Type I Diabetes And Flying

[Diabetes]

Any type 1 diabetic pilots controlling their condition with insulin out there that have lost their class one medical, please get in touch. Myself and a colleague have recently had this happen to us and we are now looking to get in touch with anyone else with the same condition. We are organising a get together in December to discuss how to move forward to appeal this case with the authority. There are Canadian Pilots out there with our condition commercially flying in and out of UK airspace and just for the fact that they are canadian gives them the right to do this. Whereas for us Europeans this is not allowed. Time for things to change!

[uklocations]

Sorry to hear that. The authorities have probably entered the world of risk management, and have likely taken the following factors into account.

Risk of IDDM pilot suffering hypoglycaemia.

Consequences of that risk.

Benefits of employing/not employing pilot with IDDM.



I guess your argument will have to focus on adjusting one of these factors, and perhaps knowledge from the Canadian guy's may help in this respect.

There is patient group in the UK (?BDA), who are pretty genned up on protecting the rights of diabetics, I wonder if there is an equivalent organisation in Canada?

One salient point, is that there are likely to be a lot more pilots in your position in the near future and there are a couple of reasons for this;

The obesity crisis is likely to tip more people into the category of Type II diabetes.

and,

Those with type II diabetes are likely to require insulin as an adjunct to oral medication earlier than they do at present-as a result of tighter control by clinicians. Present attempts at developing an oral adjunct have so far been unsuccessful.


My gut feeling, is, that at present, you'll be pis*ing in the wind, but good luck with your argument.

PS I'm not in any way affiliated with the google ad beneath my username!!

[Diabetes]

I'll give it a try p*****g in the wind, I can only get wet!

[Flyin'Dutch']

I know that the FAA will let people fly with IDDM but AFAIK only for class 3 on a special issuance and then only in US national airspace.

A raft of conditions to comply with.

Good luck.

<---any advertisement appearing in this sidebox is there courtesy of PPRuNe and is not an endorsement by me for any product or service.

[BeechNut]

I believe in Canada, you can only fly with insulin-dependant diabetes if you meet certain control criteria, and only for a Class 1 medical restricted to "as or with co-pilot"

For Class 3s, (i.e. private pilots), you tear up your license if you have insulin-dependent diabetes. A class 4 (glider/ultralight) may be possible.

Lots of information here:

http://www.tc.gc.ca/CivilAviation/Cam/tp13312-2/diabetes/menu.htm

[Cathar]

There are Canadian Pilots out there with our condition commercially flying in and out of UK airspace and just for the fact that they are canadian gives them the right to do this.

This not the case. As the medical certification of people with insulin-dependant diabetes does not meet the relevant ICAO standard they have no right to operate into the UK without specific CAA and DfT approval. I understand that such approval would not be given.

[Diabetes]

You have your facts wrong mate. There are Candadian Pilots flying in and out of Heathrow with IDDM. I have been in contact with one Air Canada Captain who flys 767 in and out of LHR FACT!

[Cathar]

Diabetes

I meant that it was not the case that they had the right to do this because they are Canadian not that it wasn't happening. However, I am surprised that pilots with IDDM are flying to the UK as they will be in breach of article 26(11)(b) of the ANO (which carries a penalty of up to two years imprisonment). Air Canada will also be in breach of their DfT permission to operate to the UK.

[Captainkarl]

diabetes, do you know me? Karl Beetson?

[sheldonbanks]

I am pretty sure that the FAA will lets people fly with IDDM.

[Shunter]

FAA allows diet-controlled diabetics access to all standards of medical. Insulin control means you can only get a class 3, but there are very strict rules which will disqualify you if you've had any hypoglycemic episodes in the past 5 years.

Apparently Canada is unique in allowing airline pilots to do this, but again, there are strict controls.

http://www.thestar.com/SpecialSections/Diabetes/article/272050

[Captainkarl]

I think its more hypoglycemic episodes which bring unconsiousness or require the intervention of another person. Yep there are candian airline pilots landing at Heathrow...

[Shunter]

Having locked horns with the CAA on a matter far more piffling than diabetes and got, well, nowhere... I wouldn't hold out for a fantastic prognosis. If I were you I'd go get myself an FAA Class 3 and an FAA PPL which you can quite happily use to fly a G-reg. If you're intention was to go down the commercial route the news obviously isn't so great (unless you emigrate to Canada), but best of luck if you decide to dig your heels in and take them on.


A. Individuals with ITDM who have no otherwise disqualifying conditions, especially significant diabetes-related complications such as arteriosclerotic coronary or cerebral disease, retinal disease, or chronic renal failure, will be evaluated for special issuance of a third-class medical certificate if they:
1. Have had no recurrent (two or more) hypoglycemic reactions resulting in a loss of consciousness or seizure within the past 5 years. A period of 1 year of demonstrated stability is required following the first episode of hypoglycemia; and
2. Have had no recurrent hypoglycemic reactions requiring intervention by another party within the past 5 years. A period of 1 year of demonstrated stability is required following the first episode of hypoglycemia; and
3. Have had no recurrent hypoglycemic reactions resulting in impaired cognitive function which occurred without warning symptoms within the past 5 years. A period of 1 year of demonstrated stability is required following the first episode of hypoglycemia.

[Captainkarl]

Shunter your not IDDM are you?

[gingernut]

and unfortunately, its sometimes difficult to get one (no hypo's) without the other (poor glycaemic control), although the technology is changing daily.

[Captainkarl]

It is possible to avoid most hypos if you check regulary, eat the right sorts of food and think about what your doing! (Lots of walking is still using energy, having to rush around don't forget to snack and stop (check)!)What you say is true, the tighter you wish your control to be the more at risk you will be from hypos. I don't know about other IDDM's but I know when a Hypos comming on as I have good awareness, sometimes this is not the case in others and the fact that some people do take really good care of their diabetes and some others do not which is why a blanket ban on certain things in this world is unfair, 1 day I will be juged and assessed for the individual I am.

[Shunter]

No I'm not, I just know someone who is and looked into it for him a while back. As he has no intention of going commercial he's gone the FAA route and is quite happily flying around with his FAA PPL.

[lucaberta]

Shunter,
If I were you I'd go get myself an FAA Class 3 and an FAA PPL which you can quite happily use to fly a G-reg.if your mate is doing this and flies outside of the USA, is he violating what the special issuance 3rd class allows him to do.

IDDM special issuance 3rd class *specifically* mention that the use of the medical is restricted to the USA. It says "NOT VALID OUTSIDE OF THE UNITED STATES" very clearly.

Reason being, FAA can derogate from ICAO rules as they please in their own territory, not so in foreign countries.

Wish I could be flying again single pilot private in Europe, but by the looks of it, I'll keep my 3rd class special issuance and happily fly in the US of A. Don't trust much EASA for such kind of changes, to be honest...

Nonetheless I fly from the right seat with friends, on their license! :ok:

Ciao, Luca

[helimutt]

Interestingly, I just asked my wife a simple question. "Would you be happy to fly in a commercial aircraft with two pilots up front both type 1 Diabetic?"

Her answer? Of course I would, why shouldn't I?

PS, She's Type 1 Insulin dependant, jut under 2 years, (no hypos so far requiring intervention etc)

[lucaberta]

She's Type 1 Insulin dependant, jut under 2 years, (no hypos so far requiring intervention etc)
your wife is of course well aware of the fact that type 1 diabetics nowadays are probably in better shape than a lot of "normal" pilots, given the number of checks we do for our health.

I do my blood tests every 90 days, and control my blood sugar a minimum of 5 times a day. And that does not take into account when I have to comply with the FAA special issuance of my 3rd class.

And with the introduction to market of Continuous Glucose Monitors, or CGMs, which provide readings every 5 minutes or even less, the excuse of a possible hypoglicaemia is now a load of BS.

http://www.dexcom.com/

Type 1 diabetic for 12 years, with my CPL/ME/IR/MCC done back then and high hopes to make it to the airlines, self-grounded at 27 with type 1 diabetes, got my 3rd class special issuance 2 years ago, happily flying in the US of A.

And I still fly microlights here in Italy, where medical regulations don't prohibit people with diabetes from flying. :ok:

12 years, never had an hypo.

No hopes that medical regulations in Europe will ever change. So I am more than happy to be flying in the US, and I do real IFR over there, without much hassle! :)

Ciao, Luca

[Captainkarl]

www.pilotswithdiabetes.com JOIN US. MAKE THE CHANGE HAPPEN NOW

[the bald eagle]

I was a private pilot untill 1999 when the CAA took my licence away from being from tablet controlled to Insulin dependent, Now we come under JAR i've got 2 hopes of ever getting it back and one of them is Bob!
However if i pay a large amount of dosh (again) i could get it back with an NPPL but then you can only fly solo which seems a bit strange amongst other restrictions, but from a previous posting by someone am i to believe that if i can convert my British PPL in to a FAA licence and take a FAA medical then will that allow me to fly even as an insulin dependant a "G" reg aircraft?
Also don't bother contacting AOPA on this as that bunch of :mad: want your money but the minute you want help/advice their far to busy saving the planet or what ever, needless to say i cancelled my membership with them

[Captainkarl]

you will be restricted to flying solo with your FAA license in UK airspace as pax carrying is only allowed on a FAA PPL in FAA airspace.

[Shunter]

Karl, I'd be interested to see the reference for that. There are plenty of people flying both G and N reg aircraft on their FAA PPLs, carrying passengers in the UK.

Someone with an FAA license, an FAA medical and an FAA aircraft is regulated almost entirely by FAA regulations, no matter what country they fly in. That's how ICAO works.

[Captainkarl]

Well the website page http://www.pilotswithdiabetes.com/pages/usa.html was written by Douglas Cairns whom has flown himself around the world while being a type 1 diabetic

The American Diabetic Association:

I. Restrictions on medical certification:

A. Individuals may be issued only a third-class airman medical certificate.

B. Individuals may exercise only the privileges of a student, recreational, or private pilot certificate.

C. Individuals are prohibited from operating an aircraft as a required crewmember on any flight outside the airspace of the United States of America.


http://www.diabetes.org/advocacy-and-legalresources/discrimination/employment/faa_protocol.jsp

[Shunter]

Interesting. Thanks.

[Captainkarl]

Not that I am a CAA/FAA enforcer :=, I myself am a type 1 diabetic:sad: and all for anyway to carry passengers in the UK:ok:, but surely some people have either found a loop-hope or flying illegally?!:confused:

[the bald eagle]

Thanks for the info CaptainKarl

I did some years ago find a loop hole where we could obtain a russian licence and fly with type 1 diabetes the snag was you had to do the air law exam again...in Russian! so that bollocked up that plan!!!

[Captainkarl]

lol... s*d that!:ok:

[ilikeplanes]

Hi all,

Just wondering if there are any airline pilots in Australia that have managed to retain a medical after being diagnosed with Type 1 Diabetes?

Thanks,

ilikeplanes

[Capt Wally]

That's a very good Q & I will be keen to find out myself seeing as the Aussie lifestyle (booze & little excercise) is rife these days!




CW

[QFcaptain]

Good friend of mine was battling a very well known case against CASA about a similar issue.He was fighting for his right to fly solo as a PPL with type 1 diabities but they wouldn't allow it unless he had a safety Pilot.So now after about 2 or more years of fighting, he has achieved success and can fly solo as a PPL.
CPL, especially airline flying would be out of the question as far as I'm aware.

qfskip

[Capt Wally]

yeah qfskip I thought too that that might be the case. Although as you would know once upon a time any med condition pretty much grounded flight crew. Open heart surgery now is possible with a full return to duties in many cases. Colour blindness also spelt the end for some but it's not as critical these days.



CW

[ilikeplanes]

QFcaptain and Capt Wally,
Thanks for the replies. I know for a fact that it is happening elsewhere in the world - medical is renewed "as or with co-pilot only" in Canada. This is however, only for pilots who are already working for an airline in a multicrew environment that get diagnosed. I believe Air Canada currently has 5 type 1 diabetics employed as pilots. It is very tightly monitored and controlled, and pilots are subject to more frequent medicals etc, but has been going on since 2004. I was just wondering if CASA are as forward thinking as the Canadians. Type 1 is actually very managable, contrary to popular belief. And with the massive increase in Type 2 diabetes diagnoses (lifestyle and age being the primary factors) there is more research than ever into the disease.
QFcaptain, you mention your friend who won the right to fly solo with type 1. Surely you must agree with me that this practice is more risky than working in a multicrew environment (all things being equal)? So again, i'd love to hear of anyone that has been granted approval in Australia for multicrew commercial operations, ie airline pilots. With this such a hot topic in the news at the moment, i thought it'd be great to hear from pilots who may have gone through this.
ilikeplanes

[mustafagander]

First lets be sure we are talking about the same thing.

Type 1 diabetes means insulin dependency - no insulin, you die in 3 weeks. The danger with type 1 diabetics performing any solo function is a "hypo". A hypo is a low blood glucose level, below that at which full mental and physical functioning is assured, which can end in death if not properly treated. Far too many type 1s die from massive hypos. They are often unpredictable, so the major defence is "feel funny", but this is unreliable when emotions intrude. Hypos can often be spotted by a trained observer. Initially a hypo can be a lot like hypoxia - inability to concentrate, poor co ordination, fixed ideas prevail etc. Most hypos are easily treated, traditionally it was jelly beans but 150ml fruit juice poppers are about the best nowadays.

There are 2 main types of insulin therapy - injection and pumping. Injection, even basal/bolus therapy is a rather blunt instrument, meaning hypos are rather frequent and stability is patchy. Pumping is very good, giving tight control of BGL but emotions can still blow you out of the water unexpectedly. Pumps also allow more than 1 insulin delivery programme to be selected so regular sport, pre menstrual hormone variations etc. can be accommodated.

Until last month I was strongly in favour of stable pumpers being allowed to fly under tight conditions - low insulin programme for flight, BGL and good sized snack within 30 minutes prior to flight, max 2 hours in the air before BGL and snack - for the basics. Then my daughter, a very stable pumper, had a massive hypo "out of the blue" which nobody saw coming and for which there was no obvious reason. I mean massive, comatose, fitting, the whole bit. All within 1h30 of her last BGL (normal) and breakfast. Were she flying as sole pilot she would quite simply have crashed. Now I just don't know, but I would never allow any of the non pilots in my family to fly with a diabetic pilot because of this experience.

So the point is that I can't see CASA ever allowing type 1 diabetic pilots to fly solo or have a professional licence, the risks are just too great IMHO.

[Richo]

Ilikeplanes

Unfortunatly not, CASA has ruled against this occuring. The case mentioned above not whistanding and the fact that the FAA(?) do allow some forms of daibeties for aircrew.
I know of a guy who developed type 1 as a mature adult, he lost his medical and subsequently his ATC rating. Mature onset type 1 is very nasty and you really should get some very good advice from your doc. My friend in the example above ended up loosing something a lot more valuable than his ATC rating!!

Pilots with Type 2 Diabeties are almost always restricted to two crew ops, where the second crew is endorsed on type. Basicaly as mentioned above.

I strongly sugest taliking to a DAME or give the CASA Medical branch a call and discuss it.

richo

[ForkTailedDrKiller]

Type 1 - not likely!

Dr :8

[ilikeplanes]

Mustafagander:

The collection of pilots elsewhere in the world are pumpers as far as i'm aware. They must maintain their BGL's slightly higher than that which is recommended (ie approx 7mmol) for the majority of the time which is obviously designed to reduce the risk of hypos. The downside of this is that it can lead to complications later in life. They also must test their blood up to 15 times a day when flying, have their blood glucose in the correct range before takeoff and landing, and carry snacks such as juice or jellybeans, as mentioned, and longer lasting complex carbs just in case. They also must demonstrate a history of no major hypos in a period leading up to re-validating a medical.
Now of course, there is always the chance of a type 1 diabetic getting a hypo at any time, but with such strict control it limits this possibility. You said your daughter is a very stable pumper, yet i'm assuming that she isn't adhering to the above mentioned guidelines as she is not a pilot? I know that this puts diabetics at a higher risk of incapacitation than a non-diabetic, but isn't that true for people that may have had a heart operation, or are diagnosed as clinically depressed, or any number or illnesses that previously would cancel a medical. It is through research that we learn new ways to manage and treat conditions, and hence rules change.

Richo:

I find it strange that you say mature onset Type 1 diabetes is nasty - is this just from your friends' experience? Age has no bearing on the "nastiness" (for lack of a better word) of the condition. What can make it nasty is if it isn't picked up in time and damage has already occurred to vital organs. There is absolutely no reason why a normal healthy person who is diagnosed with type 1 can't live a long, active and normal (apart from the daily insulin) life. With the advent of insulin pumps, it makes this all the more possible.

ForkTailedDrKiller:

Care to elaborate?

Ask any doctor, nurse, diabetic educator, endocrinologist and they'll all tell you the same thing - type 1 diabetes is a managable condition which patients have very good control over. Yes, it can lead to scary incapacitation if not managed accordingly, but as i mentioned before, there are plenty of other conditions that have the possibility of doing the same. With so much research into diabetes worldwide, surely a change of attitudes and policy is on it's way?

[Bob Murphie]

I think a few of you have already read this, but here is the link.

http://www.mckeown.com.au/articles/diabetic-pilots-final.htm

From what I can gather one win with the AAT does not make a precedent and each case must go through the execise of DAME etc to CASA Medical branch and then if you are knocked back, make your own submission to the AAT where any precedent is brought to the surface for comparison.

Thats my interpretation, but give the Barrister a call. He has had quiet a few wins of recent.

[Mr Bomb]

Ok so that covers Type 1 somewhat what about type 2 non-insulin dependant. Can they still hold a Class 1 Medical? Reason I ask is my mates son has Type 2 but is well controlled with diet only. He is wanting to get his CPL and be an instructor at this stage, but alas he is concerned about the Type 2.

Any comments or directions to this on CASA website. I have done a search for him, but the search function on the CASA website is not the friendliest...

Cheers
Mr B

[Bob Murphie]

Mate;

Ring McKeown on the link above.

Cheers,
Bob.

[cap2e]

It sure would be nice if the FAA would follow in the footsteps of ICAO and CAA and allow type 1 diabetics to fly.:ok:

[C172 Hawk XP]

follow in the footsteps of ICAO and CAA and allow type 1 diabetics to fly

The CAA (via JAA) do NOT allow type 1 diabetics to fly . . . . . .

. . . . . . . this is from the JAA Civil Aviation Medicine manual :


Type 1 diabetics requiring exogenous insulin are unfit to fly. The intrinsic risks of the disease itself
are further increased by that of hypoglycaemia. No present injection regime or insulin infusion
pumps are sufficiently efficient to act as an artificial pancreas. Nevertheless, progress in such
developments as islet transplantation may require consideration in the future

[Aer Doctor]

Any pilot requiring Insulin for control of Diabetes is not allowed to flying by any agency . Only Oral Hypoglycemic agents like Metformin is permitted that to in limited dosage.

[gingernut]

Unfortunately, the big issue, is that more and more NIDDM's will be converted to IDDM's.:(

Defyning diabetics as Type 1 or 2 probably isn't that helpful.

NIDDM's=Non Insulin Dependent Diabetic Mellitus
IDDM's= Insulin Dependent Diabetic Mellitus

Which raises a question for the AME's-do we let this man fly at the cost of his health? (or Vice Versa) :ugh:

A question which needs resolution.

[BeechNut]

I believe in Canada that an insulin-dependent diabetic can fly, provided (s)he is low-risk and previously held a class 1 medical. Also the license will be marked "as or with co-pilot".

So for all us scud-runners in spam cans we're out of luck, but an airline pilot may get to keep his license.

Relevant documentation:

TP 13312 - Handbook for Civil Aviation Medical Examiners (http://www.tc.gc.ca/CivilAviation/Cam/TP13312-2/diabetes/ITDM.htm)

[C172 Hawk XP]

I believe in Canada that an insulin-dependent diabetic can fly

Two points to note on this. I believe that approval for persons with IDDM to fly depends on their agreeing (by signing a legally binding document) to treat their diabetes sub-optimally on days when they intend to fly. Maintaining less than perfect control of the BS is thought to reduce the risk of a potentially catastrophic hypo attack. But the flip side of that is that frequent sub-optimal control probably increases the risk of developing some of the longer term complications of diabetes. Not a nice choice to have to make !

but an airline pilot may get to keep his license

Secondly, it makes much more safety sense to try this radical change, initially at any rate, in a multi-crew environment. That way, if the pilot with IDDM does have a hypo, the other guy is there to take over, and a certain disaster is avoided !

[FatFlyer]

It's good to let someone keep their medical/job if you possibly can and I am at the age where Diabetes is possibilty.

However, if you have ever seen someone have a hypo, it is often not just like the incapacition we practice in the sim where you pass out or don't respond.
They can become aggresive, impossible to reason with and completely unmanigeable through no fault of their own until there blood glucose is restored.

The thought of wrestling with the controls while the cabin crew struggle to inject them with glucagon is quite worrying. I would not like to fly, or fly with someone else with this condition.

[nuclear weapon]

I know someone who is hypo and has been flying commercially although not in Europe.

[C172 Hawk XP]

They can become aggressive, impossible to reason with and completely unmanageable, through no fault of their own until their blood glucose is restored

A brilliant resume, in literally one sentence, of just why the present regulations are in place !

Thank you. Have you ever thought of applying for a job at the JAA regulations drafting department ?

:ok: :ok:

I know someone who is hypo and has been flying commercially

. . . . . . not simultanously, one hopes.

[Flyin'Dutch']

Any pilot requiring Insulin for control of Diabetes is not allowed to flying by any agency . Only Oral Hypoglycemic agents like Metformin is permitted that to in limited dosage.

Incorrect.

The FAA allows IDDM pilots fly in US airspace; the Canadians will let them fly abroad. And the UK CAA will let insulin dependent pilots fly in UK airspace on a National PPL in the restricted category.

http://www.caa.co.uk/docs/49/SRG_MEDNPPLDiabetesV2.pdf

[DiabeticPilot]

Interesting post, do you have more info or a link for the Canadian licence. As stated elsewhere the US allow limited ops with type I diabetes, I think it is possible to instruct with diabetes there. And the UK allows you to fly light single engined planes on your own, without any passengers, on a NPPL.

Thanks in advance

[Flyin'Dutch']

No, dont have any more information on the Canadian situation.

Not sure if the FAA allows commercial ops for insulin dependent diabetics, but as I said before only allowed in US National Airspace.

The UK situation as you say.

See you are in Andorra; know nothing about the situation there.

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[whizzjet]

see:
http://www.diabetesvoice.org/files/attachments/article_37_en.pdf

Despite some of the hysterical comments above, diabetic control is now light years ahead of even 10 years ago. The chances of a professional pilot, including insulin dependent, having a Hypoglycemic attack are reduced to effectively zero. However, this is achieved by them demonstrating excellent, not good but excellent, blood sugar control for a substantial period before being granted a restricted "as or with a co-pilot" class I medical.

It is only logical that we will see a move to insulin dependent pilots flying with all classes of medical within the jar-ops/easa sphere. The question now is not so much the management of blood sugar control, but much more the monitoring and avoidance of diabetic complications. In the future this will be regarded in the same manner as flying on medication for high blood pressure.

[Saab Dastard]

Those with an interest in Type 1 diabetes and flying may be interested in this thread in the private flying forum:

http://www.pprune.org/private-flying/377841-diabetes-fundraising-record-flight-usa.html

SD