![]() 4 The medical standards are less demanding for Class 2 and again for LAPL, which reflects the more limited privileges and different levels of risks associated with these licences. In Europe there is also a light aircraft pilot's licence (LAPL) and medical certificate, with similar licensing elsewhere for “sports” aircraft. ![]() In most countries, a Class 1 medical certificate is required for a commercial licence, and a Class 2 for a private pilot's licence (Class 3 in the United States). 3 There are different classes of certificate corresponding to the types of licence privilege a pilot wants to exercise. There are international and regionally agreed standards for the issue of the medical certificates which validate a pilot's licence. The physiology and pathophysiology underpinning glucose regulation and the management of diabetes in the air, allowing certain insulin-treated pilots to fly, is discussed. Methods included searches using PubMed, together with abstract research for aeromedical scientific meetings. The purpose of this review was to gather all available information to update clinicians. 2 Aviation has been at the forefront of these changes. It is thus possible to reappraise relative risk and extend the boundaries of what is possible, practical and safe. There has been a reduced frequency of severe hypoglycaemic events and delayed diabetes-related comorbidities. ![]() 2 Advances including new insulin analogues, which reduce the risk of hypoglycaemia, insulin pumps, and non-invasive continuous glucose monitoring (CGM) devices and techniques have led to vastly improved glycaemic control in insulin-treated diabetes. 1 The risk of hypoglycaemia and incapacitation is the most widely quoted reason for a blanket ban policy preventing safety-critical occupations being performed by people with diabetes managed with insulin. The overall aim was to reduce the barriers that deny realization of full potential as members of society but have to be balanced by public safety. A right was stipulated that people with diabetes should be treated fairly in employment and career progression whilst acknowledging that there were certain occupations where identifiable risks may limit their employment. 1 The vision of this charter was to optimize health and quality of life, enable as normal a life as possible, and reduce and eliminate barriers that deny realization of full potential as members of society as a whole. This prompted the International Diabetes Federation to launch an International Charter of Rights and Responsibilities of People with Diabetes in 2011. People with diabetes face daily discrimination and prejudice about the medical condition with which they live.
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