By: Daniel Trecroci
Fourteen years ago, when he was diagnosed with type 1 diabetes, Douglas Cairns was forced to give up his dream of being a military flight instructor. He was told he could never fly again.
Fourteen years later, in the winter of 2003, Cairns touched down in an Omaha, Nebraska, airfield four months and 30,000 miles after departing from the same airfield and completing a round-the-world flight.
Doug Cairns, 39, who hails from Fort William in Scotland, had become the first person with type 1 to fly around the world. Not bad, considering that until 1996 the U.S. Federal Aviation Administration (FAA) had enforced a blanket ban on people with insulin-treated diabetes becoming pilots.
After years of intense lobbying from the American Diabetes Association and others, the ban was lifted on December 3, 1996, when the FAA began allowing people with insulin-treated diabetes to apply for pilot’s licenses.
When Cairns, who had never lost his passion for flying, discovered the new U.S. policy changes that allowed flying for people with type 1, the idea for the world flight began to take shape.
Cairns, who is a British citizen, holds a U.S private pilot’s license, which allows him to fly solo in the United States. His round-the-world flight—called Diabetes World Flight (DWF)—was conducted with the aid of two back-up pilots, James Aiden and Ty Semons, neither of whom has diabetes. They were there, according to Cairns, to make the international flights legal.
"James accompanied me from Boston to Scotland, and Ty from Scotland to Hawaii. I carried out all the flight planning and actual flying for each and every flight, and the whole project was carried out as if it were a solo flight. At one stage, Ty got quite frustrated at just sitting there and exclaimed, “I’ve never felt so useless in a cockpit!’"
Making a Point With BG Data
Cairns plans to contact a number of aviation authorities this year, providing data from his round-the-world trip to prove that pilots with insulin-treated diabetes can stay in control during a flight.
During a number of the flights, he managed to keep his readings between 108 and 180 mg/dl, although during others he did record numbers in the high 200s.
"There did not seem to be any correlation between more stressful flights and higher readings, although during the long solo flight from Hawaii to California, the readings were above 180 for the first few hours, possibly a combination of eating a decent lunch and . . . having a stressful situation of cloud, turbulence, a warning of thunderstorms close to the route, and an overweight aircraft, which can overstress its airframe if turbulence is too great."
He always tested an hour before each flight to ensure that he was above 99 mg/dl for takeoff. By regulation, Cairns also had to test 30 minutes before takeoff, every hour during a flight, and 30 minutes before landing. He asserts that at all times he adhered to this schedule.
No Special Diet Needed
Although daily scheduling varied, many international legs were between 600 and 750 nautical (approximately 690 to 860 standard) miles, usually taking about four hours.
A typical diet for Cairns on flight days did not stray too much from his usual diet. The earliest a flight would start was after breakfast, which usually consisted of cereal and a small fruit juice. He ate a sandwich for lunch and for night flights. Snacks in between meals were a Meusli bar or equivalent, or Mentos sweets—or, if indulging occasionally, part of a Twix bar.
Cairns had to keep an adequate supply of carbohydrates in his cockpit. In addition, he quenched his thirst with Diet Coke, Diet Pepsi or bottled water in order to stay hydrated while he was flying.
"I also ensured that there were two blood-testing kits in the cockpit," he emphasizes.
Cairns administered his normal insulin doses of 12 units of NPH and 14 units of Regular before breakfast and dinner.
On the few occasions when his blood glucose did go slightly below 99 mg/dl while he was flying, he immediately ingested 10 to 20 grams of carbohydrate (usually the Mentos sweets or a Meusli bar), per regulations, to bring his blood-glucose level back up.
Highlights and Lowlights
Cairns recalls some of the highlights of his trip:
- Flying over Greenland’s icecap—9,000 feet thick—in beautifully clear conditions
- Spotting tiger sharks from the air over Shark Bay, Australia
- Flying around New Caledonia, which has a mountainous interior and a stunning coral reef that fringes the main island
- Spotting humpback whales from the air over Hawaiian waters
- Making the 11-hour flight from Hawaii to San Francisco solo
- Meeting with many representatives from diabetes associations en route and learning about how people in each country cope with diabetes
- Delivering insulin and blood-glucose meters donated by Insulin for Life, a charity based in Melbourne, Australia, to Christmas Island’s Health Center. The doctor at the center was extremely grateful, as they had run out of fast-acting insulin and had only two blood-glucose meters to cover a total population of 8,000.
- "Completing the flight successfully —and in one piece!"
The flight wasn’t all bliss, however.
"I had a three-minute engine problem on switching tanks while approaching New Caledonia, in which the left engine cylinder head temperature and exhaust gas temperature went low. We lost 7 knots of airspeed, but on throttling back for descent, it sorted itself out," Cairns described.
"We also flew into a rainstorm in Indonesia, which was so intense it stripped part of the ‘Diabetes World Flight’ writing off one side of the aircraft."
The flight encountered other problems landing on Christmas Island. "After receiving a good weather forecast, . . . and after seven and a half hours of flying, we encountered appalling weather conditions, with low clouds and rainstorms. With only 30 minutes of daylight left and no air traffic controller to give accurate altimeter readings for accurate heights, we only just ‘scraped in’ under low clouds after an instrument approach."
Raising Some Cash Along the Way
Cairns is using DWF to raise funds for diabetes research. The project has raised about $19,000 thus far (with a significant amount of money coming from Roche Diagnostics).
The fund-raising efforts will continue through August 2003. To donate, you can visit the DWF Web site, www.diabetesworldflight.com; click on Donations.
So How Do You Top This?
In addition to fund-raising, Cairns plans to team up in July with another U.S.-based pilot who has type 1 diabetes in an attempt to break an existing U.S. distance/endurance record.
"We’ll start and finish during one of the major air shows in Oshkosh, Wisconsin," Cairns reports, adding that he hopes to "gain some publicity and raise more awareness of flying with diabetes and diabetes more generally."
Clearly, his accomplishments with DWF have whetted his appetite to carry out more flying and awareness projects.
As Cairns sums it up: "It was important, as it’s been a dream for the past four years. In particular, I wanted to show that a licensed pilot with type 1 can fly safely, according to the United States flying regulations, and [to point out] that diabetes should not limit the scope of people’s dreams and ambitions. If you are disciplined with your diabetes management and well controlled, you can do anything you put your mind to."
Only four countries—the United States, Canada, the United Kingdom and Australia—allow flying opportunities for people with insulin-treated diabetes.
According to Doug Cairns, the United Kingdom restricts piloting to single-engine aircraft and no passengers.
Australia still does not permit solo flying, insisting on a safety pilot being present.
"The Canadians have recently introduced commercial licenses for type 1s, and it is hoped that the United States may follow suit in time. Other countries remain opposed to licensing people with type 1," Cairns notes, but he is hopeful that the successful completion of the Diabetes World Flight might help to bring about change.
Cairns explains that, in the United States and Canada, type 1s need to meet medical requirements to fly airplanes.
"You need to be well controlled with no recent history of unexplained hypoglycemic events. You also need to demonstrate that you are well educated in controlling your diabetes, and these aspects need to be written up by a doctor in a medical report. Evidence of this includes regular recordings of blood-glucose tests."
For more information on flight regulations for people with diabetes, you can log on to the U.S. Federal Aviation Administration Web site medical pages at www1.faa.gov/avr/aam/dia-fr34.pdf.