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UK To Issue Medicals To Pilots And Air Traffic Controllers With Diabetes
By Mike Mitchell

August 14, 2012 - Pilots and air traffic controllers with diabetes treated with insulin (and other medications that significantly lower blood glucose), may now be considered for medical certificates by the UK Civil Aviation Authority (CAA), it was announced on Monday.  

Until now, only a limited number of medications for the treatment of diabetes have been allowed for pilots and air traffic controllers (ATCOs) applying for Class 1, 2 and 3 medical certificates.

However, over recent years there have been advances in the treatment and monitoring of the disease, allowing the control of the condition and any complications to be managed more effectively. The decision should allow more licensed pilots and ATCOs, who have diabetes, to continue to undertake operational duties safely.  


Individual diabetic applicants who are granted medical certificates under the new protocol will, however, be subject to a rigorous monitoring regime, including demonstrated stability of their condition, and regular blood sample self-testing during flight/duty. This is to ensure that an individual does not begin a flight or shift with too high, or too low, a sugar level, and that a safe level is maintained.  

The UK Civil Aviation Authority will provide guidance information within the next several days’ pilots and ATCOs setting out the new procedures to follow. This includes the application of operational restrictions and in-flight testing regimes.  

Dr Stuart Mitchell, Head of the Authority Medical Section of the CAA’s Medical Department, said “This decision will benefit many qualified pilots and air traffic controllers, who are currently restricted to non-operational duties because of their diabetes. With the appropriate level of monitoring to ensure safety standards are met, we believe it is right that these experienced individuals are allowed to contribute their valuable skills and knowledge in their chosen field.”

The FAA has established a policy that permits the special issuance medical certification of insulin-treated applicants for third-class medical certification. Consideration is only given to those individuals who have been clinically stable on their current treatment regimen for a period of 6 months or more. Consideration is not being given for first- or second-class certification.  



Individuals certificated under this policy will be required to provide substantial documentation regarding their history of treatment, accidents related to their disease, and current medical status. If certificated, they will be required to adhere to stringent monitoring requirements and are prohibited from operating aircraft outside the United States. The following is a summary of the evaluation protocol and an outline of the conditions that the FAA will apply:

Initial Certification

1. The applicant must have had no recurrent (two or more) episodes of hypoglycemia in the past 5 years and none in the preceding 1 year resulting in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness).

2. The applicant will be required to provide copies of all medical records as well as accident and incident records pertinent to their history of diabetes.

3. A report of a complete medical examination preferably by a physician who specializes in the treatment of diabetes will be required. The report must include, as a minimum: 

- Two measurements of glycated hemoglobin (total A1 or A1c concentration and the laboratory reference range), the first at least 90 days prior to the current measurement. 

- Specific reference to the applicant's insulin dosages and diet. 

- Specific reference to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy. 

- Confirmation by an eye specialist of the absence of clinically significant eye disease. 

- Verification that the applicant has been educated in diabetes and its control and understands the actions that should be taken if complications, especially hypoglycemia, should arise. The examining physician must also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes. 

- If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test. 

- The applicant shall submit a statement from his/her treating physician, aviation medical examiner, or other knowledgeable person attesting to the applicants dexterity and ability to determine blood glucose levels using a recording glucometer).

The FAA recommends that the medical information and Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate (FAA Form 8500-8) be submitted prior to beginning or resuming flight instruction or training. 

The CAA is the UK's specialist aviation regulator. Its activities include making sure that the aviation industry meets the highest technical and operational safety standards; preventing holidaymakers from being stranded abroad or losing money because of tour operator insolvency; planning and regulating all UK airspace; and regulating airports, air traffic services and airlines and providing advice on aviation policy from an economic standpoint.
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