title: Diabetes mellitus type 1 in five military aviators: flying with insulin.
abstract: BACKGROUND
  Diagnosis of diabetes mellitus (DM) type 1 results in medical disqualification for all military aviation duties all over the world. The main concern is hypoglycemia, which can cause sudden incapacitation. Efforts to reduce the glucose levels and long-term complications increase the frequency of hypoglycemia.
  
  
  OBJECTIVE
  This paper reviews five newly diagnosed cases of DM type 1 in Israeli Air Force aviators that presented over the last 15 yr. Four of the aviators were allowed to continue on active duty with limitations and one was disqualified.
  
  
  METHODS
  The records of all five diabetic aircrew were reviewed. Aircrews are tested every 3 mo for HbA1c levels. Every year they receive dilated fundoscopic eye examination. They have lipid levels drawn annually and are seen by both an endocrinologist and a flight surgeon for general medical examinations.
  
  
  RESULTS
  Four of the aviators continued on active duty for years. No symptomatic hypoglycemia or sudden incapacitation occurred. Three of the four airmen experienced undesirable HbA1c levels.
  
  
  CONCLUSIONS
  Our experience indicates that safely flying with newly diagnosed DM type 1 is possible. The cost of the demanding lifestyle of military aircrew members and the fear of hypoglycemic episodes can result in periods of sub-optimal glucose control.
authors.affiliation: Israeli Aeromedical Center, Tel Hashomer, Israel. carterd@zahav.net.il
authors.forename: Dan
authors.initials: D
authors.lastname: Carter
authors.forename: Bela
authors.initials: B
authors.lastname: Azaria
authors.forename: Liav
authors.initials: L
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D001359:Aviation; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004608:Eligibility Determination; D006442:Glycated Hemoglobin / Q000032:analysis; D006304:Health Status; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin