Diabetes mellitus: a mixed disease

Approximately 17 million in U.S. have diabetes mellitus (7.3% of the adult population), but only half have been diagnosed. The incidence is increasing rapidly, and is expected to double by 2010. Not only is diabetes a costly condition estimated at $100 billion per year, but it is a leading risk factor in many other diseases that adversely affect pilot's career such as heart disease, stroke, vision, kidney disease, claudication, impotence and neurologic disease. Almost 800,000 Americans are diagnosed with diabetes each year and nearly 200,000 will die from the disease. It is the 7th leading cause of death in the United States. Diabetes shortens the expected lifespan of an individual by 5-10 years. Fortunately, the condition is treatable, and in most cases, pilots may be granted authorization for all classes of airman medical certification.

Diabetes is not a single disease, but a mix of causes that have a common end result of blood glucose (sugar) levels elevated above normal. Two broad types of diabetes exist, Type I and Type II. Two other types of diabetes include Gestational (pregnancy-related) diabetes and diabetes due to other diseases and conditions.

Diabetes mellitus that is prone to causing comas due to severely elevated blood glucose, and which requires insulin for control, is termed Type I diabetes mellitus or immune-mediated diabetes . Formerly known as insulin requiring diabetes, it is the most life threatening form of the disease and may be diagnosed at any age. The body’s ability to produce its own insulin from the pancreas is destroyed in this condition. To survive, Type I diabetics require one or more shots of insulin daily.

Type II diabetes mellitus is much less prone to comatose states and frequently can be controlled without the use of insulin. It was previously known as non-insulin dependent diabetes mellitus (even though insulin was sometimes used for enhanced control). Oral medication (pills) and lifestyle changes in diet and exercise are usually adequate to control Type II diabetes .

Both types of diabetes mellitus are serious conditions that require careful monitoring and treatment to slow or prevent the numerous complications of each. The FAA treats the two types of diabetes mellitus quite differently because of the relative differences in range of blood sugars and possible effect on alertness and consciousness.