The FAA has established a policy that permits the special issuance medical certification of insulin-treated applicants for third-class medical certification. Consideration will be given only to those individuals who have been clinically stable on their current treatment regimen for a period of 6 months or more. Consideration is not being given for first- or second-class certification.

Individuals certificated under this policy will be required to provide substantial documentation regarding their history of treatment, accidents related to their disease, and current medical status. If certificated, they will be required to adhere to stringent monitoring requirements and are prohibited from operating aircraft outside the United States. The following is a summary of the evaluation protocol and an outline of the conditions that the FAA will apply:

Initial Certification
  1. The applicant must have had no recurrent (two or more) episodes of hypoglycemia in the past 5 years and none in the preceding 1 year resulting in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness).
  2. The applicant will be required to provide copies of all medical records as well as accident and incident records pertinent to their history of diabetes.
  3. A report of a complete medical examination preferably by a physician who specializes in the treatment of diabetes will be required. The report must include, as a minimum:
    • Two measurements of glycated hemoglobin (total A1 or A1c concentration and the laboratory reference range), the first at least 90 days prior to the current measurement.
    • Specific reference to the applicant's insulin dosages and diet.
    • Specific reference to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy.
    • Confirmation by an eye specialist of the absence of clinically significant eye disease.
    • Verification that the applicant has been educated in diabetes and its control and understands the actions that should be taken if complications, especially hypoglycemia, should arise. The examining physician must also verify that the applicant has the ability and willingness to properly monitor and manage his or her diabetes.
    • If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test.
    • The applicant shall submit a statement from his/her treating physician, aviation medical examiner, or other knowledgeable person attesting to the applicants dexterity and ability to determine blood glucose levels using a recording glucometer).
We recommend that the medical information and Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate (FAA Form 8500-8) be submitted prior to beginning or resuming flight instruction or training.