The FAA can certificate pilots with diabetes — including those on insulin. What matters is control, safety record, treatment regimen, and documentation of stability.
Informational Use Only. The information on this page reflects our understanding of current FAA medical certification requirements and is provided for general educational purposes only. FAA policies, the AME Guide, and special issuance protocols are updated frequently and without notice. The FAA AME Guide and FAA Civil Aerospace Medical Institute (CAMI) are the authoritative sources in all cases. Nothing on this page constitutes legal or medical advice. Always verify current requirements directly with your Aviation Medical Examiner and the official FAA AME Guide at faa.gov/ame_guide before making any certification decisions.
Initial Certification Always Requires FAA Decision
For initial medication-treated diabetes, the AME must DEFER for FAA review and possible Special Issuance; subsequent issuance follows the FAA authorization. For initial non-insulin therapy, the current medication-group table specifies metformin only (Group B): 14 days; Groups C–G: 30 days; Group A2: 60 days. Adding a Group B–G drug to an established Group A–G regimen requires 14 days; adding Group A2 requires 60 days. Dose, formulation or within-class changes require 48 hours within Groups B–G or 7 days within Group A2. These intervals do not replace the full protocol or confer permission to fly.
Your treatment type is the primary driver of your documentation pathway.
Controlled by diet and exercise only — no medications
Oral medications or non-insulin injectables (e.g., metformin, GLP-1s)
Insulin-treated diabetes
Any hypoglycemia requiring external assistance or ER visit
Complications present (eye, kidney, nerve, or cardiovascular)
The FAA publishes an Acceptable Combinations of Diabetes Medications chart that defines which drug combinations are permitted. Key rules include:
The FAA's primary concern is incapacitation risk — especially from hypoglycemia. Their review focuses on whether your management is stable, documented, and safe.
For non-insulin treatment, provide A1C within 90 days of the exam and more than 30 days after medication changes. Additional trends, glucose logs or CGM data depend on the applicable protocol and authorization; a 12-month lab history is not universally required.
Any episode requiring assistance from another person or emergency care is a significant review factor. The FAA wants to understand cause, response, and what changed in your management.
How long you've been on your current regimen, any recent changes, and whether your management plan has been stable enough to establish a reliable safety baseline.
Diabetic eye disease, kidney disease, peripheral neuropathy, and cardiovascular involvement each require specific additional evaluation. The FAA reviews complication status as part of the overall risk picture.
Documentation that you actively monitor your glucose — meter logs, CGM reports, or clinician notes referencing monitoring habits — demonstrates active management.
Regular follow-up with an endocrinologist or diabetes specialist, with timely A1C checks and medication adjustments, reflects a well-managed condition.
Medication combination outside FAA's acceptable framework — must be resolved before submission
Undisclosed hypoglycemia episode that later appears in medical records
No documentation of stability after a regimen change
Missing ophthalmology evaluation when required for complications review
Patient portal summary submitted instead of formal clinic notes and lab reports
Outdated or premature A1C documentation — for non-insulin treatment, submit a result within 90 days and more than 30 days after medication changes; follow any additional authorization requirements
What sets our practice apart for diabetes certification cases.
HIMS Senior AME
FAA-designated HIMS Senior AME with experience across the full range of diabetes certification cases — diet-controlled through insulin-treated.
Pilot, Not Just a Physician
Active corporate jet pilot (ATP, CFI, CFII, MEI) — understands the operational stakes of glucose management in the cockpit.
Direct Physician Access
You work directly with the doctor. No case managers, no handoffs — one point of contact from consultation through certification.
Remote Consultations
Consultations available remotely for pilots nationwide to review their case before traveling for an exam.
Modern Patient Portal
A digital patient portal for HIMS phase tracking, document management, and progress visibility.
Two Arizona Locations
Flagstaff and Lake Havasu City offices — serving pilots across the Southwest and beyond.