Type 2 Diabetes Certification

Type 2 diabetes is one of the most common conditions requiring FAA special issuance consideration. The FAA classifies diabetes certification into several tiers depending on your treatment regimen: diet-controlled, oral medication, non-insulin injectable (such as GLP-1 agonists), and insulin-dependent. Each tier has progressively more stringent documentation and monitoring requirements, but certification is achievable across all tiers for all classes of medical certificate.

Pilots managing type 2 diabetes with diet and exercise alone, or with a single FAA-approved oral medication, often have the most straightforward path. In many cases, your AME can issue your certificate at the time of exam under the CACI (Conditions AMEs Can Issue) pathway if you meet specific criteria — including an A1C at or below 8.5%, no history of hypoglycemic episodes, and no diabetes-related complications such as retinopathy or nephropathy. If you use insulin, including newer insulin analogs, the FAA requires a special issuance with more extensive monitoring and documentation.

For insulin-treated pilots, the FAA implemented a revised policy that allows certification across all medical classes, but requires evidence of stable glucose control, continuous glucose monitoring (CGM) data or frequent self-monitoring logs, an A1C within range, and a comprehensive evaluation by your treating endocrinologist. Hypoglycemic events are taken very seriously — any episode of altered consciousness or incapacitation due to low blood sugar will result in denial. The FAA expects pilots to carry glucose monitoring equipment and a rapid-acting glucose source in the cockpit at all times while exercising certificate privileges.