Diabetes Mellitus Type 1 In Five Military Aviators: Flying With Insulin
1. Aviat Space Environ Med. 2005 Sep 76:861-2. Diabetes mellitus type 1 in five military aviators: flying with insulin. Israeli Aeromedical Center, Tel Hashomer, Israel. OVERVIEW: Diagnosis of diabetes mellitus type 1 results in medicaldisqualification for all military aviation duties all over the world. The mainconcern is hypoglycemia, which can cause sudden incapacitation. Efforts to reducethe glucose levels and long-term complications increase the frequency ofhypoglycemia.PURPOSE: This paper reviews five newly diagnosed cases of DM type 1 in IsraeliAir 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 aretested every 3 mo for HbA1c levels. Every year they receive dilated fundoscopiceye examination. They have lipid levels drawn annually and are seen by both anendocrinologist 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 airmenexperienced 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 aircrewmembers and the fear of hypoglycemic episodes can result in periods ofsub-optimal glucose control.Continue reading > >
Blood Glucose Measuring Devices
For documentation of diabetes management, the aviator must carry and use 2 whole blood glucose measuring devices with memory function. They must immediately report to CASA any:
- hypoglycaemic incidents requiring external assistance
- involvement in accidents resulting in serious injury
- evidence of loss of control of diabetes, change in treatment regimen, or significant diabetic complications.
With any of these occurrences, the aviator must cease flying until CASA clears them.
Will T1ds Ever Be Allowed To Be Astronauts
Perhaps. I dont think NASA will ever allow T1Ds in the astronaut corps because honestly, they dont need to. But, I do think there will be a push for medically imperfect humans to be allowed on commercial spaceflights in the near-ish future. I actually wrote my grad school thesis on this very subject detailing the tests, feasibility, and safety of T1D astronauts.
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Douglas Cairns Of Flying With Diabetes
I was able to spend some time talking with Douglas Cairns from the United Kingdom, who flies with Flying with Diabetes. His ongoing mission is to increase awareness that people with diabetes can pilot aircraft safely, and should be given the opportunity to follow their dreams.
When he lost his flying privileges at age 25 after being a flight instructor with the Royal Air Force, he called the BAA once a year to inquire about possible policy changes for his situation. He was told each year that they had no intention of introducing new policies to allow pilots with insulin dependency to pilot aircraft in the UK.
He remembers he was in Thailand in 1999 when he first heard about the US system for pilots with diabetes to obtain a Class 3 medical certificate to fly privately. He jumped at the chance to get his private license back utilizing the new US system.
Through the organization, Flying with Diabetes, Cairns and other pilots have flown around the world, flown in formation with each other through Diabetes Formation Flight USA, and made special missions to places like Christmas Island in the Pacific Ocean, to deliver needed diabetes supplies and medications.
Just this past month in July, 2016, Douglas and another pilot with diabetes, Karl Beeson, set an aviation world speed record with their flights from London to Malta. On the way back, Douglas said it only took them 2 days, as they were able to reach speeds of 220 miles per hour at times.
Bolus Insulin And Basal
Bolus insulin refers to rapid- or short-acting insulin given to control the glycemic rise at meals and to correct hyperglycemia. The prandial injection dose is decided based on carbohydrate content, carbohydrate-to-insulin ratio for each meal, planned exercise, time since last insulin dose and blood glucose level. Bolus insulins include rapid-acting insulin analogues and short-acting insulin .
Preprandial injections of rapid-acting insulin analogues result in a lower postprandial glucose and improved overall glycemic control . Insulin aspart, glulisine and lispro should be administered 0 to 15 minutes before the start of the meal while short-acting regular insulin should be administered 30 to 45 minutes before the start of the meal. Faster-acting insulin aspart may be administered at the start of the meal or, when necessary, up to 20 minutes after the start of the meal . When required, insulin aspart, glulisine and lispro can be administered from 0 to 15 minutes after the start of a meal although better control of postprandial hyperglycemia is seen with preprandial injections.
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Dont Keep All Your Diabetic Supplies In One Bag
Another important tip for flying with diabetes is to NOT put all your diabetic supplies in one bag.
If you put everything in your checked baggage and that goes missing, then youâre going to struggle.
Whereas if you split your supplies between the two, at least you have enough to get by until you can source extra supplies.
Hypoglycemia And Insulin Therapy
Hypoglycemia is the most common adverse effect of insulin therapy in people with type 1 diabetes . In the DCCT, 35% of participants in the conventional treatment group and 65% in the intensive group experienced at least 1 episode of severe hypoglycemia . In a meta-analysis of 14 trials, the median incidence of severe hypoglycemia was 4.6 and 7.9 episodes per 100 patient-years in the conventionally treated and intensively treated people with type 1 diabetes, respectively . With adequate self-management education, appropriate glycemic targets, self-monitoring of blood glucose and support, intensive therapy may result in less hypoglycemia than reported in the DCCT , particularly with modern insulin formulations.
The frequency of hypoglycemic events is reduced with rapid-acting insulin analogues compared with regular insulin although there are no differences in the magnitude and temporal pattern of the physiological, symptomatic and counterregulatory hormonal responses to hypoglycemia induced by regular human insulin or rapid-acting analogues .
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Section : Diabetes Self
DSMES is an essential component of type 1 diabetes care that allows all other diabetes interventions to work optimally. The objective of DSMES is to provide those living with type 1 diabetes with the knowledge, skills, and confidence to successfully self-manage the diabetes on a daily basis and, thereby, reduce the risks of acute and long-term complications while maintaining quality of life . DSMES aims to empower people with type 1 diabetes, with an emphasis on shared decision-making and active collaboration with the health care team. Where possible, DSMES programs should be evidence-based and conform to local and national standards to demonstrate effectiveness.
Bmi And Physiologic Challenges Affecting Hba1c
The decline in BMI seen in our population coincides with the findings in existing literature on body composition changes following military deployments, particularly those that are less than 7 mo in duration. Studies on U.S. and British soldiers who deployed to Afghanistan for 49 mo reduced their body mass by 25% reflecting a decrement in both fat and lean mass. However, other studies with longer deployment durations suggest that lost body weight tends to recover, or even exceed pre-deployment weights, potentially owing to an increase in fat mass.,
Reduction in weight has been shown to improve glycemic control,,, and our results coincide with the literature. Although our results demonstrate favorable and concordant findings in terms of HbA1c and BMI responses to deployment, glycemic management can be affected other physiologic challenges in a deployed setting, which may be subject to future systematic analyses.
Dietary content and quality also inevitably change in deployment. The overall diet in a deployed environment, as measured by total Healthy Eating Index-2010 score, is considered suboptimal due to limitations in the quality and availability of perishable food items. The limitation in food choices, especially those with lower glycemic indices, is likely to contribute to hyperglycemia.
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A Year After Doctors Said He Wouldnt Be Allowed To Commission Air Force Academy Graduate Joins The Space Force
Tanner Johnson’s fiancee, Brynn Woodyard, pins on his second lieutenant bars at the commissioning ceremony for Cadet Squadron 14 at the U.S. Air Force Academy in Colorado Springs, Colo., May 25, 2021. Johnson was the first person diagnosed with Type 1 diabetes to commission into the U.S. military.
A year before Tanner Johnson was due to graduate from the U.S. Air Force Academy in Colorado, he was lying in a hospital bed and doctors were telling his family he had two hours to live.
His organs were shutting down due to complications caused by Type 1 diabetes, an autoimmune condition where the body attacks the cells that make insulin.
Type 1 diabetes usually affects young children and runs in families, but none of Johnsons relatives were diabetic. He was nearly 22when he was diagnosed in May 2020, two months after most cadets had been sent home as the academy scrambled to contain the fast-spreading coronavirus.
Johnson pulled through the worst of the health crisis and began to deal with his new reality.
The doctors said I would have to take insulin shots every day for the rest of my life, I would not be able to fly, I would not be allowed in the military, and wouldnt be allowed to return to the academy and graduate, Johnson said.
But he refused to accept what they said and set out to prove them wrong. He hoped to become the first person to be commissioned into the U.S. military with a medical condition that, up until then, was automatically disqualifying.
Canadian Pilots Taking Insulin Can Fly = Hope
The history of diabetes and aviation in Canada includes enacting a new Canadian Constitution in 1982. In the Constitution, it states that no one should be discriminated against due to their disability.
In 1992, the Civil Aviation Medicine Branch of Transport Canada started to look at the regulations, and formed a group to revise the guidelines. The change was that people with diabetes who take insulin could now be considered for a medical waiver if they can control their diabetes within certain stringent regulations.
A commercial pilot in Canada must show that he can recognize and control his diabetes symptoms. Blood sugar is to be at a higher level than what is advised during flight times. This is to minimize the risk for a low blood sugar while in the skies. Due to a possible impact on long term health that periods of high blood sugar may cause, the pilot must agree to this.
Pilots are required to perform frequent self-monitoring of blood glucose. This is between 5.5 and 15.0 mmol/l. They must of course carry their quick-acting carbohydrates at all times, and there is a co-pilot available to take over as always in the event of an emergency4.
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Section 1: Adjunctive Therapies
While insulin therapy is essential for people with type 1 diabetes, obtaining glycemic goals with insulin alone is difficult because of the risks of hypoglycemia. Furthermore, insulin therapy is often associated with undesirable weight gain, which may worsen insulin resistance, does not address other pathophysiological abnormalities, such as -cell dysfunction, and does not wholly protect individuals from an increased risk of cardiovascular disease or other complications. Adjunctive therapies aim to augment insulin therapy by addressing some of these critical unmet needs.
To date, although several drugs have been licensed as adjunctive therapies, the evidence of their effectiveness on clinically relevant outcomes other than blood glucose levels, such as cardiovascular and renal disease, is limited. It is not possible to make a general recommendation about their use, but they can be considered in individual cases . However, before these drugs are prescribed, insulin therapy should be optimized.
Implications Of Acceptance Of Meeting The Criteria By Casa
If applicants meet the above criteria, CASA will consider them for entry into the protocol cohort on a case-by-case basis.
If accepted into the cohort, the applicant will initially be issued a Class 2 certificate valid for flight with safety pilot only.
To have the safety pilot requirement removed, the applicant must:
- carry out the in-flight requirements in a 2 pilot situation for a minimum of 15 flights
- provide the on-ground and in-flight data to CASA for assessment and consideration.
CASA will tailor details of types of flights and durations to meet individual requirements.
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Why Is This Policy Decision Such A Big Deal
Ed: Up until now, pilots who already had their commercial licence when they became insulin-dependent could apply for a medical certificate to keep flying. But no one who already was on insulin could do the same. It really made no sense to us.
Austen: Shortly after my diagnosis, I attended the diabetes transition program offered by the Stollery Children’s Hospital, and was told that nearly every career opportunity was available to people like mewith the exception of military service and commercial piloting.
Section : Psychosocial Care
Type 1 diabetes is a psychologically challenging chronic condition, with treatment outcomes highly dependent on the persons ongoing self-care behaviors. Cognitive, emotional, and social factors are critical determinants of self-care behaviors and, consequently, treatment success . Emotional health is an important focus and outcome of person-centered diabetes care .
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Study Validation And Data Extraction
Two independent investigators extracted data from the included articles. Discrepancies were handled by consultation and guide from JQH. In addition, data about baseline information of participants, study design, and relevant statistics were extracted. No qualification was made to measure the seriousness stratification of T2DM.
We evaluated the included studies according to the Newcastle-Ottawa scale . A quantitative scoring device proposed by the Cochrane Collaboration was adopted to assess the studies’ methodological quality. The NOS contains three significant spaces: selecting subjects, comparability between bunches, and outcome measures. The most extreme of each region is four, two, and three. Thus, the lower the full score of the three parts, the worse the article is in methodological quality.
Dont Put Insulin In Your Checked Luggage
I have to admit, I always assumed people knew this. However, after seeing numerous threads on Facebook about flying with diabetes, I learnt of a few people who put their insulin in their checked luggage and it went missing so they were left without.
Thatâs reason number 1 why you shouldnât put your insulin in your checked baggage.
But reason number 2 is that there is a VERY high risk that your insulin will freeze on the route.
When youâre flying, the plane enters crazy cold temperatures, that insulin cannot operate under.
You might not even realise your insulin has frozen because itâs defrosted by the time you check it.
So, you should NEVER EVER EVER put your insulin in checked baggage, ever.
Thatâs exactly why you get an extra liquids bag when flying with diabetes, so you can avoid that problem.
Tip: If youâre worried about keeping your insulin cool or how to pack insulin for a flight, you can check out my post on insulin cooling cases.
But in the past, Iâve always used Frio bags and havenât had an issue with them in over 5 years of use.
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Older People With Type 1 Diabetes
Insulin regimens in older adults should be individualized and patient safety is a key priority. Glycemic targets should be based on functional status and life expectancy, rather than chronological age. As older adults with type 1 diabetes are especially vulnerable to hypoglycemia, target glucose values should be adjusted to minimize the occurrence of hypoglycemic events. Since, in some older adults with type 1 diabetes, administration of insulin may become more difficult, simplification of insulin management may be justified in cases of individuals with complications or functional or cognitive impairment. The use of advanced technologies in older individuals is useful and should not be discontinued or a priori excluded because of the older age .
Social Determinants Of Health
Social and financial hardships can negatively impact an individuals mental health, motivation, and capacity to engage in self-management practices, increasing the risk for elevated HbA1c and complications. In a review of social determinants of health and diabetes , the importance of the following domains is discussed: 1) neighborhood and physical environment 2) built environment 3) environmental exposures 4) food access, availability, and affordability and 5) health care access, affordability, and quality.
Socioeconomic challenges, particularly the inability to pay for food, insulin, other medications, and supplies, need to be recognized and addressed. Several screening tools are available . Sample questions that have been used include: How hard is it for you to pay for the very basics like food, housing, medical care, and heating? At any time since the last interview or in the last 2 years have you ended up taking less insulin than was prescribed for you because of cost? In the past 12 months has lack of transportation kept you from attending medical appointments or from getting insulin? The diabetes team should have access to a social worker and/or links to community resources to help those with these needs.
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Csii And Quality Of Life
Several studies have demonstrated improved quality of life or improved treatment satisfaction with CSII therapy whether due to improved glycemic control, flexibility in insulin administration, patient selection and/or motivation. The various studies used different measurement tools or older insulin regimens . Compared with basal-bolus injection therapy plus SMBG, CSII plus SMBG has been associated with improved diabetes-specific QOL and TS . When compared with basal-bolus injection therapy plus SMBG, CSII plus CGM has been associated with improved diabetes-specific health-related QOL , diabetes-related distress , TS , perceived frequency of hyperglycemia , fear of hypoglycemia , and general health and social functioning . Compared with CSII plus SMBG, SAP has been associated with improved TS , lower perceived frequency of hypoglycemia , less worry about hypoglycemia , and better treatment convenience and flexibility .
Data regarding long-term diabetes complications, adverse events, cost and mortality among users of CSII have been limited . An observational study of a large population-based Swedish national diabetes registry revealed lower cardiovascular mortality in users of CSII compared with users of basal-bolus injection therapy .