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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 application for an AASI for Diabetes controlled with oral hypoglycemics (glucose controlled with pills not insulin), and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or the Regional Flight Surgeon for the initial determination.
AMEs 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 current status report from the physician treating the airman's diabetes, including:
- A statement attesting that the airman is maintaining his or her diabetic diet;
- A statement regarding any diabetic symptomatology, including any history of hypoglycemic events and any cardiovascular, renal, neurologic, or ophthalmologic complications; and
- The results of a current HgA1c level performed within last 30 days.
The AME must defer to the AMCD or Region if:
- The applicant has been placed on insulin
- The HgA1c level is greater than 9.0 mg%
- Any hypoglycemic event
- The applicant has developed evidence of any of the following:
- Cardiovascular disease,
- Neurologic disease, including any change in degree of peripheral neuropathy,
- Ophthalmologic disease,
- Renal disease (including a Creatinine over 2.0)
- The airman has been placed on any amlynomimetic, such as pramlintide (Symlin)
- There is a change in oral hypoglycemic medication
- The airman has been placed on beta-blockers AND his/her oral diabetes medications include any sulfonylurea and/or any meglitinide.Commonly used meglitinides include:
- repaglinide (Prandin), and
- nateglinide (Starlix)
Commonly used sulfonylureas include:- acetohexamide (Dymelor)
- chloropropamide (Diabinese)
- tolazamide (Tolinase)
- tolbutamide (Orinase)
- glimepiride (Amaryl)
- glipizide (Glucotrol, Glucotrol XL)
- glyburide (DiaBeta, Micronase, Glynase)
- glyburide plus metformin (Glucovance)
- glipizide plus metformin (Metaglip)
- Any new treatment is initiated
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