Guide for Aviation Medical Examiners

Special Issuances
AME Assisted - All Classes - Diabetes Mellitus - Type II, Medication Controlled (Not Insulin)

AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

A FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The information can be submitted using the Diabetes or Hyperglycemia on Oral Medications Status Report (PDF)

If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, provided that the applicant does not require insulin, remains on an acceptable oral medication therapy according to the chart of Acceptable Combinations of Diabetes Medications (PDF), and if the applicant provides the following:

  • An Authorization granted by the FAA AND either
  • A Diabetes or Hyperglycemia on Oral Medications Status Report (PDF) OR
  • A current status report from the physician treating the airman's diabetes, including:
    • A statement attesting that the airman is maintaining his or her diabetic diet;
    • A statement regarding any diabetic symptomatology, including any history of hypoglycemic events and any cardiovascular, renal, neurologic, or ophthalmologic complications; and
    • The results of a current HgA1c level performed within last 30 days.

The Examiner must defer to the AMCD or Region if:

  • The applicant has been placed on insulin
  • The HgA1c level is greater than 9.0 mg%
  • The applicant has experienced:
    • Severe Hypoglycemia event(s) - requiring assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions (plasma glucose concentrations may not be available)*;
    • Documented Symptomatic Hypoglycemia event(s) - typical symptoms of hypoglycemia accompanied by a measured plasma glucose concentration <=70 mg/dL (<=3.9 mmol/L)*;
    • Asymptomatic Hypoglycemia - no reported symptoms but a measured plasma glucose concentration <=54 mg/dL (<=3.0 mmol/L)
  • The applicant has developed evidence of any of the following:
    • Cardiovascular disease,
    • Neurologic disease, including any change in degree of peripheral neuropathy,
    • Ophthalmologic disease,
    • Renal disease (including a Creatinine over 2.0)
  • The airman has been placed on any amlynomimetic, such as pramlintide (Symlin)
  • The applicant is using any medication (single or in combination) that falls outside the framework of Acceptable Combinations of Diabetes Medications (PDF).
  • The applicant has required treatment other than routine outpatient follow-up (e.g. emergency department, inpatient admission) for diabetes (e.g. hypoglycemia, ketoacidosis, non-ketotic hyperglycemia) or diabetes-related conditions.
  • The applicant has experienced any event suggesting hypoglycemia unawareness or hypoglycemia-associated autonomic failure.

* ref: Hypoglycemia Workgroup of the ADA & The Endocrine Society

Last updated: Wednesday, September 27, 2023