Guide for Aviation Medical Examiners

Decision Considerations
Disease Protocols - Insulin Treated Diabetes Mellitus - Type I or Type II - Non-CGM - Third Class Option

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 which resulted in loss of consciousness, seizure, impaired cognitive function or requiring intervention by another party, or occurring without warning (hypoglycemia unawareness).
  2. The applicant should provide copies of 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 exam must be performed within the past 90 days. The Initial Comprehensive Report (PDF), which outlines our requirements, is preferred, however, ANY report submitted MUST include, as a minimum:
    1. Two measurements of glycosylated hemoglobin (total A1 or A1c concentration and the laboratory reference range), separated by at least 90 days. The most recent measurement must be no more than 90 days old.
    2. Specific reference to the applicant's insulin dosages and diet.
    3. Specific reference to the presence or absence of cerebrovascular, cardiovascular, or peripheral vascular disease or neuropathy.
    4. Confirmation by an eye specialist of the absence of clinically significant eye disease.
    5. 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.
    6. If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded exercise stress test.
    7. The applicant shall submit a statement from his/her treating physician, Examiner, or other knowledgeable person attesting to the applicant's dexterity and ability to determine blood glucose levels using a recording glucometer.


Note: Student pilots may wish to ensure they are eligible for medical certification prior to beginning or resuming flight instruction or training. In order to serve as a pilot in command, you must have a valid medical certificate for the type of operation performed.

Last updated: Friday, March 10, 2023