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Flying aircraft and using insulin

Daniel Flanagan
Daniel Flanagan reviews the progress of acceptance of insulin users in safety-critical professions.

There are a number of professions that have historically refused to employ people with diabetes because of the risk of unexpected hypoglycaemia. However, as time has passed, the number of professions with complete bans on insulin use has slowly decreased. The background stories are very interesting and seem to follow the same course. Often a small group has had to fight hard against a slow-moving bureaucracy to allow change. In this country, Diabetes UK has worked on a number of fronts to convince the relevant authorities that it is safe to use insulin and work if the correct precautions are taken. The most important factor has been the use of analogue insulins and reductions in the frequency of hypoglycaemia. Continuous glucose monitoring and insulin pump therapy may help in the future, but for now use of these technologies is still restricted.

Aviation has been leading this slow acceptance of insulin use. The first private pilot licence for an individual with type 1 diabetes was issued in 1996, and Canada was the first country to issue a commercial licence in 2002. In order to hold a commercial aviation licence, a class 1 medical certificate needs to be obtained. In 2012, the UK Civil Aviation Authority developed a protocol for in-flight glucose monitoring, and following this the first commercial pilot’s licences for people using insulin were issued. This has certainly not been adopted universally, however, with a number of countries in Europe and elsewhere still refusing commercial licences for insulin users. The US has now progressed one step further and does allow the use of continuous glucose monitoring.

This interesting paper by Gilian Garden and colleagues is highly reassuring. The most important conclusion is that the process is safe and that discrimination against people using insulin is not necessary or acceptable. It is interesting to note that there were only four women in the cohort. The description of the in-flight protocol to ensure glucose is maintained within a narrow range sounds arduous for both the pilot and co-pilot but is perhaps reassuring for the passengers. Avoidance of disabling hypoglycaemia is the key aim of the process, and this has clearly been achieved, with no episode of severe hypoglycaemia reported over the 7-year study period.

It is encouraging to see how much change there has been for this group of people in a relatively short time. Hopefully, with new technologies, this rate of improvement will accelerate for a larger group of people with diabetes.

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