Protocol for Diabetes Mellitus 
Treated with Any Medication Other Than Insulin

All Classes

If taking any form of insulin do NOT use this protocol. Go to www.faa.gov/go/itdm.

Applicants with a diagnosis of diabetes mellitus controlled by medication must submit the following information for consideration of an Authorization for Special Issuance Medical Certificate (Authorization) for any class. See Acceptable Combinations of Diabetes Medications for allowable medications, combinations, and required recovery periods after starting or changing medication(s).

INITIAL AUTHORIZATION:  

1. Requires FAA review and determination.  

2. The AME must defer.

3. Applicant must submit either:

• Diabetes or Hyperglycemia on Oral Medications Status Report; OR
• A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or endocrinologist no more than 90 days prior to the AME exam.  It must include: 
  • A detailed summary of the history of the condition; 
  • Treatments and outcomes; 
  • Current medications, dosage, and side effects (if any); 
  • Physical exam findings; 
  • Results of any testing performed; 
  • Diagnosis; 
  • Assessment; 
  • Plan (prognosis); and
  • Follow-up. 

4. The Clinical Progress Note must also specifically include:

• If there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease); and
• If there are any hypoglycemia episodes in the past (one) year.  

5. Current Hemoglobin A1C lab test performed no more than 90 days* prior to the AME exam (and 30 days after medication change). *Note: This was previously 30 days. 

SUBSEQUENT EXAMS: 

1. See the individual’s Authorization for Special issuance.  An AME may issue a subsequent medical certificate if allowed under the provisions of the Authorization.

2. Follow-up evaluation by the treating physician is required annually.

3. The applicant must submit either:

• Diabetes or Hyperglycemia on Oral Medications Status Report; OR
• A current Detailed Clinical Progress Note from the treating physician, which contains the above information.

4. See AASI for Diabetes Mellitus – Type II Medication Controlled (Not Insulin)

GENERAL CONSIDERATIONS:

1. Initial consideration targets include:

• Hemoglobin A1C less than 9.0; and
• Use of acceptable combination of medication(s). 

2. Evidence of cardiovascular, neurological, renal, and/or ophthalmological disease are not necessarily disqualifying, however, the disease(s) must be carefully evaluated to determine any added risk to aviation safety.

3. The AME should counsel the applicant regarding:

• The significance of the disease and possible complications;  
• The potential for hypoglycemic reactions and caution to remain under close medical surveillance by the treating physician; and  
• Any changes to types or dosage of medications.
• The individual should not perform pilot or safety-related duties until required recovery periods have elapsed and the treating physician has consulted with the AME who issued the certificate, AMCD, or RFS and has determined that the condition is:
  • Under control; 
  • Stable; and
  • Presents no risk to aviation safety.