Pilots with Diabetes
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 have been able to apply for a third-class medical certificate since 1996. This means that pilots are eligible to perform private and recreational operations, fly as a student pilot, flight instructor and as a sport pilot.
For many years, the FAA did not extend special issuance consideration to insulin-treated pilots seeking first and second-class medical certificates. In April 2015, however, the FAA revised its position to state that it would provide consideration for pilots applying for first and second-class certification "on a case by case basis" but did not grant any certificates under this assertion. On November 7, 2019, the FAA published a notice in the Federal Register announcing a protocol that it will use to evaluate applicants with insulin-treated diabetes for first and second-class medical certificates.
The Association's position has always been that individual assessment of people with diabetes is the medically and legally appropriate approach to determining whether a person is qualified to perform certain activities.
Internationally, some of the world's major aviation regulators have also 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 to fly into the airspace of other countries, even if that country does not grant commercial licenses to insulin-treated pilots.
ADA Advocacy for Pilots with Diabetes
For decades, the American Diabetes Association has advocated for pilots with diabetes. The ADA’s goal, throughout its advocacy, has been to convince the FAA that, given advances in diabetes science, medicine, and treatment, it is possible to identify insulin-treated pilots who are qualified to fly. The ADA has advocated by educating, negotiating with, and ultimately by supporting litigation all geared toward convincing the FAA that it is medically appropriate to grant individual assessment to pilots treated with insulin. The ADA has met with the FAA, brought industry stakeholders to the table, convened a panel of expert endocrinologists to provide recommendations, engaged members of Congress, and filed friend-of-the-court briefs in litigation brought by pilots to challenge FAA inaction. The changes to FAA policy, first for private pilots and then for commercial, would not be possible without the dedication of tireless ADA healthcare professional, pilot, and attorney volunteers.
More Resources for Pilots
Federal Register Notice
FAA’s announcement concerning its new protocol for evaluating pilots with insulin-treated diabetes for first and second-class medical certificates.
First and Second-Class Medical Certificate Protocol
Collection of guidance documents listing the medical records and data pilots must submit to apply for a first or second-class certificate.
Third-Class Medical Certificate Initial Certification Criteria
The FAA’s established criteria to identify qualified applicants for a third-class medical certificate.
Required In-Flight Monitoring for Third-Class Operations
Pilots who use insulin are required to follow strict monitoring protocols before and during flight for third-class operations.
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.
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.