The Federal Aviation Administration will move forward with a new protocol that would permit pilots who have insulin-treated diabetes to fly commercial airlines, CNN reported Thursday. Prospective pilots with type 1 diabetes will be able to apply for first- or second-class medical certificate, one of the requirements for a commercial pilot license.
While people with type 1 diabetes or insulin-treated diabetes have been allowed to fly airplanes on a private basis since 1996, they were previously restricted from taking command of commercial flights. The U.S. has lagged behind other major nations on this front – in Canada and the U.K., for example, those countries’ aviation regulatory bodies moved in 2012 to allow pilots with insulin-treated diabetes to pilot commercial planes, provided they were accompanied by a second crewmember.
“Many private pilots who are insulin dependent have been flying safely since 1996,” Jim Coon, senior vice president of government affairs for the American Owners and Pilots Association, told CNN. “With medical advancements, such as continuous glucose monitoring along with proper protocols, the FAA’s impending proposal should help many highly qualified pilots fly commercially,”
New technologies drive policy changes
The news comes as a welcome development for people with type 1 diabetes who have career aspirations in commercial aviation, a field that long seemed out of reach.
The policy shift comes about as a consequence of two major factors: Steady advocacy from pilots’ groups and diabetes organizations such as the ADA, and the development of improved technologies, particularly continuous glucose monitors and analog insulin.
Better insulin formulations can dramatically improve blood sugar control and give people with type 1 diabetes more flexibility in scheduling meals, fewer harsh or abrupt spikes and crashes in blood sugar, and generally improved control. In the 1940s and 50s, when the regulations around people with type 1 diabetes serving as pilots were laid down, the only available insulin had to be extracted from another pancreas, usually from pigs. As insulin technologies improved, so has the ability of people with type 1 diabetes to control their blood sugar.
The contributions of CGMs may be even more critical to the shift, as the monitoring removes much of the human error from the process of detecting and treating hypo- and hyperglycemia. Blood sugar lows and accompanying disorientation, unconsciousness, and even death have been the primary concern for regulators, who remained understandably worried about giving command of a commercial airplane to pilots whose blood sugars might rapidly send them into an emergency situation.
While some people with type 1 diabetes remain acutely sensitive to changes in blood sugar, the ability to “feel” the onset of hypoglycemia varies greatly from individual to individual, and can even change over the course of the disease.
The continuous monitoring and alerts of a CGM allow both a potential pilot and any accompanying crew members to remain constantly aware of their blood sugar levels, trends, and more – just as the modern electronic instruments of a plane help keep the crew aware of every aspect of flight and navigation.