Insulin

The FAA's two insulin protocols, the CGM option and the non-CGM third-class option, say consideration is given to those who have been clinically stable on their current treatment regimen for 6 months or more, and that the FAA's policy permits the special issuance to some insulin treated applicants.

The FAA's chart of acceptable combinations of diabetes medications sets an observation time when starting insulin or adding insulin to an existing treatment plan of 90 days for third-class pilots and 180 days for first- or second-class pilots.

The FAA's insulin-treated diabetes page says insulin pumps are an acceptable form of treatment, and points to that chart for combining insulin with other medication.

The FAA's questions and answers for the insulin protocol say there is no ground time when a pilot already using a pump or CGM changes devices, and none when changing from an open-loop to a closed-loop system, and that a pilot who has never used a pump and starts one for the first time has a seven-day ground trial period.

The FAA's chart of acceptable combinations of diabetes medications lists an observation time of 7 days if transitioning between insulin injection to or from a pump, or for new insulin/CGM devices, and 7 days within Group A1 if adding a new type of insulin to the regimen, with a note that no time is needed for a minor dose change within the same drug class (short to short, long to long).

FAA rule for diabetes medication: The FAA makes the initial certification decision and the examiner must defer; combinations of up to three non-insulin medications, only one from each group, are considered acceptable, with an observation period when starting one. Each component in a combination medication is counted separately (for example, rosiglitazone + metformin counts as 2 medications), 4 or more medications may be considered on a case-by-case basis, and for unlisted medications the chart says to consult AMCD or RFS. Under medication adjustment, the chart lists 48 hours within Groups B to G, 7 days within Group A2, 7 days within Group A1 if a new type of insulin is added (with a note that no time is needed for a minor dose change within the same drug class), and 7 days if transitioning between insulin injection to or from a pump, or for new insulin/CGM devices. The FAA's diabetes disposition table says that for diabetes treated with one or more non-insulin diabetic medications the examiner should defer and submit the information to the FAA, and that the initial special issuance requires an FAA decision. The FAA's AME Assisted Special Issuance page for type II diabetes controlled by medication says that, once the FAA has granted the Authorization, examiners may re-issue a medical certificate under it, provided the applicant does not require insulin, remains on an acceptable oral medication therapy according to the chart of acceptable combinations, and provides the documents it lists. For insulin, the chart says to see Medical Certification Using Insulin, and for starting or adding insulin it gives separate lines for third-class pilots or agency ATCS and for first- or second-class pilots, who must use the CGM protocol; insulin has its own entry, which asks for the class of medical. FAA, Acceptable Combinations of Diabetes Medications