A report recently presented at the annual meeting of the European Association for the Study of Diabetes indicates that insulin users can safely function as airplane pilots.
The study was conducted in Great Britain, which in 2012 became only the second country (after Canada) to issue class 1 medical certificates for commercial pilot licenses. Since that clearance was granted, some 70 insulin users in Britain have earned a pilot’s license. During the intervening years, experts have monitored the performance of 26 of them. In all, 8,897 blood glucose monitoring values were recorded during 4,900 flight hours.
The news was encouraging, to say the least. More than 95% of the glucose readings taken from the pilots were in the designated safe range. Even better, not a single instance of pilot medical incapacitation caused by high or low blood sugar was reported.
The analysts said that a major reason for the pilots’ excellent performance was a comprehensive protocol developed by a panel of experts. This set of guidelines includes the following components:
• establishment of three specified glucose ranges: safe (green), caution (amber) and urgent (red)
• pilots must test their blood glucose at least two hours before flying. Commercial pilots must also test at least one hour prior to reporting for flight duty and again less than 30 minutes before the flight. A pilot whose level is in the red zone cannot fly.
• during flights, pilots on insulin should test at least once every hour. Those taking sulfonylureas or glinides should test at least every two hours.
• testing is performed again within 30 minutes prior to landing and repeated if the approach or landing is delayed
• if any symptoms occur, glucose levels must be tested
• if any in-flight test is in the red zone, the pilot must hand over the controls to the copilot
• pilots can cut back testing during formal rest breaks but must restart before resuming control of the plane
• pilots must undergo clinical surveillance by Britain’s Civil Aviation Authority every six months (12 months for private pilots)
• pilots are permitted to use insulin pumps and continuous glucose monitors, but they must carry backup insulin injection supplies and perform finger-stick monitoring per protocol.
The study seems to have wider implications for other professions besides flying. Julia Hine, MD, who presented the data at the meeting, said that because the report on the insulin-using pilots was so reassuring, it suggests that advances in patient care enable insulin-treated patients to safely perform complex occupational duties.
Joseph Gustaitis is a freelance writer and editor based in the Chicago area.
Want to learn more about diabetes at work? Read “Diabetes on the Job,” by certified diabetes educator Laura Hieronymus.
