AMC5 MED.B.095 Medical examination and assessment of applicants for LAPL medical
certificates
ED Decision 2019/002/R
METABOLIC AND ENDOCRINE SYSTEMS
(a) Metabolic, nutritional or endocrine dysfunction
Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit subject to demonstrated stability of the condition and satisfactory aero-medical evaluation.
Obese applicants may be assessed as fit if the excess weight is not likely to interfere with the safe exercise of the licence.
Applicants with thyroid disease may be assessed as fit once a stable euthyroid state is attained.
(1) Applicants using antidiabetic medications that are not likely to cause hypoglycaemia may be assessed as fit.
(2) Applicants with diabetes mellitus Type 1 should be assessed as unfit.
(3) Applicants with diabetes mellitus Type 2 treated with insulin may be assessed as fit with limitations for revalidation if blood sugar control has been achieved and the process under (e) and (f) is followed. An ORL is required. A TML for 12 months may be needed to ensure compliance with the follow-up requirements below. Licence privileges should not include rotary aircraft flying.
(e) Aero-medical assessment by, or under the guidance of, the medical assessor of the licensing authority:
(1) A diabetology review at yearly intervals, including:
(i) symptom review;
(ii) review of data logging of blood sugar;
(iii) cardiovascular status. Exercise ECG at age 40, at 5-yearly intervals thereafter and on clinical indication, including an accumulation of risk factors;
(iv) nephropathy status.
(2) Ophthalmological review at yearly intervals, including:
(i) visual fields — Humphrey-perimeter;
(ii) retinae — full dilatation slit lamp examination;
(iii) cataract — clinical screening.
The development of retinopathy requires a full ophthalmological review.
(3) Blood testing at 6-monthly intervals:
(i) HbA1c;
(ii) renal profile;
(iii) liver profile;
(iv) lipid profile.
(4) Applicants should be assessed as temporarily unfit after:
(i) changes of medication/insulin leading to a change to the testing regime until stable blood sugar control can be demonstrated;
(ii) a single unexplained episode of severe hypoglycaemia until stable blood sugar control can be demonstrated.
(5) Applicants should be assessed as unfit in the following cases:
(i) loss of hypoglycaemic awareness;
(ii) development of retinopathy with any visual field loss;
(iii) significant nephropathy;
(iv) any other complication of the disease where flight safety may be jeopardised.
Blood sugar testing is carried out during non-operational and operational periods. A whole blood glucose measuring device with memory should be carried and used. Equipment for continuous glucose monitoring (CGMS) should not be used. Pilots should prove to the AME or AeMC or medical assessor of the licensing authority that testing has been performed as indicated below and with which results.
(1) Testing during non-operational periods: normally 3–4 times/day or as recommended by the treating physician, and on any awareness of hypoglycaemia.
(2) Testing frequency during operational periods:
(i) 120 minutes before departure;
(ii) <30 minutes before departure;
(iii) 60 minutes during flight;
(iv) 30 minutes before landing.
(3) Actions following glucose testing:
(i) 120 minutes before departure: if the test result is >15 mmol/l, piloting should not be commenced.
(ii) 10–15g of carbohydrate should be ingested and a re-test performed within 30 minutes if:
(A) any test result is <4,5 mmol/l;
(B) the pre-landing test measurement is missed or a subsequent go-around/diversion is performed.