Pilots and Diabetes Discrimination

The Federal Aviation Administration (FAA) identifies insulin use as an absolutely disqualifying condition to receiving a medical certificate to operate aircraft. Through its special issuance procedures however, pilots with diabetes who use insulin may apply for a third class medical certificate. This means that pilots are eligible to perform private and recreational operations, fly as a student pilot, flight instructor and as a sport pilot. In April 2015, the FAA revised its policy to state that it will provide consideration for pilots applying for first and second class certification "on a case by case basis."

The Association's position is that individual assessment of people with diabetes is the appropriate approach to determining whether a person is qualified to perform certain activities. The FAA requested that the Association convene an Expert Panel to form recommendations regarding the assessment of pilots with insulin treated diabetes for first and second class certification. The Association shared those recommendations with the FAA in March 2015.

Internationally, some of the world's major aviation regulators have recognized that pilots who use insulin can be individually assessed and perform aircraft operations consistent with their national safety mandates. Canada has been allowing pilots with insulin-treated diabetes to fly commercially since 2001. In 2012, the UK also approved a protocol which allows for pilots with insulin-treated diabetes to engage in airline transport and commercial operations. The Chicago Convention is an international civil aviation treaty, signed in 1944, and permits pilots with insulin-treated diabetes from Canada and the UK to fly commercially in US airspace.


One US pilot, Eric Friedman, has challenged the FAA in court regarding the lack of published guidelines by which pilots with insulin treated diabetes seeking first- and second-class certification are judged as well as the FAA’s denial of his own application. In 2016, the D.C. Circuit Court of Appeals ruled that the FAA had in fact denied his application and had not offered reasons for its denial. The Court ordered the FAA to supply reasons for its decision. Friedman v. FAA, 841 F.3d 537 (D.C. Cir 2016). Mr. Friedman has now sought review of the FAA’s stated reasons for the denial before the same court. The Association filed friend of the court briefs in each case, to ensure that the Court had the necessary information regarding diabetes science and medicine to make a decision on the case.”

i.  [American Diabetes Association Amicus Brief from Friedman I] 
ii. [American Diabetes Association Amicus Brief from Friedman II]

More Resources for Pilots

American Diabetes Association Expert Panel Recommendations (PDF)

Third Class Medical Certificate Initial Certification Criteria
The FAA has established certain criteria to identify qualified applicants for a third class medical certificate.

Required In-Flight Monitoring
Pilots who use insulin are required to follow strict monitoring protocols before and during flight.

Ongoing Medical Certification Requirements
Pilots with a third class medical certificate with special issuance for insulin use must continue to provide specific medical documentation to the FAA to remain eligible to keep his or her license.

Medical Certificate Regulations
The Code of Federal Regulations defines the activities which can be performed with each class of medical certificate.

Discrimination on High: Flying on Insulin (PDF)
One Canadian Airline Captain provides his perspective on flying with insulin-treated diabetes.

2016 Study of Commercial Pilots in the UK
Initial data from commercial pilots in the UK, presented at the European Association for the Study of Diabetes meeting, shows no pilot medical incapacitations and no safety concerns.

  • Last Reviewed: May 24, 0017
  • Last Edited: May 25, 2017