Diabetes treated with medication
What the FAA's documents say about diabetes treated with medication, in plain words, with the FAA's own words one press away.
FAA term: Diabetes Mellitus Treated with Any Medication Other Than InsulinCovers: All classes
Short version
The FAA's table sorts it into two rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| InitialA first Authorization, for diabetes controlled by a medication other than insulin. | Defers to the FAA | Special Issuance |
| Subsequent examsA later exam, where the pilot already holds an Authorization. | Examiner issues | AASI |
Show the FAA's words: the FAA's table for Diabetes treated with medication
- Initial · Special Issuance
A first Authorization, for diabetes controlled by a medication other than insulin. FAA review and determination are required and the examiner must defer; the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current, detailed clinical progress note from a clinic visit with the treating physician or endocrinologist no more than 90 days before the exam. The protocol says the clinical progress note must also specifically include whether there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease), and whether there are any hypoglycemia episodes in the past (one) year. The protocol also lists a current Hemoglobin A1C lab test performed no more than 90 days before the exam (and 30 days after medication change).
INITIAL AUTHORIZATION: 1. Requires FAA review and determination. 2. The AME must defer . … 3. Applicant must submit either: … Diabetes or Hyperglycemia on 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. … 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).
Treated with one or more (non-insulin) diabetic medications … DEFER Submit the information to the FAA. … Initial Special Issuance – Requires FAA Decision … Follow up Special Issuances - See Diabetes Mellitus - Type II, Medication Controlled (Not Insulin)
- Subsequent exams · AASI
A later exam, where the pilot already holds an Authorization. The protocol sends the examiner to the pilot's own Authorization, allows an examiner to issue a subsequent certificate if the Authorization allows it, requires follow-up evaluation by the treating physician annually, says the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current detailed clinical progress note from the treating physician which contains the information the protocol lists above it, and points to the AASI page.
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 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)
- A note on the table, 1
The protocol's first line says not to use it if taking any form of insulin, and says to go to www.faa.gov/go/itdm.
If taking any form of insulin do NOT use this protocol. Go to www.faa.gov/go/itdm .
- A note on the table, 2
The protocol says to see Acceptable Combinations of Diabetes Medications for allowable medications, combinations, and required recovery periods after starting or changing medication(s).
See Acceptable Combinations of Diabetes Medications for allowable medications, combinations, and required recovery periods after starting or changing medication(s).
- A note on the table, 3
The protocol says its initial consideration targets include a Hemoglobin A1C less than 9.0, and use of acceptable combination of medication(s).
GENERAL CONSIDERATIONS: 1. Initial consideration targets include: … Hemoglobin A1C less than 9.0; and … Use of acceptable combination of medication(s).
- A note on the table, 4
The protocol says evidence of cardiovascular, neurological, renal, and/or ophthalmological disease is not necessarily disqualifying, and that the disease(s) must be carefully evaluated to determine any added risk to aviation safety.
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.
The FAA pathways for diabetes treated with medication
Which exam
Your step-by-step plan
Step 1: Medications within the Acceptable Combinations of Diabetes Medications
One of the protocol's initial consideration targets.Your diabetes medications, in an acceptable combination: one of the FAA's targets for a first Authorization.
Show the FAA's words: Medications within the Acceptable Combinations of Diabetes Medications
Initial consideration targets include:
Use of acceptable combination of medication(s).
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Step 2: What to submit for a first Authorization
Your diabetes records and A1C, for the FAA's review and determination.The Diabetes or Hyperglycemia on Medications Status Report
Either this FAA form or a current, detailed progress note.
On the form
- The A1C value and date, taken more than 30 days after a medication change and within 90 days of re/certification
- A narrative, tests and the like attached for any YES answer
- Returned to your AME, to upload into your FAA file
Progress note from the treating physician or endocrinologist
Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or endocrinologist, no more than 90 days before the exam.
The note
- A detailed summary of the condition's history
- Treatments and outcomes
- Current medications, dosage and any side effects
- Physical exam findings
- Results of any testing
- Diagnosis
- Assessment
- Plan (prognosis)
- Follow-up
And specifically
- Any evidence of progressive diabetes-induced end organ disease: cardiac, neurological, ophthalmological, peripheral neuropathy or renal
- Any low blood sugar episodes (hypoglycemia) in the past year
A1C
Within 90 days before the examA current A1C, performed no more than 90 days before the exam, and 30 days after a medication change.
The FAA's target
- Less than 9.0
Show the FAA's words: What to submit for a first Authorization
3. Applicant must submit either:
Diabetes or Hyperglycemia on 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.
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Hemoglobin A1C lab value and date
(A1C lab value must be taken more than 30 days after medication change and within 90 days of re/certification)
FAA source: Diabetes or Hyperglycemia on Medications Status Report. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
If YES is circled on any of the questions below, please attach narrative, tests, etc.
FAA source: Diabetes or Hyperglycemia on Medications Status Report. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Return the completed status report to your AME for upload into your FAA file.
FAA source: Diabetes or Hyperglycemia on Medications Status Report. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Diabetes or Hyperglycemia on 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.
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
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.
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
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.
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
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.
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
Initial consideration targets include:
Hemoglobin A1C less than 9.0
FAA source: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin. FAA date 28 January 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
InitialDefers to the FAASpecial Issuance
FAA review and determination are required and the examiner must defer; the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current, detailed clinical progress note from a clinic visit with the treating physician or endocrinologist no more than 90 days before the exam. The protocol says the clinical progress note must also specifically include whether there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease), and whether there are any hypoglycemia episodes in the past (one) year. The protocol also lists a current Hemoglobin A1C lab test performed no more than 90 days before the exam (and 30 days after medication change).
If the examiner defersSubsequent examsExaminer issuesAASI
The protocol sends the examiner to the pilot's own Authorization, allows an examiner to issue a subsequent certificate if the Authorization allows it, requires follow-up evaluation by the treating physician annually, says the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current detailed clinical progress note from the treating physician which contains the information the protocol lists above it, and points to the AASI page.
Show the FAA's words: what the examiner does on each row
- Initial · Special Issuance
A first Authorization, for diabetes controlled by a medication other than insulin. FAA review and determination are required and the examiner must defer; the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current, detailed clinical progress note from a clinic visit with the treating physician or endocrinologist no more than 90 days before the exam. The protocol says the clinical progress note must also specifically include whether there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease), and whether there are any hypoglycemia episodes in the past (one) year. The protocol also lists a current Hemoglobin A1C lab test performed no more than 90 days before the exam (and 30 days after medication change).
INITIAL AUTHORIZATION: 1. Requires FAA review and determination. 2. The AME must defer . … 3. Applicant must submit either: … Diabetes or Hyperglycemia on 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. … 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).
Treated with one or more (non-insulin) diabetic medications … DEFER Submit the information to the FAA. … Initial Special Issuance – Requires FAA Decision … Follow up Special Issuances - See Diabetes Mellitus - Type II, Medication Controlled (Not Insulin)
- Subsequent exams · AASI
A later exam, where the pilot already holds an Authorization. The protocol sends the examiner to the pilot's own Authorization, allows an examiner to issue a subsequent certificate if the Authorization allows it, requires follow-up evaluation by the treating physician annually, says the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current detailed clinical progress note from the treating physician which contains the information the protocol lists above it, and points to the AASI page.
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 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)
If the examiner defersSpecial Issuance
For a first Authorization the protocol says the examiner must defer, and that FAA review and determination are required.
What the FAA lists to send
- Item 1. Either the Diabetes or Hyperglycemia on Medications Status Report.
- Item 2. Or a current, detailed clinical progress note from a clinic visit with the treating physician or endocrinologist no more than 90 days before the exam, which the protocol says must include what it lists.
- Item 3. The protocol says the clinical progress note must also specifically include whether there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease), and whether there are any hypoglycemia episodes in the past (one) year.
- Item 4. A current A1C performed no more than 90 days before the exam, and 30 days after a medication change.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
For a first Authorization the protocol says the examiner must defer, and that FAA review and determination are required.
INITIAL AUTHORIZATION: 1. Requires FAA review and determination. 2. The AME must defer .
What the FAA lists to send
- Item 1
Either the Diabetes or Hyperglycemia on Medications Status Report.
Diabetes or Hyperglycemia on Medications Status Report ; OR
- Item 2
Or a current, detailed clinical progress note from a clinic visit with the treating physician or endocrinologist no more than 90 days before the exam, which the protocol says must include what it lists.
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:
- Item 3
The protocol says the clinical progress note must also specifically include whether there is any evidence of progressive diabetes-induced end organ disease (cardiac, neurological, ophthalmological, peripheral neuropathy, or renal disease), and whether there are any hypoglycemia episodes in the past (one) year.
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.
- Item 4
A current A1C performed no more than 90 days before the exam, and 30 days after a medication change.
5. Current Hemoglobin A1C lab test performed no more than 90 days* prior to the AME exam (and 30 days after medication change).
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
The protocol is headed All Classes, and says applicants with a diagnosis of diabetes mellitus controlled by medication must submit the information it lists for consideration of an Authorization for any class. For subsequent exams it says follow-up evaluation by the treating physician is required annually.
Show the FAA's words: how often the FAA asks again
All Classes … 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. … SUBSEQUENT EXAMS: … 2. Follow-up evaluation by the treating physician is required annually .
The AASI page says examiners may reissue under an Authorization provided that the pilot does not require insulin, remains on an acceptable oral medication therapy according to the chart of Acceptable Combinations of Diabetes Medications, and provides the following -- the Authorization granted by the FAA, and either the Diabetes or Hyperglycemia on Medications Status Report or a current status report from the physician treating the pilot's diabetes. That status report includes a statement attesting that the pilot is maintaining their 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 the last 30 days. For subsequent exams the protocol says the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current detailed clinical progress note from the treating physician which contains the information the protocol lists above it.
Show the FAA's words: at later exams
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 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.
SUBSEQUENT EXAMS: … 3. The applicant must submit either: … Diabetes or Hyperglycemia on Medications Status Report ; OR … A current Detailed Clinical Progress Note from the treating physician, which contains the above information.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI page's first item for a reissue is the Authorization granted by the FAA, and with it either the Diabetes or Hyperglycemia on Medications Status Report or a current status report from the physician treating the pilot's diabetes.
Show the FAA's words: The Authorization granted by the FAA
An Authorization granted by the FAA AND either … A Diabetes or Hyperglycemia on Medications Status Report ( PDF ) OR … A current status report from the physician treating the airman's diabetes, including:
The Diabetes or Hyperglycemia on Medications Status Report
For a reissue the AASI page asks for, with the Authorization, either the Diabetes or Hyperglycemia on Medications Status Report or a current status report from the physician treating the pilot's diabetes.
Show the FAA's words: The Diabetes or Hyperglycemia on Medications Status Report
An Authorization granted by the FAA AND either … A Diabetes or Hyperglycemia on Medications Status Report ( PDF ) OR … A current status report from the physician treating the airman's diabetes, including:
A current HgA1c, in the status report from the physician treating the pilot's diabetes
The AASI page says the current status report from the physician treating the pilot's diabetes includes the results of a current HgA1c level performed within the last 30 days.
Show the FAA's words: A current HgA1c, in the status report from the physician treating the pilot's diabetes
A current status report from the physician treating the airman's diabetes, including: … The results of a current HgA1c level performed within last 30 days.
A statement about the diabetic diet
The AASI page asks the physician's status report for a statement attesting that the pilot is maintaining their diabetic diet.
Show the FAA's words: A statement about the diabetic diet
A statement attesting that the airman is maintaining his or her diabetic diet;
A statement about symptoms and complications
The AASI page asks the physician's status report for a statement regarding any diabetic symptomatology, including any history of hypoglycemic events (low blood sugar) and any cardiovascular, renal, neurologic, or ophthalmologic complications.
Show the FAA's words: A statement about symptoms and complications
A statement regarding any diabetic symptomatology, including any history of hypoglycemic events and any cardiovascular, renal, neurologic, or ophthalmologic complications; and
Medications within the Acceptable Combinations of Diabetes Medications
The AASI page says examiners may reissue under the provisions of an Authorization provided that the pilot does not require insulin, remains on an acceptable oral medication therapy as the chart of Acceptable Combinations of Diabetes Medications sets out, and provides what the page lists.
Show the FAA's words: Medications within the Acceptable Combinations of Diabetes Medications
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:
Follow-up evaluation by the treating physician, annually
For subsequent exams the protocol says follow-up evaluation by the treating physician is required annually.
Show the FAA's words: Follow-up evaluation by the treating physician, annually
SUBSEQUENT EXAMS: … 2. Follow-up evaluation by the treating physician is required annually .
The status report, or a current detailed progress note from the treating physician
For subsequent exams the protocol says the pilot must submit either the Diabetes or Hyperglycemia on Medications Status Report or a current detailed clinical progress note from the treating physician which contains the information the protocol lists above it.
Show the FAA's words: The status report, or a current detailed progress note from the treating physician
SUBSEQUENT EXAMS: … 3. The applicant must submit either: … Diabetes or Hyperglycemia on Medications Status Report ; OR … A current Detailed Clinical Progress Note from the treating physician, which contains the above information.
When the examiner defers a reissue
The AASI page says the examiner must defer to the AMCD or Region if the pilot has been placed on insulin; if the HgA1c level is greater than 9.0 mg%; if the pilot has experienced severe hypoglycemia events, documented symptomatic hypoglycemia events or asymptomatic hypoglycemia, as the page defines each; if the pilot has developed evidence of cardiovascular disease, neurologic disease including any change in degree of peripheral neuropathy, ophthalmologic disease or renal disease (including a creatinine over 2.0); if the pilot has been placed on any amlynomimetic, such as pramlintide (Symlin); if the pilot is using any medication, single or in combination, that falls outside the framework of Acceptable Combinations of Diabetes Medications; if the pilot has required treatment other than routine outpatient follow-up (for example emergency department or inpatient admission) for diabetes (for example hypoglycemia, ketoacidosis or non-ketotic hyperglycemia) or diabetes-related conditions; or if the pilot has experienced any event suggesting hypoglycemia unawareness or hypoglycemia-associated autonomic failure.
Show the FAA's words: When the examiner defers a reissue
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.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
A1C timing differs between documents
For a first Authorization, the protocol asks for an A1C no more than 90 days before the exam and 30 days after a medication change. For a reissue, the AASI page asks for one within the last 30 days. The status report form says more than 30 days after a medication change and within 90 days of re/certification.
Show the FAA's words: good to know, 2
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.
A current status report from the physician treating the airman's diabetes, including: … The results of a current HgA1c level performed within last 30 days.
Hemoglobin A1C lab value … (A1C lab value must be taken more than 30 days after medication change and within 90 days of re/certification)
The A1C figure is written two ways
The protocol gives the A1C figure as 9.0 with no unit; the AASI page writes 9.0 mg%. Crosscheck shows each as published and does not decide which is correct.
Show the FAA's words: good to know, 3
Hemoglobin A1C less than 9.0; and
The HgA1c level is greater than 9.0 mg%
Three kinds of low blood sugar mean deferral
The AASI page says the examiner must defer to the AMCD or Region if the pilot has had any of three kinds of low blood sugar (hypoglycemia) it defines. One is severe, needing another person's help; the other two are set by a measured glucose level.
Show the FAA's words: good to know, 4
The Examiner must defer to the AMCD or Region if: … 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) … ref: Hypoglycemia Workgroup of the ADA & The Endocrine Society
Kidney disease or pramlintide means deferral
The AASI page says the examiner must defer to the AMCD or Region if the pilot has developed evidence of renal disease (including a creatinine over 2.0) or has been placed on any amlynomimetic, such as pramlintide (Symlin).
Show the FAA's words: good to know, 5
The Examiner must defer to the AMCD or Region if: … The applicant has developed evidence of any of the following: … Renal disease (including a Creatinine over 2.0) … The airman has been placed on any amlynomimetic, such as pramlintide (Symlin)
No pilot duties until the physician has consulted
The protocol says no pilot or safety-related duties until required recovery periods have passed and the treating physician has consulted the issuing examiner, the AMCD or the RFS, and found the condition under control, stable and no risk to aviation safety.
Show the FAA's words: good to know, 6
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.
The first AASI is deferred to the FAA
The AASI page says that when this is a first-time application for this AASI and the applicant has all the requisite medical information for a determination, the examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 7
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.
What the examiner should counsel about
Under general considerations the protocol says the examiner 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.
Show the FAA's words: good to know, 8
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.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than InsulinOpen to print: Guide for Aviation Medical Examiners – Diabetes Mellitus Treated with Any Medication Other Than Insulin, a page at the FAA, in a new tab
Special Issuance
- Guide for Aviation Medical Examiners – AASI for Diabetes Mellitus Type II, Medication ControlledOpen to print: Guide for Aviation Medical Examiners – AASI for Diabetes Mellitus Type II, Medication Controlled, a page at the FAA, in a new tab
The sheet the examiner follows to reissue under an FAA Authorization.
AASI
- Open at the FAA: Acceptable Combinations of Diabetes Medications, a PDF at the FAA, in a new tab
- Open at the FAA: Diabetes Mellitus – Type II, Medication Controlled (Not Insulin), a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
- Open at the FAA: Diabetes or Hyperglycemia on Medications Status Report, a PDF at the FAA, in a new tab
- Open at the FAA: Diabetes Mellitus Disposition Table, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.