Diabetes is an increasingly common condition that comes up for discussion. Diabetes mellitus treated with oral medications or insulin is one of the FAA's 15 specifically disqualifying medical conditions. These conditions (and others beyond the 15) require a special issuance from the FAA called an AME-Assisted Special Issuance (AASI).
Diabetes requiring oral medications requires an annual update from your doctor and a current hemoglobin A1c level. Glycated hemoglobin is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. Hypoglycemia is a much more dangerous condition than hyperglycemia, or high blood sugar, so the FAA does not want an airman to become hypoglycemic while in flight. A normal value for HgA1C is usually below 5.7 percent. Recall that in the past I told you that the FAA airman medical exam is not a preventive medicine examination, and for that reason, the FAA will allow the A1c level to be as high as 8.9 percent. Beyond that though, they will deny the airman for poor control.
What does the FAA want to see in this “current status report”? They want the treating physician to comment on when you developed the condition, and what symptoms you were having at the time. Also, the report should include a comment on all the medications you are taking for the diabetes and any other conditions as well. The physician needs to note whether you are having any complications of the diabetes, specifically eye disease (called diabetic retinopathy), cardiovascular disease, kidney disease, or neurological conditions. There also should be a note regarding any episodes of low blood sugar (hypoglycemia). The FAA has created a chart of the common medications used and the acceptable combinations of these medications. Note, however, that the FAA will not grant a special issuance for more than three medications taken concurrently. The FAA consultants feel that if an airman needs to take more than three medications, the diabetes is not really adequately controlled for aeromedical certification purposes.
And finally, as a reminder, the FAA considers a “current status report” to be no older than 90 days when it is submitted for special issuance consideration.