Type 2 Diabetes - Non-insulin dependent - High risk of hypoglycaemia

Guidance for medical examiners when assessing a patient for either a general topic or condition - hypoglycaemia.

See also:

Definition

This guidance should be used for applicants treated with any of:

  • Sulphonylureas
  • Glitazones
  • Glinides.

Aeromedical implications

Effect of aviation on condition

  • Difficulty with regular blood-sugar monitoring
  • Irregular meal and sleep times
  • Sedentary occupation
  • Access to emergency sugar

Effect of condition on aviation

  • Overt incapacitation
    • Cardiovascular event
    • Cerebrovascular event
  • Subtle incapacitation - end-organ damage
    • Visual impairment (fields, low contrast sensitivity, colour)
    • Impaired motor and sensory nerve function
    • Impaired autonomic function (hypoglycaemia awareness).

Effect of treatment on aviation

  • Loss of consciousness due to hypoglycaemic event

Approach to medical certification

Most information derived from assessments already undertaken as part of best-practice management guidelines. See Diabetes Australia and RACGP for guidance.

  • Based on the condition
    • confirmed diagnosis
    • complications of diabetes (eye, heart, brain, kidney)
    • hypoglycaemia awareness and absence of autonomic neuropathy
  • Based on Treatment
    • no hypoglycaemic episodes within previous 12 months
    • absence of significant side effects
  • Demonstrated Stability
    • HbA1c less than 7.5%
    • record of blood sugar stability without hypoglycaemia.

Risk assessment protocol - information required

New cases

  • Treating doctor report (GP or Endocrinologist) detailing:
    • current status of diabetes
    • episodes of symptomatic or biochemical hypoglycaemia / hyperglycaemia in the preceding 12 months and treatment required
    • assessment of control, HbA1c and glucose monitoring diary
    • evidence of end-organ damage (kidneys / eyes /erectile dysfunction)
    • treatment
    • follow-up recommendation
  • Ophthalmologist or Credentialed Optometrist report detailing:
    • isual acuity (with and without correction)
    • Retinal disease
    • pressures (and treatment if required)
    • any other ophthalmic pathology (fields / contrast sensitivity / colour vision)
  • DAME assessment of the cardiac risk index. (Diabetes, impaired glucose tolerance and impaired fasting glucose all carry 3 points). If more than 14, a Cardiologist report on:
    • any confirmed diagnosis
    • clinical status including any symptoms (chest pain, dyspnoea, palpitations etc)
    • investigations conducted including the results of a recent stress test
    • management:
      • control of risk factors
      • treatment and any side-effects
      • monitoring
      • risk of any acutely disabling cardiovascular event
  • Certification of completion of a diabetic counselling course from a diabetes educator
  • Glucose monitoring diary or printout.

Renewal

Class 1 and 3: 12 monthly reports required.

Class 2: 12 monthly reports. Eye report 24-monthly unless end-organ damage evident

  • Treating doctor report (GP or Endocrinologist) detailing:
    • current status of diabetes
    • episodes of symptomatic or biochemical hypoglycaemia / hyperglycaemia in the preceding 12 months and treatment required
    • assessment of control, HbA1c and glucose monitoring diary
    • evidence of end-organ damage (kidneys / eyes /erectile dysfunction)
    • treatment
    • follow-up recommendation
  • A report from an Ophthalmologist or Credentialed Optometrist detailing:
    • visual acuity (with and without correction)
    • Retinal disease
    • pressures (and treatment if required)
    • any other ophthalmic pathology (fields / contrast sensitivity / colour vision)
  • An assessment by the DAME of the cardiac risk index. IF more than 14, a report from a Cardiologist with respect to:
    • any confirmed diagnosis
    • clinical status including any symptoms
    • investigations conducted including the results of a recent stress test
    • management:
      • control of risk factors
      • treatment and any side-effects
      • monitoring
      • risk of any acutely disabling cardiovascular event
  • Glucose monitoring diary or printout.

Indicative outcomes

  • On diagnosis, DAME should inform CASA Aviation Medicine Section and advise applicant not to exercise the privileges of their licence until cleared to do so by CASA.
  • Medical certification limited to 12 months duration, on a case by case basis, with restrictions and limitations reflecting the level of control and identified complications.

Favourable

  • Absence of hypoglycaemic episodes
  • Absence of complications of diabetes
  • Satisfactory control of glucose
  • Complete and consistent personal glucose monitoring
  • Good understanding of personal management of diabetes

Unfavourable

  • Hypoglycaemia and hypoglycaemic unawareness
  • End-organ damage
  • Poor or unpredictable glucose control
  • Absent or inconsistent personal glucose monitoring.

Pilot and controller information

  • Type 2 diabetes is an aeromedically significant medical condition. Pilots and controllers who have been diagnosed with Type 2 Diabetes are required to ground themselves and notify this condition to their DAME
  • When an applicant’s medication is changed, or when its dosage is changed, they must not exercise the privileges of their medical certificate until cleared by their DAME
  • Monitoring is modelled on Diabetes Australia and the Royal Australian College of General Practitioners recommended practice to minimise additional requirements for aeromedical certification

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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