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Endocrine System

Diabetes, Diet and Oral Medication


For diabetes that is controlled by diet and exercise only, a medical certificate can be issued by the aviation medical examiner at the time of the examination and does NOT require a special issuance authorization. However, you will need to provide a current status letter from your treating physician and the results of an A1C hemoglobin determination within the past 90 days.


If you have a diagnosis of Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, or Glucose Elevation/Intolerance) your aviation medical examiner may issue a certificate at the time of examination if you have an FAA Pre-Diabetes Worksheet completed by your treating physician.

The FAA allows special issuance certification for diabetes mellitus controlled with oral medications. For special issuance consideration for diabetes mellitus on oral medications, you will need:

  • A current diabetes evaluation from your treating physician that includes:
    • A statement regarding the medication(s) being used, dosages, and frequency of use;
    • The absence or presence of side effects and mention of any clinically significant hypoglycemic episodes;
    • The results of an A1C hemoglobin determination within the past 30 days that confirms satisfactory control of the diabetes (item 2 below);
    • Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying but the disease(s) must be carefully evaluated to determine any added risk to aviation safety.
  • Laboratory Reports. After established on the medication for the appropriate time, you will need a report of glycosylated hemoglobin (Hgb A1c). While the American Diabetes Association defines a diagnosis of diabetes based on an A1C value of 6.5% or greater, the FAA uses a higher limit of 8.9% as the maximum allowable A1C for regulatory medical certification purposes. Notice, there is a difference here between clinical and regulatory limits. Your treating physician will work with you to clinically manage your diabetes as efficiently as possible. Be sure to include the actual printed laboratory report and not just a statement from the treating physician. The Hgb A1c test should be done after the required wait time and submitted to the FAA within 30 days after testing.

The number of available medications to treat diabetes is increasing, and with that comes increasing limitations on which drug combinations the FAA allows. This chart indicates the acceptable combinations of medications. Generally, the FAA will grant six-year AASI authorizations with annual follow-up. Individual cases may require more frequent reevaluation, based upon case history.

AME Assisted Special Issuance (AASI) for Diabetes, Oral Medication

After initial certification by the FAA, subsequent renewals for diabetes may qualify for AME Assisted Special Issuance (AASI), a process that provides examiners the ability to issue an airman medical certificate to an applicant who has a medical condition that is disqualifying under 14 CFR Part 67.

Examiners may reissue an airman medical certificate if you provide the following:

  • An authorization letter granted by the FAA.
  • A current status report performed within the preceding 90 days that includes all the required follow-up items and studies listed in the authorization letter and that confirms no progression of disease.

How/Where to Submit to the FAA

Helps you find the contact information for submitting your medical records.

Updated August 8, 2018