Frequently asked questions.

Yes, it is possible. Under the FAA's Insulin-Treated Diabetes Mellitus (ITDM) CGM Option, applicants who use insulin — Type 1 included — can be considered for first- and second-class medical certificates through a Special Issuance. Those are the certificate classes an airline career requires.

It is not automatic. You must demonstrate at least six months of stable control on a continuous glucose monitor and submit a five-item medical package, and you remain on a monitoring schedule for as long as you hold the certificate. How the FAA medical works.

Two things immediately, per the FAA's own guidance: see your treating physician and get stable, and stop flying. Under 14 CFR 61.53 you may not act as a required crewmember with a known medical deficiency until you hold an Authorization from the FAA.

Then the process starts: find an Aviation Medical Examiner (AME) who will work the case with you, establish care with a board-certified endocrinologist, choose an FAA-compliant CGM, and begin collecting data. If you already hold a Special Issuance for another condition, the FAA's FAQ states it becomes invalid with the new diagnosis and you will need a new Authorization Letter. The nine steps, in order.

Honest answer: the FAA's ITDM guidance doesn't state a review time, so anyone quoting you a number is guessing. What the FAA does specify is the front end — a minimum of six months of CGM data demonstrating stability before initial consideration, and it notes that a new diagnosis “may require a longer stability period.”

What you control is the back end. The FAA asks for a complete package within 14 days and says partial packages are not reviewed. While under review, you must keep submitting your endocrinologist report and monthly CGM data every three months, or the FAA has to request it and the review stalls. Complete and current is the fastest path.

No. The FAA's FAQ is explicit that a pump is not required. If you choose one, both the pump and the CGM must be FDA-approved separately and as a combination, the pump must be able to suspend insulin for a predicted low, and self-built (DIY) systems are not acceptable for flying. Starting a pump for the first time carries a seven-day ground trial; switching between devices does not.

The FAA does not endorse brands; it specifies features. The device must be a real-time CGM (intermittently scanned sensors do not qualify), have predictive trend arrows, allow customizable high and low alerts with alarms and repeat alarms turned on, have an accuracy (MARD) of 10% or less, and be your own unblinded device.

As of the FAA's August 2023 list, devices meeting the features included Dexcom G7, G6, G5, and G4 Platinum; FreeStyle Libre 3; the Medtronic MiniMed 670G and 630G systems (CGM with insulin pump) and the Medtronic Guardian Connect CGM; and Eversense and Eversense E3. The FAA notes the list may not be all-inclusive. Device requirements in full.

Three specialists, all M.D. or D.O., all within 90 days of your submission: a board-certified endocrinologist for the comprehensive evaluation (not a PA or NP for the initial), a board-certified ophthalmologist for the eye exam (the FAA states an optometrist is not acceptable), and a board-certified cardiologist for a cardiac risk evaluation with ECG at any age and a stress test at 40 and older.

After certification, the endocrinologist relationship becomes permanent: a clinical examination every three months, in person at least every six.

The FAA publishes targets for certification consideration: time in range 70–180 mg/dL of 70% or greater; 90% or more of readings between 70 and 250; less than 4% below 70 and less than 1% below 54; less than 5% above 250; GMI (glucose management indicator) under 7%; coefficient of variation at or under 36%; sensor wear of 90% or more.

Meeting the numbers is necessary but not sufficient. The FAA also reviews your weekly overlay graphs for consistency, and states that data which meets the goals but shows inconsistent control on the weekly graphs “will be considered unacceptable.” The full targets table.

Yes. The FAA's AME Guide states there are no restrictions regarding flight outside United States airspace for airmen certificated under the ITDM CGM protocol.

The FAA expects you to have a glucometer and test strips, a backup CGM sensor, and — if you use a pump — a backup insulin pen with you on every flight. If the CGM stops working, you switch to your backup plan and check by fingerstick every 30 minutes for the rest of the flight. If you cannot correct your glucose, the FAA says to treat it as any in-flight emergency and land as soon as practicable.

If you develop symptoms, or become incapacitated or impaired, because of your blood glucose at any point, you must disqualify yourself from flight activities as required by your Special Issuance (SI) and 61.53, contact your endocrinologist, and contact your AME.

The Special Issuance process above is for pilot medical certificates. Other roles have their own requirements: flight attendants and maintenance technicians generally are not required to hold an FAA medical certificate, and air traffic controllers go through a separate FAA medical clearance with its own standards — one DAPA does not yet have a resource for.

Everything else does apply. The community is for every role, and the Life on the Line guides on duty days, nutrition, redundancy, and travel were written for anyone managing diabetes around an aviation schedule. If you work one of these roles, we especially want to hear from you.

No. DAPA provides peer perspective and operational insight. Always rely on your treating medical team and the current guidance from the FAA and other applicable authorities. See our Disclaimer & Terms of Use.

No. DAPA is an independent professional community. We do not act on behalf of the FAA, any aviation authority, any employer, or any union, and nothing here has been reviewed or endorsed by them.

Operational readiness, disciplined health management, safety, and long-term career sustainability for aviation professionals living with diabetes.

No. DAPA is for pilots of every kind, flight attendants, air traffic controllers, maintenance and ground operations, aeromedical and specialized roles, and students and aspiring aviators who are managing diabetes.

Use the Join DAPA button anywhere on the site to connect with the community, or Contact DAPA to reach us directly at info@dapaaviation.org.