Ask D’Mine: Clipped Wings and “Reversing Diabetes”

Happy Saturday! Welcome to Ask D’Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil offers some thoughts on burning questions about people with diabetes (PWDs) being able to take to the skies as pilots, and whether losing weight is a “cure” for those with type 2. There might even be a Frank Sinatra reference in there…

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Amit from New York, type 1, writes:  I have been trying to find information regarding learning to fly gliders and airplanes with type 1 diabetes. I did run into some FAA rules, but they do not seem clear. In particular, for learning to fly/flying does type 1 diabetes lead to ineligibility? Most of the information I ran into on Google seemed either outdated (like 1997 discussions or was about another country (Canada, UK) or was about commercial pilot licenses.

Wil@Ask D’Mine answers: Come fly with me my dear… Oh. Wait. Never mind. I’ll stop singing Sinatra now and get to the point: You can’t. Because even though I have a Commercial Pilot’s License, I’m not allowed to use it anymore. ’Cause I have type 1 diabetes. Well, actually, the Catch-22 is a bit more complicated than that (an appropriate use of phrase, as the original book Catch-22 involves pilots).

Being a type 1 is no problem at all. What the Federal Aviation Administration (FAA) has a problem with is insulin. Of course with no insulin, as a type 1, you die…

Did someone say Catch-22?

Here in the States we have several different types of pilots licenses, called “certificates” by the FAA. On the bottom of the totem pole is the temporary Student Pilot’s Certificate. Then comes the Sport and Recreational Pilot’s Certificate. Generally speaking, these are for ultra-lights (those little one-seaters with lawn mower engines that have more in common with kites than airplanes—they were all the rage about a dozen years ago) and kit planes you build yourself. These recreational licenses are mainly intended to keep you from killing too many people beyond yourself if you crash: limit one passenger. Next up is the Private Pilot’s Certificate, harder to get, but with more privileges. You can now carry a bunch of people and fly a great variety of aircraft. Above that is the Commercial Certificate, which lets you carry people and cargo for pay. At the top of the totem pole is the Airline Transport Certificate, allowing one to serve as pilot-in-command of aircraft at least 12,500 pounds and more than 9 passenger seats.

All the certificates have various possible add-ons. Most certificates start as “single engine land” licenses. To fly a sea plane or a twin-engine plane, or to fly in bad weather just using your instruments, requires a special rating, or add-on to your certificate. Gliders require an additional rating, as do hot-air balloons. And helicopters. And so forth.

But wait! There’s more! The license is not enough to let you get into the cockpit. You also need a current medical certificate, and that’s where we insulin shooters get stuck. Pardon the pun. Medical certificates come in three flavors, called Third, Second, and First Class. As it sounds, to get a First class medical you need to be in tippity-top shape, health wise. Airline pilots need these. Hey, we don’t want airline captains freaking out in the air because of some medical problem, right? But if you’re hauling logs in Alaska, you don’t need to be in quite as good a shape. And if you’re just hauling the wife and kids… well, hell, you’re much more likely to die in a car crash on the way to the airport anyway, so you don’t need to be in perfect health.

Insulin is a no-no on all the medicals, but there is an exception that might allow you to get a Third Class medical—and that’s what’s needed for the Student, Sport, Recreational, and Private tickets. Getting the exception requires submitting a pile of medical paper work equal to, or greater than, your weight in kilograms. Prepare to submit detailed medical records about your hypos for the last five years, and general medical records for the entire time you’ve had diabetes. You’ll need to meet certain control benchmarks as well; and if you’re an AARP member, you’ll need even more records and tests. You can read all the details here.

So, what about me? I’ll never (until the cure) be able to make money on my Commercial Pilot’s License. But, but, but—I can down grade it, so to speak. Each certificate encompasses the certificate below it, and to move up the ladder you first must have the rung below it. That means my Commercial Pilot’s License still has a Private Pilot’s License living on inside of it. If I got a Third class medical, I could exercise the “private pilot privileges” of my commercial ticket.

That means I could take my friends and family to the friendly skies with me in command of the plane. I could even make my passengers pitch in for gas. But I just couldn’t charge them for the ride. So why haven’t I done it? Because it would be a hell of a lot of work, and because flying is an expensive hobby for a poor man. It’s just not worth it. Still, it’s nice to know it could be done.

And speaking of nice, I think it’s actually kinda nice that they didn’t take away my license when I got diabetes. I worked hard for it, and I’m still proud of it. I’m grounded and I don’t have a medical, but I am still—and will be to the grave—a commercial pilot. It’s not like one of those old movies where they rip the rank off your sleeve before shooting you in front of  a firing squad.

Are there any other medical conditions the FAA doesn’t like? Yep. Coronary Artery Disease and Hypertension, and you can also be grounded for some psychiatric conditions.

But of course there’s still a whole separate issue for you. I have a license. Getting it active by getting a current medical would be a pain in the ass, but it’s doable. For you, however, starting at ground zero, it might be harder. Even though you have the law on your side, the flight schools are not obligated to take you on.

Law and liability don’t always walk the same road, or fly the same course.

Ian from Michigan, type 2, writes: Hi! I’d like to introduce the topic of reversing diabetes.  A friend of mine says that he has reversed his diabetes successfully. Is that possible or achievable?  

Wil@Ask D’Mine answers: Not to be rude, Ian, but would you perchance be really, really, really, really, hugely fat? If so, you just might be in luck! That’s because the only medically documented cases of “true” diabetes reversal is post-op in people who’ve had some sort of bariatric surgery—you know, one of those procedures where they make your stomach smaller. There’re a number of different ways to go about doing this, but the results are all the same. Afterwards people have very, very, very small stomachs. And eat very, very, very small meals very, very, very often. Oh and they lose a ton of weight.

Why, they aren’t half the people they used to be. In a good way.

And low and behold, in many of these people, as you might expect, their insulin resistance plummets with their weight. Their elevated blood sugars plummet with their waist lines. And many of them are able to go off of their diabetes meds altogether and maintain normal blood sugars.

Poof! You’re cured.

Or are you?

While a great number of doctors (particularly the ones doing the operations) like to say that bariatric surgery is the only proven “cure” to type 2 diabetes, I personally beg to differ.

I don’t see it as a cure at all. I see it as just another treatment. I would bet a thousand doughnuts that if we took one of these folks, undid the surgery and fattened them back up again, the diabetes would re-appear in a New York Minute.

That’s because the surgery doesn’t cure the underlying issues that cause diabetes, which are waaaaaaaay more than just weight alone. All the surgery did was set aside one of the triggering mechanisms of diabetes. Don’t get me wrong, I think it is a great thing for anyone with type 2 to control their blood sugar med-free.

I just don’t think it’s the right use of the word “cure.” To me, a cure is a permanent fix.

But absent a real cure, I guess putting diabetes into “remission” is the next best thing.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.