Type 2 Diabetes Certification

How the FAA handles type 2 diabetes depends on how it's treated. Diabetes controlled by diet alone is the simplest case: you're eligible for all classes as long as you have no disqualifying heart, nerve, kidney, or eye complications, and your AME can issue. Once you take any medication for diabetes — pills, a GLP-1 injection, or insulin — you need an Authorization for Special Issuance, and the FAA makes the first decision. Your AME must defer your initial exam.

For diabetes treated with non-insulin medication, you'll submit either the FAA's Diabetes or Hyperglycemia on Medications Status Report or a detailed clinical progress note from your treating physician dated within 90 days of your exam. It must say whether you have any diabetes-related organ disease and whether you've had any low blood sugar episodes in the past year. You'll also need an A1C within 90 days of the exam and at least 30 days after any medication change. The FAA's initial targets are an A1C below 9.0 and an acceptable combination of medications: up to three non-insulin medications, no more than one from each FAA medication group, with an observation period after starting — 14 days for metformin alone, 30 days for most other groups, and 60 days for sulfonylureas or meglitinides. After approval, your AME can issue later certificates under the terms of your Authorization, and you'll need an annual follow-up evaluation from your treating physician.

Insulin-treated pilots can be certified in all classes, but only after being clinically stable on their current regimen for at least 6 months. First- and second-class applicants must use the FAA's continuous glucose monitoring (CGM) protocol; third-class applicants can choose the CGM protocol or a non-CGM option. After starting or adding insulin, the observation period is 90 days for third class and 180 days for first and second class. Insulin pumps are acceptable.

Weight-loss medication is a separate path. As of August 26, 2026, if you have prediabetes (not diabetes) and take a single medication — metformin, liraglutide, semaglutide (Wegovy), or tirzepatide (Zepbound) — your AME can issue under the CACI Prediabetes Worksheet, as long as your A1C is 6.4% or lower and has never been 6.5% or higher. If you have a diabetes diagnosis, the same medications fall under the diabetes Special Issuance process above.