Diabetes is a chronic condition, meaning it can stay with an individual for a lifetime.
For our bodies to work properly we need a hormone called insulin to convert glucose (sugar) from food into energy. Diabetics either don’t produce insulin at all, or else don’t produce enough to keep their bodies functioning properly.
Blood glucose levels are higher in people with diabetes because they can’t convert the glucose found in foods like breads, cereals, fruit, starchy vegetables, legumes, milk, yoghurt and sweets into energy.
Type 1 diabetes
In type 1 diabetes, the pancreas stops making insulin. Since the cells can’t turn glucose into energy, the body burns fats instead. People with type 1 diabetes need daily injections of insulin (up to four times a day) to prevent a buildup of dangerous chemicals in their blood which can cause a life-threatening condition known as ketoacidosis. They must test their blood glucose levels several times daily. Type 1 diabetes typically starts to affect people before they reach 30, but can occur at any age. About 10-15% of all cases of diabetes are type 1.
Type 2 diabetes
In type 2 diabetes, the insulin the pancreas produces is not enough to meet the body’s needs and does not work effectively. The most common form of diabetes, type 2 affects up to 90% of all people with diabetes. While it usually affects older adults, growing numbers of younger people, even children, are getting type 2 diabetes.
The effect of aviation on the condition
- People with both type 1 and 2 diabetes - whether they need insulin or not - can be adversely affected by irregular meal and sleep times.
- The sedentary nature of aviation can be detrimental to these conditions.
- Insulin-dependent diabetics (type 1 or 2) may also experience difficulty with regular blood-sugar monitoring.
- Diabetics at high risk of hypoglycaemia can be compromised by a lack of access to emergency treatment (e.g. glucose and glucagon) in flight.
The effect of the condition on aviation (types 1 and 2)
- 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).
The effect of treatment on aviation
- Insulin dependent diabetics (type 1 or 2) risk loss of consciousness due to a hypoglycaemic event.
- Non-insulin-dependent type 2 diabetics with a low risk of hypoglycaemia risk side-effects including an elevated glycemic index (GI) and pancreatitis.
Implications for pilots and controllers
- Pilots and controllers who have been diagnosed with type 1 or type 2 diabetes must ground themselves and notify their Designated Aviation Medical Examiner (DAME) of this condition.
- The type 1 diabetes protocol is only applicable for Class 2 (private) pilots. Not all pilots may be able to satisfy the entry or ongoing requirements in the protocol.
- Diabetes treated with insulin does not meet the medical standards. However Class 2 applicants may be considered in some circumstances.
- Type 2 certificate duration is limited to 12 months because of the variable nature of the condition and its complications.
Approach to medical certification
More likely to be certified
You are more likely to be certified or re-certified if you can show:
- 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.
Less likely to be certified
You are less likely to be certified or re-certified if you have:
- hypoglycaemia and hypoglycaemic unawareness
- end-organ damage
- poor or unpredictable glucose control
- no, or inconsistent personal glucose monitoring.
You are unique
Every case of diabetes is different. How you are affected by diabetes will depend on a range of circumstances. CASA makes aeromedical decisions on a case by case basis. A particular assessment decision is based on the individual circumstances of the applicant under consideration.
For further information see: