20230327 Diabetes certification v6.1

UK CAA Policy for the Medical Certification of Pilots

and Air Traffic Controllers (ATCOs) with Diabetes

Information for Pilots, ATCOs and their Instructors, Examiners and Employers

Contents

1. Introduction

2. Certification assessments for Class 1/2/3/LAPL applicants with diabetes

3. Blood testing protocols

4. Insulin pumps

5. Follow up / surveillance requirements for pilots / ATCOs with diabetes

6. Medical assessment for UK NPPL

7. Indications for change of fitness status.

8. Diabetes report specification

9. Pilot with diabetes treated with potentially hypoglycaemic medication – Operational / Medical flight

test report

10. ATCO with diabetes treated with potentially hypoglycaemic medication – Operational test report

11. Information for operators on flight crew with insulin-treated diabetes

1. Introduction

This information has been prepared to assist pilots and ATCOs in understanding the requirements for

medical certification in the UK with diabetes and gives their employers information to assist in their

transition back to work once they have regained certification.

Class 3 certificates are not included in the ARA.MED.330 protocol and so medical certificates are not

being issued to Class 3 applicants with insulin treated diabetes. As Class 1 certificates can only be

issued with an operational multi-pilot limitation (OML), for the time being we are unable to accept

applicants who do not already have a commercial licence.

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Medical Department

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Issued By: UK Civil Aviation Authority,

Medical Department

2. Certification assessments for Class 1/2/3/LAPL applicants with diabetes

Type of diabetes & treatment Available certification / limitations

Medications with potential of hypoglycaemia

Insulins (all types)

Class 1, 2, LAPL (unrestricted) - refer to CAA

Medical Assessor

Class 1 :

OML Valid only as or with qualified co-pilot

SIC Specific regular medical examination(s) -

contact licensing authority

Class 2 and LAPL** :

OSL* Valid only with a safety pilot and in

aircraft with dual controls (Class 2)

SIC Specific regular medical examination(s)

- contact licensing authority

Sulphonylureas

Glinides

(and

any combination therapy that includes

suphonylureas

or glinides)

Class

1 and 3 – refer to CAA Medical Assessor

Class

2 – in consultation with CAA Medical

Assessor

Regular

testing required – see (3) Blood

testing

protocol below

Class

OML

Valid only as or with qualified co-pilot

Class

2 and LAPL:

OSL*

Valid only with a safety pilot and in

aircraft

with dual controls (Class 2)

Class

Dependent

on history and control may need

SSL

special restriction as specified -

Standard

ATCO proximity condition

Treatment with very low risk hypoglycaemia

Glitazones

Gliptins

Incretin

mimetics (GLP-1 analogues)

Biguanides

Alphaglucosidase inhibitors

SGLT2

inhibitors

Class

OML

(unless monotherapy)

Unrestricted

class 2/3 and LAPL

Diet

only

Unrestricted

class 1/2/3/LAPL

*Unrestricted certification may be possible where a medical flight test demonstrates that the in-flight

requirements are adhered to and testing does not interfere with safe operations. It is therefore possible

to attain initial Class 2 / LAPL certification. (See medical flight test (MFT) form)

** An unrestricted LAPL medical certificate is possible for applicants accepted for certification through the

protocol. Otherwise applicants with Type 2 diabetes can be certificated with ORL for flying in non-rotary wing

aircraft in accordance with AMC5 to MED.B.095.

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3. Blood testing protocol

a. Frequency

Before flight / duty

• At least 1 hour before reporting for flight / duty period or at least 2 hours before commencing

flight / controlling (this allows good control to be confirmed or notification to company of

unfitness).

• Less than 30 minutes before take-off or commencement of controlling and duties should not

continue if testing shows a glucose level outside of the green (no action) range (see b.

Actions to be taken below) until the appropriate priority or corrective actions have been

taken and glucose level has returned to the green range.

In-flight / controlling

• For insulins: at least every hour whilst flying.

• For oral medicines that are potentially hypoglycaemic (sulphonylureas, glinides): at least

every 2 hours (4 hours ATCO) whilst flying / controlling.

• Within 30 minutes of anticipated landing time. If the approach and landing are delayed and

an unexpected period is spent in the ‘hold’, repeat blood glucose testing may be necessary.

• If any diabetic symptoms are experienced.

Pilots or ATCOs who are taking formal rest and not seated at the controls / controlling position

may suspend testing but must restart testing prior to resuming flying / controlling.

Pilots and ATCOs taking non-hypoglycaemic medications should test before commencing flight /

controlling and if symptoms are experienced during flight / controlling (mandatory for classes 1

and 3, recommended for class 2 and LAPL).

b) Actions to be taken

Blood

Glucose

(BG)

20.0 mmol/l or symptoms

- Urgent - priority action

>15.0 mmol/L

- Caution – corrective

action

No-action range

5-15 mmol/l

<5.0 mmol/l

- Caution – corrective

action

<4.0 mmol/l or symptoms

- Urgent - priority action

High Readings

Priority Action (>20.0mmol/l)

1) Repeat reading (+/- check CGMS)

2) Shall hand over duties or if solo pilot consider landing

as soon as practicable

3) Otherwise, take appropriate insulin and/or modify CHO

intake

4) Resume full duties when BG <20.0mmol/l

Corrective Action (>15.0mmol/l)

1) Repeat reading (+/- check CGMS)

2) If still >15.0mmol/l review insulin dosing and/or modify

planned CHO intake

Low Readings

Priority Action (<4.0mmol/l)

1) Repeat reading (+/-check CGMS)

2) If still <4.0mmol/l shall hand over duties or if solo pilot

consider landing as soon as practicable.

3) Ingest 10-15g readily absorbed CHO and retest after

15mins

4) Review insulin dosing and/or modify CHO intake

5) If test after ingestion is still <4.0 then ingest further 10-

15g CHO and retest after 15 min

6) Wait for 45 mins after the BG returns to the ‘green

‘range before resuming duties. (In the unlikely event of

any symptoms of cognitive impairment the pilot/ATCO

should not resume duties for the duration of the

flight/control duty period).

7) If crew assistance is required or the pilot becomes

incapacitated then a MOR shall be filed

Corrective Action (<5.0mmol/l)

1) Repeat reading (+/- check CGMS)

2) If still <5.0mmol/l ingest 10-15g readily absorbed CHO

and retest after 30 mins

3) Review insulin dosing and/or modify CHO intake

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Important notes: certificate holders must comply with the following:

• Testing should be performed using an ISO 9000 certified device. A spare device must be

carried.

• Pilots and ATCOs should ensure that blood glucose testing is pre-planned and alerts/reminders are

set up for testing as per the relevant schedule.

• All commercial pilots should brief their co-pilot fully prior to the flight. The brief should include the

nature of their diabetes, their testing regime, the timing and method of blood glucose testing, actions

to ensure the blood glucose remains in the acceptable range, medication that will be or may be

required during the flight, possible symptoms of high or low blood glucose and actions to be taken

in the event of incapacitation, according to the SOPs.

• Commercial pilots should ensure their co-pilot cross checks their test result and should always say

the reading aloud so that it is recorded on the voice flight recorder.

• All pilots and ATCOs should annotate the results of testing in their log book for compliance

monitoring (alternative, electronic recording methods may be acceptable).

• Pilots who have to take action for a high or low reading should always make an entry in their log

book, documenting the action taken.

• The basic principle of following the ‘Be aware ➔ Eat ➔ Test’ cycle should be remembered at all

times.

• The test meter memory will be periodically reviewed by an AME or the CAA against the

flying/controlling log to ensure protocol compliance. Failure to demonstrate compliance with the

schedule of testing is likely to result in suspension of the medical certificate.

• General aviation pilots should record the blood glucose levels in their log book along with the time

of testing. They may wish to use the commercial pilot recording template (see ‘information for

operators’ section below) as a checklist for longer flights.

• Emergency situations are covered in the section ‘Information for operators’ below. Pilots should

always adhere to the failsafe position which is to always take rapidly absorbed carbohydrate if

unable to test.

4. Insulin pumps

For insulin pumps, use of continuous glucose monitoring systems (CGMS) and closed loop systems,

please see UK Aircrew Regulation ARA.MED.330: Medical Assessment Protocol for Pilots with

Diabetes Treated with Insulin and / or Potentially Hypoglycaemic Medication. Looping DIY

systems are not permitted.

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5. Follow up / surveillance requirements for pilots / ATCOs with diabetes

a. Requirements for pilots on insulin or pilots / ATCOs taking other hypoglycaemic

medication

Class 1 and 3 Class 2 LAPL

Review

with CAA diabetes

specialist

- symptoms, clinical

reports,

review of data logging of

operational

blood sugars and

review

of flying / duty log

Six monthly Annual

For first diabetes

assessment only

HbA1c

frequency

Three monthly for 2

years, then six

monthly thereafter if

stable

Six monthly Six monthly

Medical

report(s) From

applicant’s

own consultant

diabetologist

(see CAA

specification

for diabetes reports)

Six monthly

alternating with

review by CAA

Annual alternating

with review by

CAA

(Report from

specialist

diabetologist or GP

diabetes clinic)

Annual - Review by

AME – pilot should

ensure that copies of

the reports are also

provided to the CAA

Medical Assessor for

diabetes protocol

data

collection purposes

(Report from

specialist

diabetologist or GP

diabetes clinic)

Cardiology

review

Notes:

At first diabetes

assessment then:

At first diabetes

assessment then:

5 yearly under 40

Annual over 40

If omitted, requires

OSL/OPL and ECG

at every medical

At first diabetes

assessment then:

) A cardiology review,

including

exercise test, may be

required

at any time on clinical indication

5 yearly under 40

(see note 2)

3 yearly over 40

Pilots require annual cardiology

review, to include exercise

ECG testing if their

cardiovascular risk is >10%

over

10 years. If acceptable, the

exercise ECG should be

repeated annually if the risk is

>20% and every other year if

>10% and <20% (see CAA

Exercise ECG Test Protocol)

Annual over 40

If omitted, requires

OSL/OPL and

ECG at every medical

Certification

review

Oral

6 monthly by CAA

Medical Assessor

Annual by AME Annual by AME

Insulins

6 monthly by CAA

Medical Assessor

(not Class 3)

Annual by CAA

Medical Assessor

Annual by CAA

Medical Assessor

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b. Requirements for pilots / ATCOs taking non-hypoglycaemic medication

Class 1 and 3 Class 2 LAPL

HbA1c

frequency

Six monthly Annual

Medical

report(s)

(See

CAA specification for reports)

Annual (specialist) Annual (specialist or GP)

Cardiology

review

Notes:

1) A cardiology review, including

exercise test, may be required at

any time on clinical indication

2) Pilots require annual cardiology

review, to include exercise ECG

testing if their cardiovascular risk

is >10% over 10 years. If

acceptable the exercise ECG

should be repeated annually if the

risk is >20% and every other year

if >10% and <20% (see CAA

Exercise ECG Test Protocol)

At first diabetes

assessment

5 yearly under

40 (see note 2)

Annual over 40

If 10 year

cardiovascular

risk >10%

If acceptable,

see note 2 for

repeat exercise

ECG testing

intervals

On clinical

indication

Certification

review

Annual by CAA

Medical Assessor

Annual by AME

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6. Medical assessment for UK National Private Pilots’ Licence (NPPL)

UK pilots who wish to exercise the privileges of a NPPL flying aircraft less than 5700kg MTOM must

visit an AME and apply for a LAPL medical certificate. Those who wish to exercise the privileges of

a NPPL flying aircraft no greater than 2000kg MTOM may self-declare their fitness as long as they

meet and continue to meet the requirements (including the DVLA blood glucose testing schedule).

7. Indications for change of fit status

• An HbA1c between 8.5-10% should trigger a diabetes review and review of treatment. A period of

unfitness may be required to re-stabilise treatment.

• An HbA1c of greater than 10% indicates poor control and should normally entail an unfit

assessment.

• Medication change (which necessitates a change to the testing protocol, e.g. starting insulin) =

unfit minimum 2 months. Those who should be under continuing CAA clinic surveillance as

indicated in 5(a) above must be reviewed before a return to flying / controlling. Otherwise a

medical report of stability / symptoms / satisfactory BGMs is required before return to flying.

• Change of insulin regimen (including new use of pump) = unfit minimum 1 month. Those who

should be under continuing CAA clinic surveillance as indicated in 5(a) above must be reviewed

before a return to flying / controlling. Otherwise a medical report of stability / symptoms /

satisfactory BGMs is required before return to flying.

• Change of non-hypoglycaemic medication type or dose = 2 weeks unfit. Stability should be

reviewed / confirmed by GP or AME.

• Episodes of severe hypoglycaemia must be reported. Such occurrences (including but not

limited to severe hypoglycaemia requiring the assistance of another person) will normally entail

an unfit assessment. Specialist review will be required before consideration of any resumption of

flying / duties.

• Development of any retinopathy requires CAA ophthalmological assessment and is likely to result

in further restriction or unfitness if there is any field loss or reduction in visual acuity.

• Presence of significant nephropathy significantly increases cardiovascular risk and is likely to entail

unfitness.

• Non-declaration of symptoms, medical history or provision of incomplete testing records / flying log

book is likely to entail unfitness.

8. Diabetes report specification

The following headings are for guidance purposes only and should not be taken as an exhaustive list.

All relevant information should be reported.

Please note that the UK regulations and the CAA’s guidance material for fitness decisions, acceptable

treatments and required investigations (if specified) can be found in the medical section of the CAA

website (www.caa.co.uk/medical ). For many conditions, there are also flow charts available for

guidance on the assessment process.

1. Diagnoses

Type

Comorbidities

2. Presenting History and initial Investigation and Treatment (initial report only)

Presenting complaint and symptoms (including date of diagnosis)

Nature of condition, circumstances surrounding onset, precipitating factors

3. Progress since last report

Review and management of glucose monitoring, correlated with symptom review

Changes to treatment

Number of severe hypoglycaemic episodes in past year Loss

of hypoglycaemic awareness

Other relevant medical history

Current treatment

4. Screening Examination and Investigation Findings

Blood tests

HbA1c

Liver and Renal Function (eGFR and ACR)

Lipids

Screening for complications

Retinopathy report including gradings (for Class 1 & 3

by an ophthalmologist/specialist clinic)

Neuropathy

Nephropathy

Cardiovascular risk assessment confirming no evidence of cardiovascular disease

See requirement for periodic exercise ECG testing (pages 6 & 7)

Risk factors including family history, smoking, alcohol intake and weight (BMI)

Blood Pressure within acceptable parameters (British Hypertension Guidelines)

5. Follow up and further investigations/referrals planned or recommended

Anticipated follow up / frequency of clinical reviews and investigations

Confirmation disease is well controlled at date of report on stable dose of acceptable medication

6. Clinical Implications

Any concerns regarding disease progression, treatment compliance or risk of sudden

incapacity

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9. PILOT WITH DIABETES TREATED WITH POTENTIALLY HYPOGLYCAEMIC MEDICATION

UNITED KINGDOM CIVIL AVIATION AUTHORITY

OPERATIONAL/MEDICAL FLIGHT TEST REPORT

Note: For commercial pilots the Medical Flight Test should preferably be undertaken on the first

line flight, as testing in the simulator may not adequately replicate the relevant aspects of the

flight environment.

1) Candidate’s Personal Details:

Name

(in full): ........................................................................

CAA

Ref No: ........................................................................

Date

of Birth:

......../......../........

Current

Address: .................... .....................................................

.................... .....................................................

Telephone

Numbers

Home:

.............................................

Work:

.............................................

Mobile:

Purpose of test:

.............................................

To determine that the applicant demonstrates knowledge of the aeromedical issues relevant to diabetes

and demonstrates safe management of their health condition whilst exercising licence privileges

3) Declaration

I understand the purpose of the medical flight test

Signature of candidate ......................................Date ......../......../........

Name: …………………………………………………...........CAA Ref No ...........................................

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4) Medical Flight Test Report (To be completed by Company TRE for Class 1, CFI or FIE for Class

2 or LAPL)

Aircraft Type & Registration: ........................................................................................................

Flight/Sectors assessed: ..............................................................................................................

Date & Place Of Test: ......../......../........ - ......................................................................................

Examiner's Name (please print): ..................................................................................................

Examiner’s CAA Licence No: .......................................................................................................

Blood Testing machine Used: ......................................................................................................

Acceptable

Appropriate briefing on diabetes conducted using UK CAA briefing sheet ........................Yes/No

Evidence of compliance with blood testing in accordance with relevant protocol................Yes/No

Check Log book and glucose memory meter congruity for previous flight(s) ...............Yes/No/N/A

Tests conducted in safe manner without interference with safe operations ........................Yes/No

Tests conducted at correct times in accordance with schedule ..........................................Yes/No

Time

Flight

phase

Result

& Comments

Time

Flight

phase

Result

& Comments

Spare meter available?...................................................................................................... Yes/No

Appropriate stowage of equipment/resources .....................................................................Yes/No

Availability of carbohydrate – state what............................................................................ Yes/No

Comments:

Recommendations (e.g. any type/class-specific issues)

Signed ................................................................................................ Date ......../......../........

Return completed form to: CAA Medical Department, Aviation House, Beehive Ring Road,

Crawley, West Sussex RH6 0YR

10. ATCO WITH DIABETES TREATED WITH POTENTIALLY HYPOGLYCAEMIC MEDICATION

UNITED KINGDOM CIVIL AVIATION AUTHORITY

OPERATIONAL TEST REPORT

1) Candidate’s Personal Details:

Name

(in full):

........................................................................

CAA

Ref No:

........................................................................

Date

of Birth:

......../......../........

Current

Address:

.........................................................................

..........................................................................

Telephone

Numbers

Home:

.............................................

Work:

.............................................

Mobile:

Purpose of

test:

.............................................

To determine that the applicant demonstrates knowledge of the aeromedical issues relevant to diabetes

and demonstrates safe management of their health condition whilst exercising licence privileges

3) Declaration:

I understand the purpose of the operational test

Signature of candidate ......................................Date ......../......../........

Name of ATCO: …………………………………………………..CAA Ref No ........................................

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4) Operational Test Report (To be completed by Watch Manager)

Job role (e.g. area, approach, tower): ..........................................................................................

Duty period(s) assessed: .............................................................................................................

Date & Place of Test: ......../......../........ - .......................................................................................

Examiner's Name (please print): ..................................................................................................

Examiner’s CAA Licence No: .......................................................................................................

Blood Testing Machine Used: ......................................................................................................

Acceptable

Appropriate briefing on diabetes conducted using UK CAA briefing sheet…………………Yes/No

Spare blood testing machine available ..............................................................................Yes/No

Where an insulin pump is used, alternative delivery method available ........................Yes/No/N/A

Availability of carbohydrate – state what............................................................................Yes/No

Appropriate stowage of medication/equipment/resources ..................................................Yes/No

Check operational blood glucose testing records and glucose memory meter congruity ....Yes/No

Evidence of compliance with blood testing in accordance with relevant protocol................Yes/No

Tests conducted in safe manner without interference with safe operations ........................Yes/No

Time

Result

& Comments

Time

Result

& Comments

Appropriate stowage of equipment/resources ....................................................................Yes/No

Availability of carbohydrate – state what............................................................................Yes/No

Comments:

Recommendations (e.g. any type/class-specific issues)

Signed ................................................................................................. Date ......../......../........

Return completed form to: CAA Medical Department, Aviation House, Beehive Ring Road,

Crawley, West Sussex RH6 0YR

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11. Information for Operators on Flight Crew with Insulin-Treated Diabetes

Summary

Operators may have flight crew who develop diabetes requiring insulin who wish to return to flying

once their condition has stabilised or may recruit a pilot with this condition. This guidance provides

information for operators and should be read in conjunction with the document ‘‘The Medical Assessment

Protocol for Pilots with Diabetes Treated with Insulin and/or Potentially Hypoglycaemic Medication”.

Background

Diabetes

Insulin is a hormone produced by the pancreas which controls blood glucose (sugar) levels. Diabetes

develops when there is insufficient insulin or it cannot be effectively used by the body and blood sugar

level regulation becomes unbalanced.

Treatment is often with medicines (tablets or insulin injections) that allow the body to use the circulating

sugar, thus keeping the blood sugar level in the normal range. High levels occur if not enough medicine

is taken/used or too much carbohydrate is eaten and low levels can occur if toomuch medicine is

taken/used or not enough carbohydrate is eaten to balance the medicine.

Pilots with insulin-treated diabetes

A Class 1 medical certificate is only issued to a pilot on insulin if they fulfil stringent criteria including

demonstration of excellent control of their diabetes.

Pilots with insulin-treated diabetes have to comply with the ARA.MED.330 protocol including frequent

blood sugar testing before and during a flight duty period to ensure their blood glucose levels remain

within an acceptable range. Hazards should be identified through the operator’s safety management

system (SMS) and the operator is responsible for putting in place measures to remove, or mitigate, the

risks of the identified hazards.

Examples:

Hazard

Mitigation

Incapacitation

due to low or high

blood

sugar level

•

Multi-pilot flying only in commercial operations.

•

Adherence to blood glucose mandatory blood glucose testing

protocol.

•

Awareness of the risk of not adhering to the protocol through

training and pre-briefing.

•

Cross checking of blood glucose results by other pilot(s).

•

Immediate consumption of carbohydrate in the event of a low

reading or if operational circumstances prevent blood glucose.

Sharps

injury from blood sugar testing

equipment

Use

of a self-contained testing system or a sharps box for lancet

after

use.

Distraction

of other pilot

Full

briefing in advance of flight duty.

Pilot

incapacitation not identified

All

pilots briefed in standard operating procedures in the event of a

pilot

becoming unwell or uncommunicative.

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Considerations for operations manuals

a) General (these items are likely to be included already)

Pilot responsibility - decrease in medical fitness

The operations regulations contain requirements for crew not to perform duties when unfit orif aware

of any decrease in their medical fitness that might render them unable to safely exercise licence

privileges.

Incapacitation of pilot

Any incapacitation, whether sudden or subtle, should be handled in the same way as any othermedical

incapacitation.

Training for pilot incapacitation

Training on how to recognise pilot incapacitation and the standard operating procedures to follow

in the event of pilot incapacitation should be included in the annual SEP training.

b) Specific (these items may need to be added)

Possible symptoms of low or high blood sugar

Low

blood glucose

(hypoglycaemia)

(if

level less than 3)

High

blood glucose

(hyperglycaemia)

(if

level greater than 20)

Sweaty,

pale skin

Thirst

Mood

changes

Excess

urine output

Poor

concentration / distraction

Dehydration

Confusion

Mood

changes

Excessive

tiredness / sleepy

Blurred

vision

Pilot responsibilities - insulin-treated diabetes

Flight crew members must inform their line manager if returning to flying after being re- certificated

following a diagnosis of diabetes and being treated with insulin. In this circumstance, class 1 medical

certification will be subject to an operational multi-pilot limitation; the line manager should be informed

of any other operational limitations.

The pilot must comply with the schedule of blood glucose testing required by the UK CAA.

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The pilot must brief the other member(s) of the flight crew (and other members of the crew as

necessary) before each flight on:

• The reason for blood glucose tests.

• How the blood glucose test is done.

• When blood glucose tests are required (including with reference to the flight plan).

• Actions to be taken in the event of a blood glucose test outside of the

acceptable range (below 5 or above 15 mmol/l).

• Whether, when and how insulin will be used during the flight duty period.

• Possible symptoms of low or high blood glucose.

• Actions to be taken by the pilot if a test is ‘out of range’.

Blood glucose test times should be pre-planned, by time from departure, waypoints, or by setting

up alarms - an iPad, phone or in-cockpit alarm could be used.

It is the pilot’s responsibility, when on duty, to carry any medication (e.g. insulin) required, any

equipment required to deliver the medication (e.g. pens and pumps) and documentary evidence from

their general practitioner or diabetes specialist confirming the need to carry the medication and

equipment. Sufficient medication and equipment should be carried to cover the planned duty period

and additional contingency for unplanned extensions. All equipment, medication and carbohydrate for

emergency consumption should be safely stored in the cockpit and immediately accessible.

Testing should always be undertaken ensuring compliance with standard operating procedures at all

times. The pilot should avoid testing blood glucose during ground manoeuvring in the vicinity of

runway holding areas or entering or crossing a runway, or in phases of flight associated with heavy

workload including the take-off and approach and landing.

The result of the blood glucose test should be spoken aloud by the pilot so that it is captured on the

cockpit voice recorder (CVR) and the test result should be shown to and cross-checked by the other

pilot.

The blood testing schedules are described in ‘Blood glucose testing’ (Section 3 above).

Blood glucose levels should be recorded in, and a comment made in the remarks column of, the log

book.

An example template for recording blood glucose levels is shown here:

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Blood Glucose Log (for pilots with diabetes)

Pilot name: CAA reference no:

A/C type: Flight no: Route:

Date and

time:

Flight phase:

Reading

(mmoL

-1

)

X-check:

Symptoms

Comments

Pre-Report

Pre-Flight

In Flight

Pre-Landing

Other

Crew

CVR

A record should be made of any snacks or meals taken, insulin used, any bunk rest and any corrective

action that was required in the event of a low or high result.

Any crew intervention required to assist a pilot in controlling their blood glucose levels is a reportable

event and should be reported under the MOR scheme and the pilot should declare themselves unfit.

Any failure to comply with the testing schedule is a reportable event and should be reported under the

MOR scheme.

Blood glucose testing must be done after every period of prolonged rest, 30 minutes prior to resuming

flight duties.

If the testing equipment is not self-contained, the lancet, needle and any clinical waste should be

disposed of in a single use sharps box.

The pilot should always carry a spare, functioning glucose meter with memory; if both meters become

unserviceable the pilot should hand over control of the aircraft to the other pilot. In this event it is

recommended that the autopilot should be engaged to reduce workload.

Emergency situations

If operational considerations prevent the pilot from undertaking a blood glucose test at the required

time 15g of rapidly absorbable glucose/carbohydrate (e.g. 3 jelly babies, 4 glucotabs) should be

consumed immediately and blood glucose testing done as soon as possible.

In an event such as a rapid decompression there would be no time to take precautionary carbohydrate

and priority would be given to flying the aircraft. Carbohydrate should be taken once the emergency

has stabilised. If a mask continues to be required, it could be quickly lifted, carbohydrate consumed

and the mask replaced within a couple of seconds. In any other emergency situation 15g carbohydrate

should be taken as soon as practicable.

If an operational emergency is prolonged, with no opportunity for blood glucose testing, this

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Diabetes Certification Guidance

03/2023v6.1

Issued By: UK Civil Aviation Authority,

Medical Department

consumption of 15g carbohydrate must be repeated every hour. Blood glucose testing should be

undertaken hourly or more frequently if there was any concern about the pre-emergency glucose trend

or if a lot of carbohydrate has been taken over the course of several hours without the possibility of

testing.

If the pilot has an insulin pump, in the event of a decompression, it should be switched off and 15g

carbohydrate should be taken as soon as possible.

If the pilot is awoken from their bunk for an emergency, blood glucose must be tested prior to resuming

control.

Responsibilities of other pilot(s) (whether commander or not)

The operator may wish to inform the whole fleet that they may be rostered with a pilot with insulin-

treated diabetes so that flight crew who have any concerns about flying with another pilot using a

needle and syringe on the flight deck and periodically undertaking finger prick blood tests have the

opportunity to raise these concerns. Any pilot who is uncomfortable should notify their line

management to ensure this can be addressed through appropriate rostering.

The other pilot(s) should positively cross-check each blood sugar test result during the flight duty

period and confirm the result verbally.

The other pilot should respect the confidentiality of any medical information shared by the pilot.

Responsibilities of the operator

The operator will need to ensure all additional operational procedures and information is promulgated

to all pilots in the fleet of a pilot with insulin-treated diabetes.

Flight manuals may need to be amended to include operational considerations for pilots and operators

of pilots operating with insulin-treated diabetes.

The operator will have access to confidential medical information about their pilot with insulin-treated

diabetes. The normal rules of medical confidentiality apply and must be respected at all times.

Flight crew with diabetes treated with medication other than insulin

Other medications that may lower blood sugar levels, e.g. sulphonylureas or glinides, may be used by

diabetic pilots to control their blood sugar levels. Pilots on these medications should be subject to the

same blood sugar tests, protocols and operational procedures as pilots on insulin. The only difference

is that the periodicity of the in-flight testing schedule is reduced to every 2 hours.

Pilots on glitazones, gliptins, GLP-1 analogues, biguanides, alphaglucosidase inhibitors only require

one pre-flight blood glucose check; if this is within the acceptable range, they do not need to undertake

further in-flight testing.