At one point, it was not possible for people with diabetes to become pilots in any capacity.
Thankfully, this is changing, so anyone with diabetes can become a pilot of even a commercial airliner, though the process is more stringent for diabetics.
To become a pilot, a medical certificate is required that involves passing a medical exam.
A private pilot requires a third class medical certificate; a commercial pilot requires a second class medical certificate, and an airline pilot requires a first class medical certificate.
The Rules for Diabetec Pilots
There are two types of diabetes: insulin-dependent (Type 1) and non-insulin dependent (Type 2).
Type 1 Diabetes
For insulin-dependent diabetics (aka type 1 diabetics), only a class III Special Issuance is allowed.
In other words, type 1 diabetics can only become private pilots (at least this was previously the case).
However, there is no guarantee that every insulin dependent diabetic will be granted this Special Issuance.
It is only available to those who:
- Have demonstrated excellent control of their diabetes
- Are meticulous in their insulin and dietary management
- Have no episodes of hypoglycemia
- Have no other significant medical problems that would interfere with their disease management
There are also rules concerning checking blood sugars prior and during flight, and prior to landing.
However, since 2019, the FAA announced a protocol that would allow insulin-treated diabetics to also potentially obtain first and second-class medical certificates that would allow them to exercise the privileges of commercial and airline transport pilot licenses.
Type 2 Diabetes
For non-insulin dependent diabetics (aka type 2 diabetics) who are able to control their blood sugar by diet and exercise alone, all classes of medical certificates are allowed.
In other words, it’s possible for type 2 diabetics to obtain private, commercial, and airline transport pilot licenses without having to go through a thorough process as type 1 diabetics.
If a diabetic is able to control their diagnosis of diabetes through the use of an oral medication, a Special Issuance may be considered for all three classes of medical certification.
However, according to the FFA:
“Following initiation of such oral medication, a minimum 60-day period must elapse prior to certification to assure stabilization, adequate control, and the absence of side effects or complications from the medication.”
Becoming an Airline Pilot With Diabetes
According to the FAA, only “a subset of low-risk applicants whose glycemic stability is sufficiently controlled” and those who can “safely maintain diabetic control for the duration of a commercial flight” are able to become airline pilots.
Criteria used to evaluate whether a type-1 diabetic can become an airline pilot includes:
- A full report from the treating and board-certified endocrinologist
- Passing comprehensive laboratory benchmarks
- Submitting blood sugar glucose monitoring data
- Continuous glucose monitoring data for at least the preceding 6-months that identifies continuous glucose monitoring and actions taken to deal with incidents of low or high glucose levels
- An eye test
- A cardiac evaluation
It is now possible to become an airline pilot with diabetes due to:
“Recent advances in technology and diabetes medical science have allowed the FAA to develop an evidence-based protocol that can both identify a subset of low-risk applicants whose glycemic stability is sufficiently controlled and also ensure these pilots can safely maintain diabetic control for the duration of a commercial flight.”
The U.S. is Behind the Rest of the World
Other countries have long been ahead of the U.S. when it comes to diabetic pilots.
In 2012, Canada relaxed its restrictions for type-1 diabetics, so they could become airline pilots.
Pilots in the UK, Australia and New Zealand could also become airline pilots soon after the ruling was made in Canada.
Ironically, type-1 diabetics could also pilot a commercial airliner into US airspace.
Why it’s Harder to Become a Pilot With Diabetes
According to the Federal Air Surgeon, Michael Berry, it is more challenging to become a pilot with diabetes because:
“A hypoglycemic event, which can result in impaired cognitive function, seizures, unconsciousness, and even death, that occurs in the cockpit of a commercial flight has the potential to place the safety of hundreds of individuals in jeopardy.”
How FAA Tests Pilots for Diabetes
When you take a medical exam, there is a urine test.
However, this urine test doesn’t test for drugs, it tests for sugars and proteins as possible indicators of diabetes or kidney disease.
Some people looking to obtain a medical certificate for flying actually first find out that they have diabetes through this test, which can be very disconcerting, as you can imagine.
Related: Do Pilots Get Drug Tested?
Other Disqualifying Conditions for Pilots
Besides diabetes, substance use and dependence, and mental health conditions, other disqualifying conditions include:
- Angina pectoris
- Bipolar disease
- Cardiac valve replacement
- Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant
- Disturbance of consciousness without satisfactory explanation of the cause
- Heart replacement
- Myocardial infarction
- Permanent cardiac pacemaker
- Transient loss of control of nervous system function(s) without a satisfactory explanation of the cause
Fighter Pilots Aren’t Allowed to Have Diabetes
If someone has any form of diabetes, they cannot become a fighter pilot.
In fact, if they have diabetes, they can actually not serve in the military at all except for civilian positions within the Department of Defense.
If someone develops diabetes while serving, it is not necessarily grounds for disqualification.
The person must undergo an individual assessment, known as a Medical Evaluation Board (MEB), to demonstrate that they can continue to meet medical standards.