Living with diabetes means living in a world of limitations—some imposed by society and some by the disease itself. Diagnosed with type 1 diabetes at the age of 5, I’ve spent the last 35 years trying to break free of those limitations.
Today, medicine and technology make good control more achievable than ever before, so some of the barriers are falling. But one barrier that seemed destined to never come down was the one erected by the Federal Aviation Administration (FAA): a blanket ban on people with diabetes becoming pilots.
My childhood dream was to pilot a small plane. But, with every glance skyward, I had to resign myself to knowing the closest I’d get was being a passenger.
Lobbying Pays Off
Then, on December 3, 1996, after several years of intense lobbying by the American Diabetes Association, the FAA made policy changes to allow people with insulin-dependent diabetes to apply for a pilot’s license. Although this was a victory for people with diabetes, the policy change didn’t take place without controversy.
Several organizations lobbied against the proposed rule changes, including the American Association of Endocrinologists (AACE), some Aviation Medical Examiners and other physicians. To avoid the dangers of hypoglycemia, the FAA guidelines required for maintaining an Airman’s Medical Certificate specify blood-glucose levels somewhat higher than the range considered optimal by the AACE. The AACE argues for tighter control, fearing that adherence to the FAA guidelines could lead to higher A1Cs and might leave a person with diabetes more vulnerable to long-term complications.
Earning My Wings
The process of earning my wings began not with flight lessons or even with ground school, but rather with the lengthy—and expensive—process of obtaining an Airman’s Medical Certificate to fly. Obtaining this certificate requires seeing three or four different physicians, filling out mountains of paperwork, providing complete medical records, and taking tests and more tests.
My first step was to contact Dr. Esmond Braun, an Aviation Medical Examiner in Portland, Oregon. Dr. Braun explained that applicants cannot have had recurrent (two or more) episodes of hypoglycemia in the past five years or any in the past year that resulted in “loss of consciousness, seizure, impaired cognitive function, or required intervention by another party, or that occurred without warning.”
To qualify for flight, I must be compulsive about monitoring my blood glucose and keeping records. Before each flight, my blood glucose can be no lower than 100 mg/dl and no higher than 300 mg/dl. At every hour in flight, I must check my blood glucose. (It’s not as awkward as it sounds.) If my test result is less than 100 mg/dl, I am required to have a 20-gram glucose snack. If my test result is over 300, I must land at the nearest airport.
Willingness to follow this regimen is an important factor in the effort to become a pilot. As Dr. Braun testified, “Pilots are motivated. They really want to fly. To fly a plane, you’ve got to be in control. The same as with diabetes.”
I began to wonder whether I had the undaunted commitment to work through the bureaucratic and medical maze. But the blue sky still beckoned.
In my first flight as a student, we walked around the plane for a pre-flight check. Then I did my own pre-flight check. My blood glucose tested at an ideal pre-flight reading of 127 mg/dl. I carried my standard “kit” of two vials of glucose tabs, a can of Coke and my meter.
With a mixture of sweaty-palm fear and nervous excitement, we crawled into the cramped cockpit of the Cessna 152. The heat waves curled up from the tarmac and rose into the clear blue sky.
As we taxied onto the runway, I experienced a mix of euphoric realization and relief that for once in my life, even though I have to be relentless in my control, I am not limited by diabetes.
And that, to me, is the beauty of this moment.