Guide for Aviation Medical Examiners

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


  1. For documentation of diabetes management, the applicant will be required to carry and use a whole blood glucose measuring device with memory and must report to the FAA immediately any hypoglycemic incidents, any involvement in accidents that result in serious injury (whether or not related to hypoglycemia); and any evidence of loss of control of diabetes, change in treatment regimen, or significant diabetic complications. With any of these occurrences, the individual must cease flying until cleared by the FAA.
  2. At 3-month intervals, the airman must be evaluated by the treating physician. This evaluation must include a general physical examination, review of the interval medical history, and the results of a test for glycosylated hemoglobin concentration. The physician must review the record of the airman's daily blood glucose measurements and comment on the results. The results of these quarterly evaluations must be accumulated and submitted annually unless there has been a change. (See No. 1 above - If there has been a change the individual must report the change(s) to the FAA and wait for an eligibility letter before resuming flight duties).
  3. On an annual basis, the reports from the examining physician must include confirmation by an eye specialist of the absence of significant eye disease.
  4. At the first examination after age 40 and at 5 year intervals, the report, with ECG tracings, of a maximal graded exercise stress test must be included in consideration of continued medical certification.

See Diabetes on Insulin Re-Certification Status Report Non CGM - Third Class Option (PDF).

Last updated: Tuesday, March 21, 2023