Pilots with Diabetes
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FLYING SOLO WITH TYPE 1 DIABETES

By Roger Serong

Sometimes with persistence, the little bloke can win through. This happened for me at Christmas when the Administrative Appeals Tribunal handed down their decision regarding the restrictions on my medical certificates.

I contracted Type 1 (insulin dependent) diabetes in 1996, upon completing an Instructor Rating, aged 48 – unusual at this age for a condition previously known as ‘juvenile onset’ diabetes. As a result I lost my class 1 medical and with it any hopes of commencing my intended mature-aged instructing career. I was now limited to flying privately only with a safety pilot on my class 2. Not much hope of carrying a non-pilot passenger with a restriction like this in two-seater aircraft!

In their welcome decision that came at the end of an eighteen-month process, the Tribunal determined that a safety pilot is no longer necessary for private day VFR flights of not more than three hours duration. Instead, I must follow a strict regimen of pre- and in-flight blood glucose level (BGL) testing using my personal blood glucose monitor and must maintain my BGLs within pre-determined limits. (See box). This requirement is similar to a system, known as the FAA Protocol, which has been in place in the US for the past ten years and which has enabled pilots with Type 1 diabetes to enjoy full PPL privileges, while maintaining an excellent safety record.

For flights other than the ones specified, the Tribunal still requires me to fly with another pilot. They also have not re-instated my class 1 medical, however the wording of the decision leaves that door slightly ajar for the future....

I have campaigned for ten years to have the FAA Protocol system introduced into Australia, unsuccessfully until now. It seemed to me that over the intervening years Australia was adopting just about everything else the FAA was doing – airspace structural reorganisation, remodelling of the CARs to become FAR-based CASRs, CTAF procedures; why not also adopt the Protocol system which was working safely in the US? If it were safe there, why would it not be safe in our less-congested airspace? I even obtained an RA-Aus Pilot Certificate and did 60 hours solo in RA-Aus-registered Jabirus to prove that the FAA Protocol provides a safe method of ensuring that a pilot with type 1 diabetes can maintain satisfactory BGLs during extended flights. (See Winjeel to Jabiru – Third First Solo, AA, August 2005, p37.)

The Tribunal’s decision has been made possible through advances in medical technology over recent years which have resulted in modern blood glucose monitors being much improved, simple to use in flight and which give accurate, reliable readings in as little as five seconds. The improved types of insulin available now are more stable and predictable, resulting in better control of blood glucose levels. If responsible pilots with diabetes exercise the same level of self-discipline in managing their diabetes as they do when flying their aircraft, then safety can be assured through close monitoring and control of their condition at all stages of flight. Any pilot will be highly motivated to do this of course, as no one in his or her right mind would entertain the possibility of becoming incapacitated in flight for whatever reason.

While indeed very significant, the Tribunal’s decision is also singular, as I am now the first licensed pilot with Type 1 diabetes to be allowed to fly solo in Australia. I had hoped that this decision would pave the way for other pilots and would-be pilots, whose condition is well controlled and who can jump through the necessary pre-qualification hoops, to follow in my footsteps. Unfortunately this may be some time yet, as CASA at this stage shows no signs of incorporating the FAA system into Australia’s medical standards. Instead, in CASA’s Autumn Newsletter to DAMEs they state:

CASA acknowledges the AAT decision, but will not be making any changes to the CASRs or guidance material as the outcome does not act as a precedent for other decisions…. CASA will continue to assess each application made by a type 1 diabetic on a case by case basis with respect to the standard in Part 67.

In other words, bad luck – the existing CASR Part 67 does not allow solo flight for pilots with Type 1 diabetes. If other applicants with Type 1 want to fly solo, they will have to navigate the tortuous and time-consuming AAT process to achieve their aim, with no guarantee of success. This is disappointing to say the least, considering that the Tribunal observed:

Having now been in operation for some 10 years, without a single incident attributable to diabetes, the FAA protocol is most certainly no longer experimental and its safety has been adequately demonstrated.

If anyone is contemplating using the Administrative Appeals Tribunal to resolve an issue, then my advice is to think very carefully about it because you only get one shot – Tribunal decisions are only appealable to the Federal Court on a matter of law, not on the facts of the issue. You must know your subject matter extremely well and be very well prepared in order to give evidence under oath and be cross-examined. You also need to be supported by good people who can give sworn expert evidence on your behalf.

It’s a rather daunting task for a self-represented individual pilot to take on a powerful and monolithic regulator like CASA, with endless resources at their disposal including an in-house Legal Services Group with consultant barrister, and expect to win. This is especially so, considering that another applicant to the Tribunal on the same matter was unsuccessful in 2003. At times it would have been all too easy to give in when the odds were stacked against me. But hey, Darryl Kerrigan did it in The Castle and now - so have I!

The full text of the Tribunal’s decision is available at:
http://www.austlii.edu.au/au/cases/cth/aat/2006/1123.html

I would like to thank my family, friends and work colleagues who have given me encouragement over the years to see this through. I also especially want to thank all those intrepid pilots who have flown with me and kept me in the air over those ten years. Without them, I would have been permanently grounded. I have enjoyed flying with them in the past, and will again at night no doubt, but now for day VFR flights of less than three hours duration, which is 99% of my flying, it gives me the greatest of pleasure to sack them all!

Diabetes

Diabetes is one of those diseases that everyone has heard of but which remains somewhat of a mystery regarding its implications until you find out you have it yourself. It is a chronic medical condition in which the body’s ability to process blood glucose is impaired. Unfortunately, in a population eating more and exercising less, obesity is on the increase in Australia, and with that statistic comes an increased risk of Type 2 diabetes, which is life-style related, even amongst people of school age. Type 2 diabetes is a condition in which a person’s pancreas still produces insulin, but their system is insulin-resistant. The condition can usually be controlled by diet, exercise or tablets, or a combination of all three. If undiagnosed over a period of time, sometimes it is discovered by the presence of secondary complications arising from the disease, such as damage to the eyes, and by then the disease is well advanced.

Type 1 diabetes, previously known as Juvenile Onset because it is often contracted during childhood, is an autoimmune condition in which antibodies destroy the insulin-producing cells in the pancreas. It is treated by the individual self-injecting insulin in order to keep blood glucose levels (BGL) within acceptable limits. If not properly controlled, episodes of temporary incapacitation caused by low BGL can occur, as well as other serious long-term medical complications. This has obvious implications for pilots. However with knowledge, self-discipline and expert medical supervision, it is possible for the individual to keep the condition under good control and lead a normal life-style.

Both types of diabetes have the potential to wreck a successful commercial pilot’s career and play havoc with the flying freedom of private pilots.

For more information about flying with diabetes, contact Roger here.

AAT Conditions for Solo Flight with Type 1 Diabetes – (Day VFR, not more than 3 hours duration)

1. The pilot must carry two functioning glucometers on each flight, together with an amount of readily absorbable glucose, in 10-gram portions, appropriate for the planned duration of the flight.
2. One half-hour prior to the commencement of the flight, the pilot must measure his blood glucose level. If the reading obtained is less than 5 mmol/L he must ingest not less than 10 grams of a glucose snack and wait for a further one half hour before taking another blood glucose measurement. If that measurement is between 5 and 15 mmol/L, the flight may be commenced. If his blood glucose level remains below 5 mmol/L a further glucose snack must be ingested and a further measurement taken one half hour later. Should his blood glucose level exceed 15 mmol/L after ingesting the absorbable glucose snack, the pilot must cancel the flight.
3. The pilot must test his blood glucose level within one hour of becoming airborne and every hour thereafter for the duration of the flight. If his blood glucose level falls below 5 mmol/L, he must ingest a 20-gram snack of absorbable glucose. He must maintain a blood glucose reading of between 5 and 15 mmol/L throughout the duration the flight. If his blood glucose level exceeds 15 mmol/L, he must land at the nearest suitable airfield and not resume flight until his blood glucose level falls back within the range of 5-15mmol/L.
4. Thirty (30) minutes prior to his estimated time of arrival on any flight, the pilot must measure his blood glucose level to ensure that it is not less than 5 mmol/L prior to making an approach and landing.
5. On application for renewal of the class two medical certificate, the pilot must provide the following:
   (a) a clinical report from his endocrinologist with particular reference to the presence or absence of any end organ changes;
   (b) daily blood glucose estimations for the preceding 12 months performed on a memory        glucometer with the hard copy printouts endorsed by his doctor;
   (c) a collated report of glycosylated haemoglobin (HbA1c) estimations performed every three months ie tests must be done every three months and the reports provided to CASA at the end of the year;
   (d) a report from an ophthalmologist with regard to any diabetic retinopathy; and
   (e) a report from a cardiologist who has conducted a coronary risk assessment including a Stress ECG (Bruce Protocol) while not taking any Betablockers.

This article first appeared in the May 2007 edition of "Australian Aviation"  (www.ausaviation.com.au)


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