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Becoming a Pilot While Living With Type 1 Diabetes

In February 2019, Austen McDonald, from Edmonton, Alberta, became the first person with type 1 diabetes (T1D) to get a professional pilot licence in Canada. He had been advocating for several years for Transport Canada to authorize people with T1D to pursue this career.  

In many countries around the world, becoming a pilot is still off limits for people with T1D.   

The rationale for these restrictions, and a shift in mentality

Prior to February 2019, the main reason for not letting people with T1D become pilots was the risk of hypoglycemia, the challenge of assessing this risk and the potential impacts of a hypoglycemic episode. For those reasons, it was impossible for someone with T1D to obtain the medical certificate that is required to get a pilot licence.

However, it is interesting to note that people who were already licensed pilots when they received their T1D diagnosis were able to get this certificate and continue flying. This surprising difference highlights just how people with T1D can be discriminated against and stigmatized.

Pilots were able to keep their licences after getting diagnosed for over 15 years, until this policy was changed. During those 15 years, no diabetes-related incident or security issues were reported.

That’s when Austen McDonald and his father started to make a case for changing minds and discriminatory regulations. With the support of Diabetes Canada and Austen’s healthcare team, they achieved their goal in a little over five years.

Flying with restrictions

People with T1D are now able to obtain the medical certificate required to become recreational pilots, air traffic controllers or airline pilots. 

To obtain the certificate, they must see a doctor and meet the following criteria: 

  • No severe hypoglycemia (loss of consciousness, inability to treat it alone) within the last five years.
  • Blood sugar levels over 5.5 mmol/L 90% of the time. 
  • Appropriate knowledge and understanding of diabetes and good glycemic control.
  • Hypoglycemia awareness.
  • Check-up by a diabetes specialist every three months.
  • Check-up by an ophthalmologist, a cardiologist, a neurologist and a nephrologist as part of the initial medical exam.  

So, anyone who meets these criteria and doesn’t have any major diabetes-related complications can get the certificate. 

Once they have their licence, they have to work alongside a co-pilot and check their blood sugar level before taking off, every hour during the flight and 30 minutes before landing.  

This may seem like a lot of requirements, but they’re not impossible to fulfill. They basically reflect the guidelines to follow for optimal glycemic control. 

Living your dream despite having T1D

This is a great example to show how perspectives can be shifted, even though people with T1D are still discriminated against today.

Max Domi, for example, has T1D and plays in the National Hockey League. There are also many police officers, firefighters, paramedics, etc. in Canada who live with T1D.   

Having T1D can make things more difficult and require more efforts, but nothing is out of reach! If you are strongly motivated and have the right support to manage your blood sugar levels, you can make your dreams come true. 


The BETTER registry (a kind of census of people with type 1 diabetes in Quebec) wants to paint a picture of the stigmatization of people with T1D. Sign up for the registry and help us shed light on your reality and shift perspectives. 
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