Yes. The FAA has a pathway for each kind of diabetes treatment. Diabetes controlled by diet alone is compatible with all three classes of medical certificate if there are no disqualifying complications. Diabetes that requires insulin or another hypoglycemic medication is disqualifying under 14 CFR part 67, but the FAA grants special issuances: diabetes treated with non-insulin medication goes to the FAA for an initial decision, and insulin users can be considered for any class through a continuous glucose monitor (CGM) protocol, with a non-CGM option for third class.
This guide explains 14 CFR part 67 and the FAA’s Guide for Aviation Medical Examiners (AME Guide) as of its September 30, 2026 revision; it is not medical advice. Your treatment belongs to you and your physician. For medication-treated diabetes the Aviation Medical Examiner (AME) defers and the FAA makes the first decision, so talk to an AME early.
What part 67 says about diabetes
The general medical standard for every class of medical certificate rules out an “established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control” (67.113(a), 67.213(a), 67.313(a)). That makes medication-treated diabetes one of the specifically disqualifying conditions. It is not a dead end: 67.401 lets the FAA grant an Authorization for Special Issuance when you show you can fly without endangering public safety, and the AME Guide sets out how. Student pilots need their medical before the first solo, as our student pilot certificate guide explains.
The FAA diabetes pathways at a glance
| Situation | AME Guide pathway | Who decides |
|---|---|---|
| Prediabetes on lifestyle changes or one approved medication | Prediabetes table; CACI worksheet when one medication is used | The AME can issue if all criteria are met |
| Diabetes controlled by diet alone or in remission | Diet-controlled protocol | The AME can issue for any class if there is no disqualifying heart, nerve, kidney or eye disease |
| Non-insulin diabetes medication | Special issuance; later renewals through the AASI | The FAA grants the first authorization; your AME may reissue after that |
| Insulin, first or second class | CGM protocol (required) | The FAA |
| Insulin, third class | CGM protocol or the non-CGM third-class option | The FAA |
For prediabetes treated with one medication, the CACI worksheet requires, among other items, a current A1C of 6.4% or less and no A1C of 6.5% or greater, ever.
Non-insulin medications
If you take any diabetes medication other than insulin, the first authorization requires FAA review, so the AME must defer. You submit either the FAA’s Diabetes or Hyperglycemia on Medications Status Report or a detailed clinical progress note from your treating physician dated within 90 days of the exam, covering any hypoglycemia in the past year and any diabetes-related heart, neurological, eye, kidney or peripheral nerve disease, plus a hemoglobin A1C done within 90 days of the exam and at least 30 days after any medication change. The protocol’s initial targets are an A1C below 9.0 and an acceptable combination of medications. After the FAA grants the authorization, your AME may reissue at later exams under the AME Assisted Special Issuance (AASI), with a yearly report from your treating physician.
The AME Guide’s medication chart treats up to three non-insulin medications, no more than one from each group, as acceptable for routine treatment, and considers four or more case by case. It also sets observation periods before you fly when you start diabetes treatment: 14 days for metformin alone, 30 days for most other groups, and 60 days for sulfonylureas or meglitinides.
Insulin-treated diabetes: the CGM protocol
Pilots who use insulin can be considered for any class through the CGM protocol, and first- and second-class applicants must use it. The FAA considers applicants who have been clinically stable on their current treatment for 6 months or more, and its medication chart sets an observation time after starting insulin of 90 days for third class and 180 days for first or second class. For the initial review, the AME Guide asks for:
- At least 6 months of monthly CGM reports, up to 12 months when available, from a device that meets FAA requirements, with alarms on
- A comprehensive evaluation by a board-certified endocrinologist (MD or DO) within the past 90 days
- A lab panel, including all A1C results from the past 12 months
- An eye evaluation by a board-certified ophthalmologist, or by an optometrist if you have no retinopathy
- A cardiac risk evaluation by a board-certified cardiologist with labs and an ECG, plus an exercise stress test if you are 40 or older
The CGM goals include time in range (70 to 180 mg/dL) of 70% or more, a glucose management indicator below 7%, fewer than 1% of readings below 54 mg/dL, and sensor wear 90% of the time or more, and the weekly graphs must show consistent control. The AME cannot issue the first certificate; it goes to the FAA. As of September 30, 2026, the baseline certificate for CGM users is 6 months, with 12 months considered case by case only for exceptionally well-controlled pilots. Renewals include endocrinology visits every 3 months and CGM reports every 6 months, and the FAA’s answers for pilots say to carry a glucose meter and backup supplies in flight. The protocol places no restriction on flying outside United States airspace.
If your physician changes your treatment, check the AME Guide before your next flight. Its observation periods apply after starting or adding a medication, and the insulin protocol tells pilots who develop symptoms on a trip to stop flying under 61.53 and contact their endocrinologist and AME.
The third-class non-CGM option
Third-class applicants may instead use the non-CGM protocol. It requires no recurrent hypoglycemia (two or more episodes) in the past 5 years, and none in the past year that caused loss of consciousness, seizure or impaired thinking, needed someone else’s help, or came without warning. You also need two A1C results at least 90 days apart, an eye specialist’s report, and a stress test if you are 40 or older. In flight you carry a recording glucose meter and fast-acting glucose, check your level 30 minutes before takeoff (100 to 300 mg/dl to go), every hour in flight and within 30 minutes before landing, and land at the nearest suitable airport if it is above 300 mg/dl.
Sport pilot and BasicMed
A sport pilot can use a U.S. driver’s license instead of a medical certificate if they meet 61.23(c)(2): if they have applied for a medical, their most recent application must have found them eligible, and they must not know of any condition that would keep them from flying safely. Asked about a chronic condition such as diabetes, the FAA’s answer for sport pilots who have never sought medical certification is to consult your physician; you may fly if you are in good health, your condition is under control, you follow your physician’s treatment and you are satisfied you can fly safely.
BasicMed requires having held an FAA medical certificate after July 14, 2006, and being under a physician’s care for any diagnosed condition that may affect your flying (61.23(c)(3)). Diabetes is not on the list of conditions that need a one-time special issuance before BasicMed (68.9), but the examining physician must certify that they know of no condition that, as treated, could interfere with safe flight. The FAA also lists diabetes among common causes of acquired color vision deficiency, which can bring extra color testing (see our color blind pilot guide). Ask an AME how your own history fits these rules, and use the IMSAFE checklist before every flight.
What you'll need
The regulations behind your medical, plus the FAA handbook whose Chapter 17 covers aeromedical factors.
Frequently asked questions
Can you be a pilot with type 1 diabetes?
Potentially, yes. Insulin-treated diabetes, type 1 or type 2, is disqualifying under part 67, but the FAA can grant a special issuance through its CGM protocol for any class, or the non-CGM option for third class. The AME defers and the FAA decides.
Can a pilot with insulin-treated diabetes fly for an airline?
The FAA considers insulin-treated applicants for first- and second-class certificates through its CGM protocol, which requires at least 6 months of CGM data plus endocrinology, eye and cardiac evaluations. The FAA decides each case.
Can my AME issue my medical if I take metformin for diabetes?
Not at the first exam. The first authorization for diabetes treated with any non-insulin medication is an FAA decision, so the AME defers. After the FAA grants it, your AME may be able to reissue under the AASI.
How long is a medical certificate valid for a pilot on insulin?
As of September 30, 2026, the AME Guide sets the baseline certificate for CGM users at 6 months, with 12 months considered case by case for exceptionally well-controlled pilots. Your authorization letter sets your own terms.
What if my diabetes is controlled by diet alone?
The AME Guide considers diabetes controlled by diet alone eligible for all classes, provided there is no associated disqualifying cardiovascular, neurological, kidney or eye disease.