Two type 1 pilots—veteran flyer Douglas Cairns, and Thor Dahl, a newbie—recently climbed into the tight quarters of a twin-engine plane with diabetes supplies, snacks for blood sugar lows and everything else necessary for a really long plane trip.
The goal: beating the previously-set world flying record of landing in 23 states in 24 hours. That’s a little less than one state per hour!
Just a handful of countries allow people with diabetes to fly commercially. The United States is not one of them.
Douglas and Thor’s recent accomplishment demonstrates the capability and endurance of pilots with diabetes and aims to build support for changing the policy that prohibits insulin-dependent people from flying commercial airlines in most places around the globe.
Aviator's note: If you have type 1 diabetes in the United States your are automatically disqualified from flying commercial—essentially working as a professional pilot and being paid to fly. The Federal Aviation Administration (FAA) claims it will individually assess people with diabetes for commercial flying purposes but to our knowledge at this time, no one in the US has ever been granted an individual assessment. Interestingly people with type 1 in the UK and Canada can fly commercially and even enter the US but people in the US cannot do the same.
Douglas, 55 and Thor, 24 both grounded military pilots due to type 1 diabetes, believe more countries should change the regulations to allow pilots with insulin-treated diabetes to fly commercially. Many policies are dated and do not reflect current research or recent advances in diabetes technology.
Torbjorn Dahl (Thor) resides outside of Oslo, Norway. In August 2017, just two months after he successfully completed the four years of training required to become a Norwegian Air Force helicopter pilot, Thor was diagnosed with type 1 diabetes which meant the loss of his ability to fly in the air force.
The young Norwegian was so upset at the restriction he set out to research what could be done to right this wrong. His long-held dream of being a military pilot was pulled right out from under him! But it wasn’t long before Thor came across Douglas through his work assisting and educating pilots with diabetes. The two men quickly struck up a friendship fueled by their common goal of getting more pilots with diabetes in the cockpit.
Douglas had a similar tale. When he was diagnosed with type 1 diabetes in 1988 he had been working as a jet-flying instructor in the Royal British Air Force. Like Thor, the diagnosis grounded him from his flying duties.
In an effort to promote awareness of this problem and build a case for widespread policy change, the pair departed from Sanford, Maine on July 29, 2018, and worked their way down the east coast before turning west toward Arkansas and finally north toward Indiana.
Their 2,000-mile journey ended in my home state of Minnesota where not only did they set a new world record but they beat the old one by six whole states! Their record: 29 states in 24 hours. (Old record: 23 states.)
I got a chance to interview this dynamic duo last week about their inspiring flight and what it felt like to accomplish their high-flying goal.
Quinn: I’m very excited to have the opportunity to speak with you both, not only as a fellow type 1 but also because I have a brother named Thor and I’m from Minnesota and Minnesota was the last stop in your world record-setting journey.
Anyway, packing for travel is overwhelming whether you’re a pilot or not I think. I mean I travel in my job as a professional speaker quite a bit and I know what goes into that…diabetes supplies of course, along with clothes, shoes, makeup, etc. but I can’t imagine what’s involved in packing for a 24-hour journey in a small plane. Can you tell us what you put in your bag?
Thor: I never leave home without Skittles—it's my go-to for low blood sugar—so I had some of those along with low-carb, nutritious snacks and protein-rich food. My most important item though was probably my Dexcom CGM—having this technology is really, really helpful.
Douglas: We stayed in a little hotel in Maine and went to the local Walgreens. It was a well-stocked store and we picked up all our diabetes supplies and snacks there.
We'd like the audience to know that in the US there is quite a lot of government monitoring when it comes to obtaining a license to fly when you have diabetes. I’m from Great Britain originally where the process and the policy are a bit different. The FAA requires a rigorous demonstration of good glucose control in order to gain what’s known as a 3rd class medical license to fly small planes. (First and 2ndclass licenses are reserved for pilots that do not have diabetes.)
Pilots in the US are required to have blood sugars between 100 mg/DL and 300 mg/DL during flight. US pilots with blood glucose readings over 300 during a flight are required to land ASAP and can’t fly again until blood sugar has stabilized.
I echo what Thor said—the CGM is a really useful and valuable tool. The technology really makes it convenient and easy to frequently monitor blood sugar levels. Incidentally, Dexcom sponsored our flight so here's a shout out to Dexcom! Thank you for your support.
Currently, only a handful of countries—the UK, Canada, Ireland, Austria, Poland, the Philippines and Israel allow commercial (as part of a multi-crew operation) and private flying for people with diabetes. Canada’s system was introduced in 2001; the UK in 2012 and Ireland followed in 2015—thanks in part to the work of our group.
Quinn: How did the two of you meet?
Thor: I found Douglas through my online research. He's involved with two websites: Pilots with Diabetes (PWD) and Flying with Diabetes. As soon as I learned that having diabetes would impact my ability to fly—a long-held dream of mine—I started researching what was involved so I could get back to flying as soon as possible. I had recently completed training to become a military pilot and this was devastating news.
In February, I flew to London from Norway to speak to Douglas in person. I recognized immediately that he was the person to ask. It was apparent from his work and the quality of the information he provides to the flying community that he was the authority. On a personal level, Douglas has helped and encouraged me immensely.
Quinn: What was it like touching down in the last state, Minnesota? I should probably preface this by reminding you that I'm a proud Minnesotan. I consider it God’s country. What did you do to celebrate your achievement?
Thor: We popped a bottle of champagne but only for the bubbles. Didn’t dare indulge for obvious reasons but it seemed like an appropriate way to commemorate breaking the world record. It was a great feeling even though we hadn’t slept in more than 30 hours!
Douglas: It was a truly fantastic feeling. We were lucky with the weather—it had been terrible on the East Coast, but rain and clouds lifted and we found ourselves in a fortunate spot.
One observation I made—with regards to fatigue—it wasn't really an issue for me. Probably because I felt really well rested going into the flight. I’d even say “fresh” at the start of the journey. I’d had a few consecutive days of good, solid rest. Getting eight hours of sleep was an important part of the preparation. It helped me feel truly ready to go. It was a marvelous combination of factors—good weather, good sleep, and good company.
Douglas and Thor's Facebook post from July 30, 2018:
“If you guys thought we were gonna settle at 24 states, think again! Just over 23 hours, of which 15.6 was airborne, over 2000 miles, 12 Red Bulls (sugar-free!) and around 40 blood sugar readings (all within limits) later, we finished up in Minnesota, crushing the previous record (23) by six states. New record to beat: 29 states.”
Quinn: Why are there so few countries that allow people with diabetes to fly commercially?
Douglas: Interestingly Canada, the USA, and Australia introduced private flying regulations for people with diabetes in 1977. The FAA in the US has had a good deal of congressional support. Other countries have been much slower to follow the policy lead.
There’s the risk of hypoglycemia of course but a lot of research has been conducted and technological advancements have been made since the policy was first introduced in 1977—that was a long time ago.
The good news is that more countries are expected to sign on very soon. For more information and updates, visit Pilots with Diabetes.
We’re working hard to persuade other countries and making gradual progress. It’s one of the reasons achieving the world record was so meaningful. It demonstrates that flying with diabetes is safe and possible.
CGMs have been an incredibly powerful tool and have opened many doors for us. And the future seems like it will have even fewer barriers given we may soon see devices that don't require any calibration at all. One more reason to say, “yes” to pilots with diabetes.
Quinn: Here’s a question from Facebook asked by a dad whose type 1 son dreams of becoming a pilot one day. “Are there any non-standard preventative measures required by them due to their condition? And is the bar higher for them to prove their condition isn’t an increased risk factor for them and their passengers? In other words, do they have to report their AIC numbers to maintain their credentials?”
Douglas: Yes, your A1C levels have to be in an acceptable range and tested regularly—every 3 months. The pilot's license must also be renewed yearly.
In Europe, they’ve taken it one step further and require even more data for a license. We have to record blood glucose readings pre-flight, during flight and post-flight.
In Canada, studies of commercial pilots have concluded there is no greater risk of an airline incident in planes operated by pilots with diabetes. This is a significant finding.
Thor: I’m currently working to have my military airline license renewed so I can work as a pilot in Norway. It’s a similar protocol there. I had been in the Air Force and am 100% committed to working as an Air Force pilot again.
Douglas: I’m delighted by Thor’s feedback that Norway is considering so seriously bringing Thor back into the military. This is real progress! As for future partnerships, Thor and I are keen to do another project together soon.
Next year is the 100thanniversary of an incredible achievement that we may try to replicate. In 1919 two British pilots flew bomber planes during WWI. It was a harrowing flight from Newfoundland in Canada to Galway in Ireland. We’re considering making a commemorative flight next year.
Quinn: In closing, what do you want people to know about overcoming barriers with diabetes. Do you have any advice for people with type 1 diabetes?
Thor: With the right motivation and knowledge, diabetes should never be a barrier—ever! Of course, you must take precautions and be responsible but anything is possible with diabetes.
Douglas: Most of the apprehension surrounding the issue is truly due to a lack of knowledge. Diabetes can be managed and today's CGM and other tools are accurate, powerful and effective. Diabetes need not limit the scope of anything.
Don't be discouraged. If you have diabetes and want to fly, check out the websites for more information. We also have a very active Facebook group where plenty of advice and encouragement is shared plus, terrific photos from our trip!