Guide for Aviation Medical Examiners
Special Issuances

AME Assisted - All Classes
Diabetes Mellitus - Type II, Medication Controlled

For aviation purposes, diabetes is roughly divided into 3 categories:

• diet controlled diabetes
• medication controlled diabetes (oral medications -- no insulin required)
• insulin dependent diabetes

It is possible to get a waiver to fly with diabetes, and this process requires an initial phase and subsequent review phases. Pilots are expected to monitor their progress and report their medical status to the FAA. AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• A statement attesting that the airman is maintaining his or her diabetic diet;
• A statement regarding any diabetic symptomology; and
• The results of a current HgA1c level performed within last 90 days.

• The applicant has been placed on insulin;
• The HbA1c level is greater than 9.0 mg%; or
• The applicant has developed cardiovascular, neurological, renal and/or ophthalmological disease.

AME Assisted Special Issuance (AASI) is a process whereby the FAA delegates to AMEs the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

A staff FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.