Diabetes case-based scenario

At 65 years old, Roger runs a 300,000-hectare cattle station in Western Australia and uses 2 aircraft on the property including a helicopter and a fixed wing, 4 seat single engine aircraft.

Roger has held a Private Pilot’s Licence for 25 years with a Class 2 medical certificate. Every 2 years, Roger visits his Designated Aviation Medical Examiner (DAME) to renew his medical certificate.

After noticing some changes in his wellbeing, Roger sought the advice of GP who ordered a series of tests. Roger soon learned he had type 2 diabetes.

'I started getting leg cramps, fatigue in flight and occasional blurry vision, 'Roger said. 'When they told me I had type 2 diabetes, I thought I wouldn’t be able to fly again.’

Understanding his diagnosis

Diabetes is a condition where the insulin produced is insufficient to meet the body's needs and does not work effectively.

Type 2 diabetes is the most common form of diabetes and has a strong hereditary component. Several members of Roger's family have the disease which makes him at high risk of developing the condition.

The risk of contracting type 2 diabetes increases when associated with lifestyle factors, including:

  • high blood pressure
  • being overweight or obese
  • insufficient physical activity
  • poor diet
  • extra weight around the waist.

The GP referred Roger to a diabetes educator to help him learn about:

  • type 2 diabetes and its management
  • how to use a glucometer
  • community support services available.

The GP also recommended Roger change his lifestyle and start monitoring his blood glucose levels.

Visiting the DAME

Roger contacted his DAME and told him of his new diagnosis.

The DAME notified Aviation Medicine (AvMed) of a change in Roger’s medical condition as per the Civil Aviation Safety Regulations.

The DAME told Roger not to fly until he received a clearance either from CASA or the DAME himself.

The DAME provided Roger’s GP and diabetes educator reports to AvMed for their review.

To check for heart disease, CASA also asked Roger to do an exercise stress test which he passed.

Cleared for flying

CASA assessed Roger’s risk of having an acute medical incapacitation episode, as a complication of his diabetes and its treatment, in the next 12 months. As such, there were no operational restrictions to his medical certificate.

The information on the CASA website helped Roger’s DAME to minimise the length of time he was grounded. Roger began flying again within a fortnight of the notification to CASA.

As a low-risk diabetic, Roger has to provide CASA with an annual:

  • report from his GP describing the management of his diabetes
  • assessment of his cardiovascular risk score from his DAME.

Roger must also notify his DAME or CASA about any changes to his condition or treatment such as prescribed diabetes tablets or insulin. CASA monitors pilots and controllers on diabetic medications in case of hypoglycaemic episodes.

As the disease progresses, AvMed may also request specialist reviews from an:

  • endocrinologist (hormone specialist)
  • cardiologist (heart specialist)
  • ophthalmologist (eye specialist)
  • nephrologist (kidney specialist).

‘Having diabetes is bit of a pain,' Roger said. 'Luckily with a few simple lifestyle changes, I’m able to fly again. I hope to be able to continue to fly for many years to come.'

Online version available at: https://www.casa.gov.au//resources-and-education/publications-and-resources/aviation-medicine-fact-sheets-and-case-studies/diabetes-case-based-scenario
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