Planning a diabetes research project...I need your help please

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Diabetic Pilot

Diabetic Pilot

Active Member
Relationship to Diabetes
Type 1
Hi everyone, I am struggling with my ideas so thought I would seek the help of my fellow diabetes comrades!

I want to do a study on diabetes effect on pilot performance in the aviation workplace the cockpit. This would use a professional flight simulator and I have access to continuous glucose monitoring technology for logging glucose data.

The aviation authorities wont allow diabetics to fly due to the risk and effects of incapacitating hypoglycemia. However with careful management I believe this shouldnt be a issue.

I would like to try and pull together a research topic for this to submit to my academic supervisor (who has suggested 1 idea but it is negative towards diabetics and I think it is defeatist)

His proposal:

"Project title: The effect of simulated flying on performance and blood glucose levels in diabetic and non-diabetic pilots

Aim: To characterise the impact of simulated flying and flying emergencies on airman performance and blood glucose levels in diabetic and non-diabetic pilots.

Principal hypotheses: Diabetic pilots with medication-controlled blood glucose levels under conditions of simulated flying (including flying emergencies) will display

* a drop in blood glucose concentration that is significantly larger than in non-diabetic pilots under the same conditions;

* a reduction in performance that is significantly larger than in non-diabetic pilots under the same conditions.

Method:

The method will be approved by the Life Sciences Ethics Committee.

Subjects: 5 diabetic and an age/sex/flying experience matched group of non-diabetic pilots will be trained to fly in the CAA/FAA-validated xxx flying simulator to ensure a comparable experience baseline between subjects.

Blood glucose measurement: Blood glucose concentrations will be measured using the pin prick method (xxx) every xx min, and by using a Dexcom (xxx) continuous tissue glucose meter.

Performance measurement: Pilot performance will be measured...

Statistical analysis: xxx

Protocol: After training, subjects will participate in a 1hr session in the simulator as Pilot-In-Command (PIC). The session will be uniformly scheduled 2hr after a meal. Blood glucose concentration will be measured from 1 hour before the session to establish a baseline, and until 1 hr after the session. Simulation of take-off and emergencies (including resolution), and landing will take place, with the option of repeats of part of the protocol."

My response was:
Hi Areles,

The hypothesis seems rather negative and somewhat incorrect as it is known that blood sugars rise with stress and not fall. I got mixed up and told you this so I am sorry. It would be much better to have a positive slant I.e that with frequent enough blood sugar testing AND blood sugar management, that there are no significant safety issues but this is obviously biased positive so can we not have a middle/compromise hypothesis?
I know we have ethics issues etc but the BIG issue which faces diabetes in the cockpit is hypoglycemia (low glucose levels) Can we try and work this into the study somehow?
Thanks

Karl

His reply to that:
Hi Karl,

The hypothesis you are suggesting is understandable but very propagandist and impossible to substantiate with the proposed set of experiments (although it can be falsified). It is far better to create a clear, relevant and verifiable challenge, hopefully with the result that the challenge can be met by diabetic pilots. This would be a positive outcome that is substantiated by the data. This does not mean we can't tweak what I have written.

There are a few more issues. Regarding the blood testing, to gain a resolution of, let's say, a measurement every 5 min over 2-3 hours, the best way is to use a cannula, rather than individual pricks. We are currently having staff trained to do this and I'm sure we would get one of them to help if they are available. This also involves getting semi-instantaneous readings (within 1-2 min of the sample extraction) and therefore almost real-time monitoring of blood glucose; we have the portable gear. This is important because we need to set a minimum and perhaps maximum blood glucose level in which we conduct the experiment. If we go outside this range the ethics committee would not accept the proposal on safety grounds, particularly if we don't have a nurse or physician present.

On the academic side, it is unlikely that the project will be accepted with only the experiments we thought of so far. It is simply too thin for a year's work. We would have to consider expanding the experiments, for example to include manipulation of diet or day rhythm, and inclusion of further physical and cognitive tests. This has implications for, amongst other things, the demands we put on the subjects.

Have a think....

Areles

I really need some help, I have been messed around by various tutors and being passed from 1 to the 1 I am now with since MAY and I want to start the research this academic year in the UK.

Please help me with ideas and suggestions, my head has become a mess and is making me want to quit but my heart wants to study this as I am truely passionate and interested in diabetes and aviation human factors.

Looking forward to hearing from you
 
i can only comment ( as can we all ) on our own personal experiances of this condition

in my opinion
1) my experiance of this condition is that it has an unpredictable nature even at its best control

2)i personaly dont even drive , my diabeties is far too unpredictable and feel that in me doing so would/could endanger other road users/pedestrians/my family

3)flying /transporting people who pay , expect the top service an would not want to put thier lives in the hand of someone who 'could' flake out at at any time ,or have a hypo at an important moment of flying ie...landing /taking off/turbulance/emergency situations

as i said this is only my personal opinion and while it may seem negative the facts can not be ignored , hypos DO happen at the most unprredictable times even with good blood glucose control

i wish you good luck with you research
 
I am sure you have already researched this, but if not, it might be interesting and helpful to find out what other countries who do allow people with diabetes to pilot planes use as their tests and criteria, and if there are any restraints they have which might benefit from further research and elucidation. Good luck with your efforts! 🙂
 
i can only comment ( as can we all ) on our own personal experiances of this condition - I agree and they will all be different.

in my opinion
1) my experiance of this condition is that it has an unpredictable nature even at its best control.

- I agree but when flying its more predictable if your testing each hour in flight and before take off and landings. Even more predictable if you use continuous glucose monitors in addition to traditional testing.

2)i personaly dont even drive , my diabeties is far too unpredictable and feel that in me doing so would/could endanger other road users/pedestrians/my family

- I agree but in airline pilot situations you have 2 p[ilots for a reason. Statistically I believe your more likely to have a pilot getting a heart attack then going into a major hypo.

3)flying /transporting people who pay , expect the top service an would not want to put thier lives in the hand of someone who 'could' flake out at at any time ,or have a hypo at an important moment of flying ie...landing /taking off/turbulance/emergency situations

- This is where disability discrimination comes into play... 15 or so type 1 diabetic candian airline pilots have been flying for quite a few years now...even in and out of heathrow but nobody kicks up a fuss that a plane could end up in their garden.

as i said this is only my personal opinion and while it may seem negative the facts can not be ignored , hypos DO happen at the most unprredictable times even with good blood glucose control.

- I agree but 1 fact is having diabetes need not limit the scope of your dreams and ambitions...take a look at a project ive been involved with: www.diabetesflight48.com www.diabetesflight50.com this is long endurance flying with diabetes to raise funds for diabetes research and awareness of the condition.


Thanks
 
Unlike Bex, I have been a driver for about 26 years as a type 1 diabetic although there are times I look back on which may have been more risky than I would want to go through now.

I would have thought that provisos could be made, such as no fair paying passengers, only so many hours continuous flying time, only if using CGM.

The difficulty would come in if your CGM signals a hypo, you can't pull over and wait 10 minutes after eating. You would need to set a lower limit of maybe 5mmol/l and then keep topping up.

I've found with stress that my BG can go up into the high teens fairly quickly and refuses to budge. I would imagine flying can be stressful at best of times so not sure how this could be combatted.

Presumably a pump/CGM set would be the only realistic method of control to enable you to fly ?

Rob
 
My son uses a cgm with his pump. The 'problem' could be that it is not 'real time' accuracy. I think (?) ours lags behind by 15 minutes - so in theory you can be hypo BEFORE the cgm catches up. However, the pump is also capable of alerting you to this fact, so if you are dropping quickly it will show 2 arrows going down and you then have time to do a finger prick test and treat accordingly - thus avoiding the potential hypo situation.

As everyone is individual with their diabetes - it could be that for some their levels go high whilst flying and others go low. But this would not be a problem using a pump as you can then set temporary basals for the length of the flight and keep levels within the required range.

My son puts himself on 50% for bike rides for example and he very rarely has a hypo as we have now worked out that this is a good level for him to cycle for 3 hours or so. So to me, it would be a matter of working out individual needs and tailoring them accordingly. You could have a practice on the simulator to see what it does to your levels and then work out a programme for flying that would suit.

The only other 'problem' could be interference to the sensor transmitter - but I dont know enough about planes and whats on board to know whether this would be a problem.

Not sure if any of this has helped you - but good luck with your quest.🙂Bev
 
I would toootally be fine with the pilot of a plane being diabetic as long as there is a second pilot. Even if there wasn't a second pilot I would still be pretty confident with all those checks 😉
 
Diabetic Pilot said:
i can only comment ( as can we all ) on our own personal experiances of this condition - I agree and they will all be different.

in my opinion
1) my experiance of this condition is that it has an unpredictable nature even at its best control.

- I agree but when flying its more predictable if your testing each hour in flight and before take off and landings. Even more predictable if you use continuous glucose monitors in addition to traditional testing.

2)i personaly dont even drive , my diabeties is far too unpredictable and feel that in me doing so would/could endanger other road users/pedestrians/my family

- I agree but in airline pilot situations you have 2 p[ilots for a reason. Statistically I believe your more likely to have a pilot getting a heart attack then going into a major hypo.

3)flying /transporting people who pay , expect the top service an would not want to put thier lives in the hand of someone who 'could' flake out at at any time ,or have a hypo at an important moment of flying ie...landing /taking off/turbulance/emergency situations

- This is where disability discrimination comes into play... 15 or so type 1 diabetic candian airline pilots have been flying for quite a few years now...even in and out of heathrow but nobody kicks up a fuss that a plane could end up in their garden.

as i said this is only my personal opinion and while it may seem negative the facts can not be ignored , hypos DO happen at the most unprredictable times even with good blood glucose control.

- I agree but 1 fact is having diabetes need not limit the scope of your dreams and ambitions...take a look at a project ive been involved with: www.diabetesflight48.com www.diabetesflight50.com this is long endurance flying with diabetes to raise funds for diabetes research and awareness of the condition.


Thanks
Click to expand...

fair enough..... was just my opinion , you did ask......
i belive you reasearch will not get very far if you are unable to look at both sides of the argument with out being bias
as i said personal opinion.......
 
A few extra points to consider - perhaps not what you want to hear, but finding a suitable supervisor can be a key factor; I was fortunate for my MSc thesis, carried out in Northern Ireland, my college in London found me one London supervisor and was happy to accept the one I found in Belfast. [Off the point: Then just had to convince my Dutch course leader that my risks of being blown up in NI were no greater than if I stayed in London, and in fact, other crime risks were considerably lower. Not sure that being there the summer of the Omagh bomb (1998) and having my car stolen entirely convinced him! My car was recovered by police, which probably wouldn't have happened across the water.]

Have you been in touch with Dr Ian Gallen, the physician / researcher behind www.runsweet.com website and works in Buckinghamshire? He has lots of experience of working with sportspeople with diabetes treated with insulin.

My guess is that flying with diabetes probably has more in common with SCUBA diving with diabetes, than driving. In flying, there's a co-pilot, in SCUBA diving, there's a buddy. In flying, you can't stop by the kerb; in SCUBA diving, you can't come to the surface instantly, due to pressure changes.
 
I think the issue with continuous blood monitors is they measure the fluid between the cells not the blood and so do lag by about 15 mins, however given you can continue to get data 15 mins after the flight for you experiments thats not a problem. you can also then upload all this data for a good picture of what was happening.
With regard to driving and flying, as long as you monitor your BG whats the problem with driving if you are well controlled. If you experience a lot of problems controlling BG then I would agree but this is generally not the case for most.
As for commercial aircraft, there is a co-pilot and both he and the pilot are only really there to make you feel safe and cope with 'non-standard' situations, modern aircraft can fly and land themselves without pilot intervention. They could probably take off as well, but this is done by the pilot/co-pilot based on local conditions. For light aircraft things
are a bit different and I can understand the 'issues' with Diabetics. However if there is
a co-pilot then no problem. Thats what the he's there for.
I would try to get a CGM, try contacting the manufacturers to see if they are interested in helping. I know Abbot produce one as do Medisense and I think there is another one. Realistically you could not use a canular nor do you need blood pricks, you wear the sensor on your arm like a patch and it links wirelessly to the base unit that records the data. I don't see why this is not sufficent to measure the BG, I manufacturers should
be able to provide details of the data recording. Unless the ethics committee are medical or diabetes experts how do they know if its safe anyway ??
 
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