top of descent.

His Class One medical was restricted to Multi Pilot operations.

He was a male approx 24 years old.

Good Luck:ok:

[Denti]

Every 20 minutes? Ouch, my finger tips are shot and hurt immensely after only a few weeks of eight times a day, very glad that i have to do a full profile now only every couple days. Every 20 minutes must hurt like hell after some time, doesnt he have a continous blood sugar level monitor instead? I believe those are available nowadays.

[Ulster]

Information about pre-flight and in-flight testing, and lots of other current (ie EASA) stuff of interest to all diabetics, can be found here
http://www.caa.co.uk/docs/49/20130226DiabetesCertificationGuidanceFeb13.pdf

[Matty J]

This is an interesting discussion regarding type 1 diabetes. I have been type 1 now since 2004 & prior to that I was mid-way through my PPL. As my dream was to become a commercial pilot once I was diagnosed I gave up after realising that dream had been snatched from me.

At the time I worked at Stansted airport and was worried that my medical would be invalid & I would no longer be able to continue as a tug driver and work on the manoeuvring area. This was not the case I was still fully permitted to tow and dispatch multi-million pound aircraft around the airport. I was frustrated at the rules for diabetics regarding type 1 medical and believe that the law makers don't really understand the condition! I have never had a hypo in my life and if my sugar level starts to slowly drop your body gives you signs and I can take a chocolate bar or sugary drink without it Affecting any task I'm undertaking. Diabetics do not suddenly collapse with no warning if they correctly control the condition so it makes us no less safe to have in a cockpit as any other healthy pilot. Every time I visit my gp or nurse they do all the relevant checks and can't believe the control I have over my diabetes and they have even told me it's like I'm not even a diabetic!

I understand the rules have now been relaxed regarding diabetes & class 1 meds but for me it's almost too little too late. Commercial aircraft are always crewed by at least 2 pilots so if in the unlikely event I was rendered unable to continue my duty (which has not & would not ever happen) there is another pilot there to continue to operate the aircraft safely. The condition needs to be understood far more than it is!

[Matty J]

Just to add to a post above.

I check my blood sugar levels 3 times per day which are morning, lunch & dinner.
Every 20 minutes seems very very excessive and I can't imagine the state of the chaps finger tips!

:ok:

[The bird]

I am a T1 diabetic pilot flying multi pilot ops with an airline in europe. I was convinced that my career had come to an end abruptly. Luckily I managed to regain a medical again after about 6 months. Happy ever since and flying without issues! Both my company and the CAA did a great job. Hope we can convince easa to amend part med.

Best of luck

[Ulster]

Luckily I managed to regain a medical again after about 6 months. Happy ever since and flying without issues!

Well done ! You did very well to get treatment sufficiently stabilised for class 1 certification in such a short space of time ! Are you doing the in-flight BS testing ? If so, how are you finding doing that ? :)

[The bird]

Yes I managed to get stable BS levels within 2 weeks after treatment. I think the most important thing is to understand what is affecting your BS so you can take appropriate action.

Whilst flying I stricly follow the CAA protocol. Brief the crew about the condition. Measure the BS levels 2 hrs before flight, 30 min before off blocks, every hour during flt and 30 min before ldg.

Every 6 months you need to provide the CAA with some data and once a year the basic renewal.

For me it is not a problem. Of course the fingertips might get a bit sore but I just consider myself very lucky to be flying again thanks to the UK CAA. I understand the risk but with the medical aids and treatment nowadays I cant see why this conditions should preclude medical fitness. I sincerely hope that my data will help the CAA to convince EASA as well.

[Radgirl]

We wouldnt measure blood sugars this frequently on a critially ill patient in theatre or ITU. Indeed I would consider it dangerous. Even with the most brittle diabetic, we only do readings every 4 hours or so although we vary the times.

Presumably the CAA arent so daft as to want these readings for the individual's safety so they must be collecting data for research. ie using the pilot as a guinea pig. Do they need informed consent for this? Can they refuse a medical because a pilot refuses to participate in research?

There are continuous measurement devices which would be more, um, humane

Some interesting issues here

[The bird]

Hi Radgirl,

What do you mean with we? Are you talking about pilots, doctors? Critically ill?

The system looks a lot like the Canadian system. They have been doing it for 10 years now. It is still early days so of course they need as much data as possible. The testing regime is designed to minimize hypo's. On non operational days I only measure 2 or 3 times a day.

For flying Continious glucose monitoring is a possibility but not as a primary source. Even with CGM you need do the conventional finger prick testing according to the schedule. It is still early days and I think that the protocol will become less strict (i.e. CGM, testing regime etc)

If you refuse to stick to the protocol the CAA will revoke the medical (understandably) I am more than willing to cooperate in order to make it easier for colleagues in the future!

[AngioJet]

Like everything it's probably a policy based on 'rather safe than sorry', although like radgirl, I agree the frequency appears a bit OTT IMHO.

Well done to those of you who've managed to get your class 1's with T1DM, let's hope your fingers are still intact by the time the CAA decides on a slightly more lenient testing regime!

[Radgirl]

The Bird

By we I mean the medical fraternity

You make my argument better than me by pointing out that on non flying days you only test 2 or 3 times. This is presumably what your diabetologist considers necessary.....I suspect your blood sugars vary more not less on non flying days

I am afraid I do not consider very frequent testing is better safe or indeed better. As doctors, nurses and radiographers we are told from day one that everything we do, especially an invasive procedure, must be necessary. If we do it to gather data for the common good but not the individual it is research and requires specific consent. In most countries you cannot be penalised for refusing to participate.

[Ulster]

Like everything it's probably a policy based on 'rather safe than sorry'

That's certainly true of much of the thinking on new things at the Belgrano. One must, I suppose, have a little sympathy, since they have had their knuckles sharply and publicly rapped at accident enquiries when medical causations have peen postulated.

The confidence of the travelling public needs to be considered too. Just try suggesting to your average Ibiza-goer that one of the guys driving him there is an insulin-dependent diabetic who might go unconscious at any time.

For many years reasoning exactly like those totally excluded type 1 diabetics from a career as a pilot. I, for one, welcome the fact that that is now changing, but the change must not be at the cost of reduced flight safety for all. It's a very steep learning curve for all concerned, not least the CAA whose task it is to regulate the process.

Radgirl's comments about the "research" aspects of this are a little harsh. It certainly is research - it has to be to learn, in order to make better decisions in the future, for upcoming generations. But reasonable people will be happy to contribute to that research, while being able to fulfil their own long-aspired career ambitions. The Bird exemplifies that approach just about perfectly - long may he continue flying safely ! :ok:

[gingersam86]

Does anyone know what the restrictions if any, are for people with type2 diabetes with a class one medical? The CAA website is as usual not helpful.

[kui2324]

There is quite a bit of info on the website if you know where to look :)
http://www.caa.co.uk/docs/2499/20140127DiabetesBriefingSheetJan2014v3.pdf
http://www.caa.co.uk/docs/2499/20140410DiabetesCertificationGuidanceApr2014.pdf
http://www.caa.co.uk/docs/2499/025%20METABOLIC%20DIABETIC%20REPORTS.pdf
http://www.caa.co.uk/docs/2499/20141006MFTDiabetes(Online).pdf

[RONTOM-EGPD]

Hi,

I myself have had type 1 diabetes since I was 10. I'll be 26 this year and I've held my Class 2 medical for nearly 2 years now, with the intent of obtaining a Class 1 and applying to an FTC. What the CAA are doing are moving into the 21st century. I've seen a fair amount of changes over the years regarding insulin, glucose monitoring, retinal checks, so on.... The phrase, "I'm a diabetic" means something different to what it meant in 2000. I'm currently awaiting for my new Omni Pod. It's a device that sticks to my stomach or under my arm. It sends a constant signal to the app which I'll have on my iPhone. It constantly (every 5 seconds) updates the glucose result on the app. With that, there's an insulin pump device coming out in the near future which will work together with Omni Pod delivering insulin to counteract the glucose. What the electronic devices do and a working human pancreas does are exactly the same thing. In fact, I'd bet if in decades to come scientists looked at the glucose trends of someone with the electronics and someone with a working pancreas, the one wired up will have a far more stable trend in glucose levels. Medical technology is moving forward at an exponential rate, thus reducing complications with diabetes for a lot of people. I remember one of the specialists from a few years ago and he said, "I don't like the term, I have diabetes." He's right, you can't really say, they're diabetic. Really, some peoples pancreas are part of their liver. Mines at the moment is in a pen.

I'm not saying everyone injecting insulin is as thorough and careful as others. Believe me, I wish they were but for us that want to embrace it, live with it and not let it affect us, what's the problem? Let's keep moving forward with flight. Hopefully very soon, the rest of the world will move out of the 20th century and adopt what the Drs and the rest of the medical professionals here in the UK have done.

[gingersam86]

Thanks kui2324, must try harder next time :)

[G_STRING]

Rontome

Brilliant post, I wish you all the best

[paully]

Rontome

I wish you well and hope you get the pod asap...However I`m, afraid that the UK is as always, miles behind the curve. I too am affected by this condition and have spoken to my pharmacist who says that the NICE committee are refusing to allow it for general use, even though it would transform lives and long term save the NHS a forture, due to its present cost..Also the big boys of the pharmacutical world are fighting its introduction as hard as they can.It would of course affect their market share and profits, which is all they care about :ugh:

They are allowing it for those in certain occupations, like yourself and for children and those with a documented phobia of needles etc..Keep us informed and I`m sure it will be great for you :ok:

Apparantly the latest thinking is that this treatment is years away, for general use, in the UK :{

[Jared636]

Hello,
I just wanted to gain some more information on the rules and restrictions
regarding class 1 medicals and type 1 diabetes. I understand that due to
changes in recent years pilots can obtain class 1 medicals if they have
been diagnosed while flying commercially, but I am unsure if you can obtain
one for the first time to enable you start commercial pilot training if you
suffer from this condition. The information online is limited so any help
would be deeply appreciated. Kind regards, Jared.

[Driftdown89]

Jared636,

I have just received my Class 1 medical having been diagnosed with Type 1 at the end of June. I did have my Class 1 already so this was a case of regaining my medical.

I spoke to my AME who just issued my revalidated medical 3 weeks prior with no signs of diabetes! Well, he didn't pick anything up anyway... He didn't know how to proceed and suggested I get my consultant doctor to write a report. I tried calling the CAA to which they said I was to speak to my AME... I called my airline and I'm the first with Type 1 within the company and so they couldn't really help me there... I emailed the CAA medical dept, not thinking anything would come of it. A couple of days later, I got a call from a senior aeromedical advisor and she told me everything that I had to do...

Provide 90 days of blood sugar readings (3 or 4 readings a day)
HBA1c value
Renal Profile
Lipids
Urine sample checking for various items (see CAA guidance material below)
Checks for any diabetic complication - retinopathy check, checking of your feet, checking of your kidneys and an ECG stress test checking for any cardiovascular disease.

All of these results were then put into a report by my diabetic consultant and sent off with my spreadsheet of 90 days blood sugar readings.

It's then checked by the chief AME and if satisfactory, you're invited to meet with the CAA diabetic consultant. If all goes okay then you'll have your medical posted out to you soon after.

Sorry I can't help from the point of getting your medical for the first time - I can only speak of my experience.

Here is the CAA guidance material on how to construct the report and the results required - https://www.caa.co.uk/WorkArea/DownloadAsset.aspx?id=4294973794

[gingernut]

Took me three months to get my medical back when I was diagnosed with diabetes and the main part of it was proving that I cannot go into hypoglycemia, even with a doubled dose of my meds (metformin), without eating and very heavy exercise

Never come across anyone who's had a true hypoglycaemic episode with metformin alone.

It may give you the sh*t's in high dose though.

Interesting thread.

[gingernut]

Gliclazides can, in theory, induce hypoglycaemia, never actually seen it happen, but our latest guidelines have a caveat in about drivers.

The main stay of diabetes control, was traditionally to try and reduce HBA1c. It's an area of rapidly changing parameters. It's likely that sorting lipids and blood pressure control out is likely more important in the long run

Probably not apt to you young pilot chappie's, but one episode of hypoglycaemia doubles your risk of early cardiovascular disease by a factor of 2.

Sorry, can't specifically answer questions about type 1, it's a fast changing field, so don't give up hope.

[ExXB]

I can recommend the FreeStyleLibre (http://www.freestylelibre.co.uk/) as an alternative to finger pricks. One benefit is that it can give you an accurate estimate of your HB1c.

[Driftdown89]

I use the Freestyle Libre whilst on and off duty. As it measures interstitial and not capillary, the CAA as well as the DVLA do not accept it.

Blood testing via traditional finger prick still has to be carried out.

When I met with the diabetic specialist at the CAA, he knew from my consultant's report that I used the Libre and encouraged it's use. I also use an insulin pump - my control on pens were good but my NHS team decided to offer me the pump due to my occupation. It's great.

The A1c calculation on the Libre is very much a rough guide. It estimated mine to be approx 6.9%. When I got my bloods done, I was 5.9%. Certainly keeps you in the ball park however.

I fly purple aircraft for a well known regional airline and was swimming in the hold pool for the UK flag carrier before I was diagnosed. I told them straight away and they were more than happy to still offer me a position with them provided I could get my medical back - I start with the in the new year and that's with me having Type 1. Don't let diabetes totally rule anything out!

[ExXB]

My HB1c was estimated by the FreeStyleLibre application as 6.4. The following day at Dr.s office it was 6.5.

It is an estimate, however, and inter-stitial is not glucose, but it is very helpful.

I'm impressed with 5.9 though, well done.

[Driftdown89]

I'll need to get some tips from you, would be ideal to have a nice accurate reading before I head off for my 3 months bloods!

It's a great tool, I love it. You can head out for meals, drinks etc and just a simple swipe to let you know if things are in check. A simple swipe can indicate if you're high or low and then that'll trigger me to check my actual blood and correct as required nice an early to bring my blood sugar down or up so as to avoid a hypo - even before my body tells me I'm low with shaking and sweaty palms. Great for keeping the A1c in check.

Many thanks. I am still in the honey moon phase and so I guess that helps. I would simply like to keep my A1c 6.5% or below and thus doing the best I can to avoid complications.

I find it easier to control my diabetes whilst flying as I'm strapped to a seat all day, it moves very little!

[gingernut]

There are two competing perspectives here.....

HBA1c is a measure of long(er) term control. With BP, lipid and lifestyle control, it's essential for living a longer and healthy life. It's a video of the train.

Plasma glucose level is probably more relevant to a diabetic pilot who is about to pilot his passengers about......but generally only if he or she is at risk of having a hypoglycaemic attack, and thus rendering him suddenly incapable. This is usually only the case when a pilot is actually taking a medicine that would cause this.

Plasma glucose level (the usual "fingerprick" machines), take a snap shot of the train. It show's where the train is now. It doesn't show where it's been, where it's going, or how fast it's getting there.

[Driftdown89]

As you say, I guess the biggest issue with diabetes (insulin dependant) is the risk of incapacitation due to mis-calculating the amount of insulin taken with the amount of carbohydrate consumed. I bring my own food to work as the crew food supplied to us isn't labelled and I don't really fancy guessing carbs for the very reason of misjudging the insulin required unless it's food with standard values such as bread in a sandwich. I usually have food very low in carbs, or have zero carbs. Peanuts for example. I was telling my consultant this and he did say there is potential for the body to convert the protein to glucose if not consumed with carbohydrates?

Anyway, keeping an eye on things once I've eaten isn't a problem with the CAA testing protocol (within 30 minutes of take-off and landing and every hour during flight). I'll then use that instantaneous snap shot of my blood and couple it to the trend arrow on my Libre to get a pretty solid understanding of where my sugars are heading.

It's just finding that balance of keeping sugar levels from going low and from keeping them running high as to cause long term (and short term) issues.

[AmarChana]

Hello! I have been a Type 1 Diabetic for 4 years now and I am turning 18 in the near future. I want to start my private pilot's license and ultimately do a commercial pilots license and become an airline pilot in the future. My question is, can I obtain a Class 1 medical in the UK from the CAA, if I already have Type 1 Diabetes and have not previously held a Class 1 medical certification? :uhoh:

Thanks, Amar!