Diabetes mellitus type 1 in five military aviators: Flying with insulin

Overview: Diagnosis of diabetes mellitus (DM) type 1 results in medical disqualification for all military aviation duties all over the world. The main concern is hypoglycemia, which can cause sudden incapacitation. Efforts to reduce the glucose levels and long-term complications increase the frequency of hypoglycemia. Purpose: This paper reviews five newly diagnosed cases of DM type 1 in Israeli Air Force aviators that presented over the last 15 yr. Four of the aviators were allowed to continue on active duty with limitations and one was disqualified. Methods: The records of all five diabetic aircrew were reviewed. Aircrews are tested every 3 mo for HbA1c levels. Every year they receive dilated fundoscopic eye examination. They have lipid levels drawn annually and are seen by both an endocrinologist and a flight surgeon for general medical examinations. Results: Four of the aviators continued on active duty for years. No symptomatic hypoglycemia or sudden incapacitation occurred. Three of the four airmen experienced undesirable HbA1c levels. Conclusions: Our experience indicates that safely flying with newly diagnosed DM type 1 is possible. The cost of the demanding lifestyle of military aircrew members and the fear of hypoglycemic episodes can result in periods of sub-optimal glucose control. Reprint &