Applicants with a diagnosis of diabetes mellitus controlled by use of an oral medication may be considered by the FAA for Special Issuance of a Medical Certificate. Following initiation of oral medication treatment, a 60-day period must elapse prior to certification to assure stabilization, adequate control, and the absence of side effects or complications from the medication.
Initial certification decisions shall not be made by the Examiner. These cases will be deferred to the AMCD. Examiners may be delegated authority to make subsequent certification decisions, subject to AMCD review and consideration.
The initial determination of eligibility will be made on the basis of a report from the treating physician. For favorable consideration, the report must contain a statement regarding the medication used, dosage, the absence or presence of side effects and clinically significant hypoglycemic episodes, and an indication of satisfactory control of the diabetes. The results of an A1C hemoglobin determination within the past 30 days must be included. Note must also be made of the absence or presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying, but the disease(s) must be carefully evaluated to determine any added risk to aviation safety.
Recertification decisions will also be made on the basis of reports from the treating physician. The contents of the report must contain the same information required for initial certification and specifically reference the presence or absence of satisfactory control, any change in the dosage or type of oral hypoglycemic drug, and the presence or absence of complications or side effects from the medication. In the event of an adverse change in the applicant's diabetic status (poor control or complications or side effects from the medication), or the appearance of an associated systemic disease, an Examiner who has been given the authority to issue a certificate pending further review and consideration by the AMCD must defer certification to the AMCD.
If, upon further review, it is decided that recertification is appropriate, the Examiner may again be given the authority to issue certificates (subject to AMCD review and consideration) based on data provided by the treating physician, including such information as may be required to assess the associated medical condition(s).
As a minimum, followup evaluations by the treating physician of the applicant's diabetes status are required annually for all classes.
Airmen who are diabetics should be counseled by Examiners regarding the significance of their disease and its possible complications. They should be informed of the potential for hypoglycemic reactions and cautioned to remain under close medical surveillance by their treating physicians. They should also be advised that should their oral hypoglycemic be changed or dosages modified, they should not perform airman duties until the treating physician has concluded that their conditions are under control and present no hazard to aviation safety. Airmen who use insulin for the treatment of their diabetics, may only be considered for special issuance for third-class medical certification.
