TEM | T2DM the silent threat to your flying career?
- Dr. Rob Massera | DAME
- Apr 3
- 5 min read
Updated: Apr 4
Q: What is Type 2 diabetes?
Type 2 diabetes - also known as adult-onset or non-insulin dependent diabetes - is a condition where the body either becomes resistant to insulin or cannot produce enough of it, causing blood sugar levels to rise. Insulin is a hormone that helps cells absorb glucose (fuel) for energy, and when this process is impaired, glucose builds up in the bloodstream. If left untreated, this can cause serious health complications that can compromise a pilot’s fitness-to-fly.
Using an aviation analogy: Insulin is like the fuel-mix lever that adjusts the fuel control valve to regulate fuel-flow into the engine. In type 2 diabetes the “fuel control valve” becomes less responsive to the "fuel-mix lever" (insulin), meaning fuel (glucose) can’t enter the engine (cells) properly, causing the engine (cells) to run inefficiently and fuel (glucose) to accumulate in the fuel-system (blood-stream).
The good news for pilots is that type 2 diabetes is often preventable with diet, exercise & weight-loss - or manageable - with the addition of medications and medical care.
Q: Why is it relevant to pilots & aviation safety?
Poorly managed type 2 diabetes can impair or incapacitate a pilot and cause complications, such as: eye disease, nerve damage, kidney disease and heart disease, all of which pose a threat to a pilot’s health, medical certification & aviation safety.
Dangerous blood sugar fluctuations (hyper/hypoglycaemia) can cause: headaches, confusion, blurred vision or unconsciousness resulting in rapid pilot impairment or incapacitation. While diabetic complications can cause eye disease (retinopathy, cataracts & glaucoma) which impair vision - or cardiovascular disease, which increase the risk of heart attack, stroke and high blood pressure (hypertension) - all these complications can threaten fitness-to-fly & medical certification. Finally, an aviation career: long hours sitting, poor airport food options, stress, shift work and sleep disruption further increase the risk of type 2 diabetes and make it harder to manage.
For all these reasons CASA requires DAMEs to screen for diabetes (with urinalysis) and closely monitor any pilots with type 2 diabetes.
Q: What causes type 2 diabetes & what are the risk factors?
While the exact causes are still unknown, we do know that age, genetics and modifiable life-style factors - such as: poor quality diet, physical inactivity, high blood pressure, elevated cholesterol, overweight & obesity (the classic “apple-shaped” body) - significantly increase the risk of developing the condition. By being aware of these latent threats, pilots can take countermeasures to mitigate their chances of developing type 2 diabetes & remain fit-to-fly for the long-haul.
Q: What are the symptoms & how is it diagnosed?
Type 2 diabetes is a silent or latent threat to pilots because it often has few symptoms until the condition progresses or complications develop. Symptoms can include: vague headaches, fatigue or lethargy, blurred vision, increased thirst, frequent urination and weight gain. While it may be detected by your DAME on routine urinalysis, your GP will diagnose it with a combination of blood tests:
Random Blood Glucose Test (BGL): A blood sugar test taken at any time of day, with a result of 5.5 (mmol/L) or higher, accompanied by symptoms, may indicate diabetes.
Fasting Blood Glucose Test (FBGL): Measures blood sugar after fasting for at least 8 hours. A result of 7 (mmol/L) or higher indicates diabetes.
Oral Glucose Tolerance Test (OGTT): Measures blood sugar after fasting and then drinking a sugary solution. A reading of 7.8 (mmol/L) or higher one hour after drinking the solution suggests diabetes.
Haemoglobin A1C Test (HbA1C): Measures the average blood sugar level over the past 2-3 months. A result of 6.5% or higher is considered diagnostic for diabetes.
Q: Can I fly with Type 2 diabetes?
AFFIRMATIVE - you can fly with type 2 diabetes. However, it must be well-controlled with few complications. CASA requires regular monitoring of blood sugar levels, cardiovascular risk profile and eye health, along with strict reporting. Pilots with type 2 diabetes must stay on top of their BGL management and work closely with their GP and DAME to meet CASA’s guidelines to maintain their medical certification.
Q: How will it affect my medical certification?
Medical certification for pilots with type 2 diabetes is assessed by CASA on a case-by-case basis and limited to 12 months for all classes. Restrictions/limitations depend on diabetic control and complications - CASA classifies pilots with type 2 diabetes into one of three categories for assessment:
Non-insulin dependent with LOW risk of hypoglycaemia - will require: annual medical certification (Class 1, 2 & 3), certificate of completion of a certified diabetes counselling course (book this through NDSS or ADEA | Australian Diabetes Educators Association), glucose monitoring diary (or print-out), GP or Endocrinologist report, HbA1C < 7.5% (annually), albumin to creatinine ratio (annually), ophthalmologist report (on diagnosis & 2 yearly), cardio-vascular disease risk index < 14 (cardiologist report if > 14).
Non-insulin dependent with HIGH-risk of hypoglycaemia - will require all the above: plus records demonstrating no evidence of symptomatic or biochemical hypoglycaemic episodes in the past 12 months.
Insulin dependent + HIGH risk of hypoglycaemia - certification occurs in TWO stages & requires rigorous monitoring, reporting & health surveillance requirements - (article to come here).
In summary, Pilots with type 2 diabetes can maintain any class of medical certification - however strict monitoring and reporting apply - especially as the condition worsens. That’s why it’s critical to prevent type 2 diabetes with healthy lifestyle habits or manage it carefully if diagnosed.
Q: How is type 2 diabetes managed in pilots?
Management is with a combination of lifestyle changes, medication, and regular BSL/BGL monitoring - a continuous blood glucose meter (CGM) is ideal. A low sugar/carb diet, resistance exercise and stress management help control blood sugar, while medications like metformin (taken orally) or insulin (via injection) may be needed if lifestyle changes are not enough. To maintain medical certification, pilots must closely monitor their blood glucose levels (BGL) and keep their HbA1C < 7.5%. While regular check-ups with the GP or endocrinologist are essential to maintain glycaemic control and prevent complications. The good news - with life-style changes, good management and few complications, pilots with type 2 diabetes can continue to fly.
Q: What countermeasures can pilots take against type 2 diabetes?
The majority of cases of type 2 diabetes can be prevented or delayed through good pilot maintenance (healthy lifestyle choices) - Pilots can reduce their risk by:
Practicing a Good Sleep habit - getting 7 to 9 hours of good quality sleep nightly
Choosing the right fuel - for your biological machine - high-fibre foods, lean proteins, healthy fats (nuts, seeds, olive oil), whole grains and low GI carbohydrates - AVOID processed foods and simple sugars.
Weight & balance envelope - remaining within your ideal envelope based on your Body Mass Index & waist circumference to height ratio.
Regular resistance exercise - plus aerobic activity like running or swimming improves insulin sensitivity of muscles and organs
Manage Stress – Techniques like meditation, yoga, or deep breathing can stabilize blood sugar levels.
Regular Maintenance-cycle - medical check-ups help detect early signs or risk factors such as high cholesterol or high-blood pressure - especially for those with risk factors.
By employing these countermeasures pilots can lower their risk of type 2 diabetes and stay fit to fly now and well into the future!
Q: Got more questions?
Start a conversation: info@aerokare.com.au
References & links to more information:
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