Covering up an illness to gain a Class One Medical.

[goatface]

I have Type Two Diabetes - at the moment it's diet controlled, but invariably - due to my age, in due course I will have to take tablets for the condition and possibly at a later date, inject insulin, although that depends upon advances in medicine etc.

I have frequently posted on the Medical and Health Forum to assist and give informal advice to anyone who suddenly finds themselves in the same situation, it was a tremendous shock to me and I'd like to think that now I have the situation under control, I can help out.

Recently, I've been approached by several different individuals (via PMs) asking if there's any way of covering up the symptoms of diabetes in order to progress from a Class two to a Class one Medical Certificate, so that the person involved can go forward to either be sponsored for, or join an approved course for an ATPL.

The honest answer is yes, if you stick to a healthy diet, keep fit etc, then there's a very good chance that your urine sample will be clear and the problem won't be picked up.
My moral problem is that, although I have come through all the obstacles - which was an extremely stressful time for me - there probably are easy ways of masking the majority of medical problems if you knew the way to do it, the internet being of great assistance.

I am an ATCO, so if suddenly didn't feel well, I know that I would always have back up to take over if required.

As I've pointed out to all the people who've approached me, they could well be in the air when they throw a wobbly and have no one to help out, the fact they could even consider taking such risks is unthinkable but they are out there and, by the lack of responses, they don't seem to care.

I know that such folk are in a very small minority, but it seems that they are all younger pilots who are keen to cover up a known condition in order to progress career wise, whatever the cost - and that is very worrying.

[HEATHROW DIRECTOR]

I wonder how someone who had "covered up" an illness would feel if his wife and kids were on an aeroplane piloted by such an irresponsible person?

I was an ATCO and always believed in telling the docs everything; I couldn't have lived with myself otherwise.

A good friend and colleague of mine had diabetes and appeared to be one of the fittest amongst us..... until he died suddenly.

[Flight Safety]

Type 2 Diabetes is cureable in the majority of cases with weight loss and lifestyle changes. I suggest you try this approach. In the majority of cases Type 2 Diabetes is life style caused, therefore lifestyle cured.

[niknak]

Type 2 Diabetes is cureable in the majority of cases with weight loss and lifestyle changes. I suggest you try this approach. In the majority of cases Type 2 Diabetes is life style caused, therefore lifestyle cured.

Complete nonsense!:ugh:

There is no "cure" for any sort of diabetes, although type two can be controlled with a sensible lifestyle and diet.

[Pilot DAR]

Not to sound un-empathetic, but is there also a thread on how to conseal damage in aircraft, so the next pilot takes it, and we don't get blamed for the damage? It's about the same attitude...

[BEagle]

And the fine for making a false declaration on your medical application is.......

[Rodent1982]

I'd hope it would be more than a fine for knowingly putting you passengers in a dangerous situation!

Young'uns today just don't give a :mad:

I remember hearing on the radio that they had found a cure, or are close to a cure for a type of diabeties? Correct me if I'm wrong.

[sleemanj]

I remember hearing on the radio that they had found a cure, or are close to a cure for a type of diabeties? Correct me if I'm wrong.

Diabetes is not really "curable", it is treatable, but curable not so much.

Here's the ultra brief break down of diabetes:

Type 1: The insulin producing cells in your pancreas have died. You must manually give yourself insulin several times a day, for the rest of your life, you will be permanantly aware of and thinking about your diabetes, every thing you do, eat and drink will be accompanied by a mental conversation about how this affects your diabetes, even what time you go to sleep and get up will be subject to your diabetic requirements. If you are lucky or wealthy you might get to wear an insulin pump, attached like a life giving umbilical to constantly feed insulin under your skin.

Unfortunately, it's hard to manage type 1 very well with present technology, even if you have a pump. It's like using a sledge hammer to hit a tack.

Potential for "cure" is presently limited to pancreatic transplant, the cure is worse than the disease and really only done at the same time as a kidney transplant.

Long term "as good as the real thing" treatment is getting closer though with the potential for xeno transplantation of pig islets (insulin cells) into patients, the cells are from a special group of pigs which are bred in NZ under strict quarantine, the cells ecapsulated in a membrane which disguises them to avoid rejection problems, then injected. They can last maybe months or longer, working just like the real things, or at least helping. By closer, I mean that human trials are going to start again soon, but I could see it being a decade from actual general usage.

Type 2: Your insulin producing cells don't produce enough insulin, or your body isn't sensitive enough to the insulin, meaning that you must use a combination of diet, exercise and possibly oral medication to reduce your insulin requirements or increase your sensitivity. In more serious cases supplemental insulin maybe required. Managing type 2 is I think it would be fair to say, an easier affair.

The danger with diabetic pilots, particularly type 1, is that of sudden incapacitation due to low blood sugar. When somebody runs low on blood sugar their brain goes a bit crazy (quite like hypoxia really), possibly without realising it you will make mistakes, and it's a very quick journey from being a little bit low to being "that's funny, why is the ground getting bigger, what am I supposed to do with this stick thing again, is it push forward or pull back" low, a few minutes.

To the subject at hand:
I am a type 1 diabetic, even if I *could* hide the condition, which is impossible (maybe for type 2 you could), I would not, because quite simply, whilst I don't LIKE that I don't have some of the options in life that others do with regards to flying and other occupations/recreations like this, I do ACCEPT that the reasons for this are well founded.

I am permitted to fly microlights in New Zealand (and this is the case in most countries I believe, for various definitions of microlight), and could - should I get my doctors approval and appropriate ratings - take a passenger, however I personally would not be comfortable in doing so unless that passenger was also a pilot, and even then they would be well briefed. I have to accept that there is the possibility, no matter how good I could be at diabetic control (and I'm not that good at all), that I could make one single slip up, take a double dose accidentally, and the show comes to a sticky end if that kicks in at X000 feet without me noticing it quickly.

I don't mind increasing the danger to myself to a degree, I do not however wish to cause increased risk to innocent passengers.

As a result, in my opinion, Diabetics like myself (and others with similar disqualifying conditions) need to accept that, yeah, it really really sucks, but it's the right and just thing that they are disqualified.

[Barnaby the Bear]

I wonder how someone who had "covered up" an illness would feel if his wife and kids were on an aeroplane piloted by such an irresponsible person?

Its equally bad for the unsuspecting public on the ground which are potentially put at risk.

[Rodent1982]

Thanks for the info sleemanj, and sorry to hear you have it mate.

I know I did hear something about 'cure' and 'diabetes', not so long ago, I think this is what they were talking about on the radio a couple of months ago now.

Stem cells used 'to cure diabetes' (http://www.nhs.uk/news/2009/04April/Pages/StemCellDiabetesTreatement.aspx)

[Sir Niall Dementia]

A former chairman of the PFA got caught making a false declaration on his medical about diabetes if I remember correctly. The fine was a monster with costs added.

I once flew with a colleague who had been covering up migraines for years. No-one knew until the day he threw a grand mal epileptic fit shortly after take off with a full load of pax on board. According to one of the doctors I met that day migraine and epilepsy are related. I was relieved to get the aircraft on the ground and bloody angry when I found out what he had done. If he had been alone the consequences would have been horrific.

[Bealzebub]

the Air Navigation Order 2005 is the statutory instrument covering this matter:
(4) A person shall not be entitled to act as a member of the flight crew of an aircraft registered in the United Kingdom if he knows or suspects that his physical or mental condition renders him temporarily or permanently unfit to perform such functions or to act in such capacity.

The certificate (if issued) would therefore be effectively suspended. Procuring a certificate by non disclosure or concealment of a known condition would lay the offender open to possible criminal charges as well as the withdrawal of whatever benefit they had wrongly procured by virtue of that action. Therefore all a bit pointless.

I think most sensible people would agree that anyone considering this type of fraud would be eminently unsuitable for the position they were seeking.

[wings folded]

In my case it was not a class one medical (rather the PPL medical) and not diabetes, just a worsening, due to age, of a congenital malformation with secondary effects.

It was suggested to me, to my horror, that if I went to see the right medic, I would get my medical nodded through.

I loved flying, but would not want to be solo, holding a yoke with hands and arms that no longer always respond to control inputs, if you see what I mean.

So I stopped flying.

I keep a little bit in touch through this forum.

It is pleasant, but not quite the same.

[gingernut]

Bit of an naieve question, but does type II (diet or tablet controlled) stop you flying?

And if so, why?. I can understand the issues with type I, what's the issue with type II?

[goatface]

Gingernut.

A perfectly sensible question I would wager.

For the most part, you can still fly if you are taking tablets, although if it's on a class one medical for commercial purposes, you may be restricted to two crew operations but most non commercial flying can be done as single pilot Ops.
The WHO (World Health Organisation) now recommend that type 2 diabetics over the age of 40 are also prescribed statins and blood pressure tablets, if and when you start taking these - along with the above - the Medical Branch usually insist upon you taking a 7 day break from flying or controlling duties just to ensure that there are no side effects.

[gingernut]

Hmmm, I'm a bit puzzled.

I guess that the authorities main concern is to forsee (and prevent) incapacitation at the wheel, stick or yoke. Fair enough in insulin controlled diabetes.

I'm trying to work out why type II diabetics would be more at risk of this.

Ketoacidosis is unlikely. And it's onset is likely to be slow.

Hypoglycaemia isn't an issue with dietary control and metformin, and I've never known it with sulphonylureas. (eg gliclazide).



So, I'm puzzled, what's the issue.:confused:

(It's an important point- as we lower the threshold for diagnosis, and we continue to play on x-boxes and eat supersized take away's, it'll affect more and more of us.)

[11daysoff]

I'm a diabetic in the USA on metformin and byetta and hold a 1st class medical. Insulin is allowed for a 1st class in Canada as long as you are well controlled. Hopefully, someday it will be allowed all over the world.

This numb-nuts didn't help our cause.
Former Cape Air pilot sent to prison | CapeCodOnline.com (http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20080322/NEWS/803220323)

In closing, not the best idea to cover up when you knowingly have a disease, unless you like prison food. On the flip side, they do give you three square meals a day.

[Old Smokey]

Gingernut,

Your quote - "Hypoglycaemia isn't an issue with dietary control and metformin, and I've never known it with sulphonylureas. (eg gliclazide)"

My family is rife with diabetes, my father (Type I), my cousin (Type I), my daughter (Type I), and my wife Type II.

My cousin and my daughter had to quit flying when diagnosed as Type I, top marks to them that they did so responsibly without trying to hide it.

Getting back to your query, my wife with Type II diabetes with dietary control and Metformin prescribed, has some "very near" hypoglycaemic attacks from time to time, particularly if carbohydrate intake has been low. Whilst it should be theoretically impossible for her to suffer a "full blown" hypo, her blood glucose reading at the time has been as low as 2.8 mmol/L (Please convert if you use another system of management). If my father or daughter reached that level, they'd be walking on the ceiling!

My top marks go to the many VERY responsible people in this thread who have accepted their condition, and acted responsibly in withdrawing from flying. It will be my turn one day, genetics say so! (So far so good).:ok:

Regards,

Old Smokey

[gingernut]

I do think it's an important issue for pilots for the reasons stated-of course, public safety is paramount, but is it always justified to take away peoples careers in these circumstances.

We have to be careful about going down the route of relying on blood sugar measurements, we need to be looking at the outcome itself.

I'm not sure what a "near hypo" actually is, and I'm unsure if you can rely on a correlation between your wifes blood sugar and her symptoms.

As far as I can ascertain, metformin and/or diet control do not result in hypo's. I'm not sure if anyone has anything more scientific to rely upon other than my experience and the BNF.

Type I, of course, is a seperate issue.

[Old Smokey]

Hi Gingernut,

What I describe as a "near hypo" in my wife's case includes shakiness, cold sweat, feebleness, and a degree of confusion whilst still remaining mentally coherent. If I saw the same symptoms in my Type I Father and Daughter, they would (by my description) be "near hypo" and about 10 minutes away from the real thing.

My wife recovers very rapidly after high Carbohydrate intake .... well, she is a bit odd, she married me after all :ok:

My wife's blood glucose levels vary between 2.8 to 11.0 Mmol/L, so the higher reading eliminates any thoughts of her being a "borderline" Type II. Type II is rampant in her family, whilst Type I is in mine.

Regards,

Old Smokey

[11daysoff]

You have to realize that a pilot who takes care of their diabetes is going to watch their numbers much more closely than any other diabetic. Type 1's can hold a 1st class medical in Canada but are required to check their blood sugars 1/2 hour prior to departure, every hour enroute, and 1/2 hour before landing along with other requirements. Also, with new CGM (continuous glucose monitors), it's very difficult to have a low. If your career depends on it, it's amazing how much better you can control your diabetes. Just my opinion.