Flying on Insulin

Every pilot’s nightmare is the thought of losing his medical certification and being stopped from flying. That happened to me in May of 1986, when I was diagnosed with type 1. In accordance with the International Civil Aviation Organization (ICAO) Standards and Recommended Practices, Canada, along with every other country in the world, would not allow insulin-dependent pilots to hold any type of pilot’s license. My short eight-year career with Air Canada came to an abrupt end, and I was told in no uncertain terms that I would never be allowed to fly an aircraft again.

ICAO worried that a type 1 pilot might not always be able to maintain the delicate balance of food intake, timing of meals, insulin, exercise and fatigue that all type 1’s struggle with. If a pilot suffered a low blood glucose during flight, he could lose consciousness, with obvious disastrous consequences. For these safety reasons, ICAO prohibited all persons with type 1 from acting as a crewmember. In 1986, no consideration was given to how well an individual could control his diabetes.

Because I was only 30 years old at the time, I decided to start a new career. What followed was a five-year commitment to obtain my law degree and three years of private practice as a general practice lawyer. Although I did not specifically pick my new job as a lawyer with the intent of attempting to regain my pilot’s license, it turned out that this became a fortuitous benefit of my newly chosen career. Special thanks must go to Air Canada because they were very supportive during this transition period. I was hired as a simulator instructor and spent eight years as both a full-time and, during law school, a part-time simulator instructor on the DC-9, teaching other pilots how to fly this aircraft.

In 1982, Transport Canada’s Civil Aviation Medicine Branch decided to reexamine its policies on diabetes mellitus. However, this proved to be a very drawn out affair. In 1986, Transport Canada started to look at re-licensing pilots who had non-insulin dependent diabetes and who were taking oral agents to control their diabetes. Unfortunately for me, Transport Canada was still shying away from looking at insulin-treated diabetes. Things turned the corner in April 1992, when a panel of expert doctors met to review diabetes in the context of the modern aviation environment. Thanks to the work of the late Dr. Gerald S. Wong, Dr. James Wallace, Dr. Robert Depuis, and Dr. G.Y. Takahashi, a new process for pilots with type 1 was born.

During this ten-year process, the Canadian Diabetes Association decided to take the issue to court in an attempt to speed things up. The Canadian Charter of Rights and Freedoms was used to attempt to force Transport Canada to develop guidelines to reinstate pilots with type 1. In Her Majesty the Queen as represented by the Minister of Transport (Appellant) (Defendant) v. Eileen Grace Bahlsen (Respondent) (Plaintiff) (1996), the Federal Court of Appeal ruled that refusing a medical certificate to an applicant for a pilot’s license because of a blanket prohibition against diabetes was justified under Canadian law. Even though the practice discriminated against the applicant, the court held that as there was no other state licensing type 1 pilots for solo (single pilot) flight, and as there was no consensus of medical opinion on the safety of solo flight by insulin-dependent pilots, Transport Canada was justified in prohibiting pilots with type 1 from flying. The case did, however, help spur Transport Canada into looking at re-licensing pilots with diabetes for multi-crewed aircraft.

The very first pilot in the world with type 1 to get his medical certification and, therefore, his pilot’s license reinstated was a Canadian military pilot, Capt. Chuck Grenkow. Chuck was diagnosed with diabetes in 1987. After two years of monitoring and individual assessments of his ability to control his diabetes, a very forward thinking Dr. Gary Gray, with the help of Chuck’s endocrinologist, Dr. John Dupre, authorized Chuck to return to flying duties. In August of 1989, Chuck moved to Summerside PEI and returned to active flying status at 413 Sqn. Chuck is presently working as a Major in Esquimalt, BC, where he is still licensed to fly. He will be retiring from the Canadian Forces in July of 2010.

On the civilian side of things, it took much longer.

John McDermott was the first civilian pilot to receive his medical certification with type 1. John had been a Boeing 727 Captain with Air Canada before developing diabetes in 1981. John’s medical certificate was returned to him in September of 1999, and he returned to Air Canada on a Boeing 767 course. Unfortunately, John ran into a number of circumstances totally outside of flying that precluded him from completing his return to work. John was the pioneer in the return-to-work protocol, and it is quite likely that without his efforts, none of the rest of us would have been able to return to flying. He is owed a great debt for paving the way for others.

Brett Walker was next. Brett was diagnosed with diabetes in December of 1998, but he was able to stay off insulin for awhile and continue flying the Boeing 737 and later the Airbus A320. He had to start taking insulin in December 2000 and had his medical certification revoked at that time, but it was returned to him in June of 2001. Brett returned to flying as a First Officer (Co-Pilot) on the Airbus A320 based in Toronto. Brett was the very first civilian pilot with type 1 to return to operational line flying anywhere in the world.

Next came myself and another Air Canada First Officer whom we will call “Tom.” We both received our medical recertification in December of 2001. Tom returned to flying on the Airbus A320 in January of 2002. He is now an Embraer Captain based in Toronto.

I took a little longer because I was living in Hong Kong at the time. I gave up the practice of law in 1994 and moved to Hong Kong to work as a simulator instructor on the Airbus A340 with Cathay Pacific Airways. Following our family’s return from Hong Kong, I returned to Air Canada in November of 2002 as a Captain on the Airbus A320. The return-to-work protocol required me to fly as a First Officer for the first six months to make sure everything went well, but I was able to transition into the left seat (Captain) in October 2003. This made me the first person in the world to fly as the Captain of a commercial airliner while taking insulin. In June 2006, I transitioned to the Boeing 767, which I am still happily flying on international routes around the globe.

Ron Swaisland was the latest of the current crop of airline pilots with diabetes. Ron was first diagnosed with type 2 diabetes in August of 1996. He maintained his active flight status by controlling his blood glucose levels with diet and exercise until July of 2004, when he had to transition to oral medications. Unfortunately for Ron, the oral medications proved unsuccessful and he was placed on insulin therapy in October 2004. Ron returned to active flying status in June 2006 as an Airbus A340 Captain. He retired from Air Canada on June 1, 2007.

Canada is the only country in the world allowing commercial pilots with type 1 to fly, and we are subject to a very strict in-flight protocol to ensure the safety of our flights. We must complete a fingertip blood test within 30 minutes prior to flight departure and at least every 60 minutes thereafter for the duration of the flight. In cases when the blood glucose readings are in the lower range of acceptable readings, that time period is reduced to 30 minutes between blood tests. All of these readings must be forwarded to Transport Canada with each medical renewal, and these readings are the deciding factor in whether our medical certificates are re-issued each medical cycle. We are by far the most medically scrutinized pilots in the world. Our licenses are never renewed: they are revoked at the end of each medical period and then re-issued if we continue to comply with the requirements set forth by Transport Canada.

Today in Canada there are 15 Airline Transport or Commercial pilots with type 1. Three of us continue fly for Air Canada. There are also two air traffic controllers working with type 1.

Canadian pilots are still the only pilots in the world flying with type 1 in a commercial environment. We hope that through our experiences in Canada, type 1 pilots in other countries will eventually gain the medical re-certification that Transport Canada has provided to us.

For each one of the pilots named in this article, a very special thank you must go to the doctors who saw fit to give us the opportunity to return to work. To Drs. Gary Gray at the DRDC, Jim Wallace and Edward Brook at Transport Canada, Ed Bekeris, Craig Winsor and Peter Hopkins at Air Canada, along with some very special endocrinologists, Dr. John Dupre and Dr. Irv Gottesman, we give our personal thanks. A very special thank you is also owed to Capt. Dave Noble of the Air Canada Pilots Association and to Air Canada Flight Operations Management for their help in the return-to-work process. Without the help of these individuals, none of this would have been possible.

Read the current regulations for flying with diabetes in Canada

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