STEPHEN STEELE: FLYING ON INSULIN
In 1986, airline pilot Stephen Steele had his medical certificate revoked when he was diagnosed with Type I diabetes. It would be 16 years before he could fly again. Today, Stephen is showing pilots around the world that insulin-dependence is not necessarily an end to their flying careers.
Stephen Steele had been flying as a commercial airline pilot for Air Canada for eight years when he got the news: he had Type I diabetes. It was a day he would never forget.
“When my doctor gave me the diagnosis, he was very understanding and compassionate as he realized the implications of the diagnosis for my flying career,” recalls Stephen.
Losing his or her medical certificate is every pilot’s nightmare. But in 1986, in accordance with International Civil Aviation Organization standards, insulin-dependent pilots could not hold a licence over concerns that a low blood glucose could lead to a loss of consciousness in flight. Stephen was permanently grounded.
Faced with this new reality, Stephen transitioned to a career in law. After studying and practicing law for eight years, he returned full time to the aviation industry in 1994, accepting a job with Cathay Pacific Airways in Hong Kong as a flight simulator instructor, teaching other pilots how to fly. For the next eight years, it was the closest he would come to flying a real aircraft.
Back in Canada, the wheels of legislative and legal change slowly turned. As far back as 1982, Transport Canada’s Civil Aviation Medicine Branch (CAM) was examining its policies on diabetes, and in 1986, CAM started to look at relicensing pilots who had Type II diabetes. But it wasn’t until six years later, in 1992, that a panel of expert doctors was assembled to review diabetes in the modern aviation environment, and a new process for pilots with Type 1 diabetes was conceived. During this decade-long process, the Canadian Diabetes Association took Transport Canada to court on the grounds that pilots were being discriminated against, and their rights were being violated under the Charter of Rights and Freedoms. Although the court ruled in Transport Canada’s favour in 1996, it opened the doors to re-licensing pilots of multi-crewed aircraft.
“I wanted to come back to Canada and prove that flying on insulin could be done safely.”
In the ensuing years after the ruling, one Canadian military and three other civilian pilots had their licences reinstated. It was 2002, and time for Stephen to come home. “Leaving Hong Kong was one of the hardest things I had done to that point. But I wanted to come back to Canada and prove that flying on insulin could be done safely,” he recalls.
On February 3, 2003, just over one year after he had his licence reinstated, Stephen flew as a first officer to Houston, Texas on an Airbus A320 with Air Canada. “No one knew for sure this would work,” says Stephen. The 3 1/2-hour flight went without incident, and Stephen would join the small, exclusive group of Canadian pilots with Type 1 diabetes to fly commercially. “It was so nice to actually prove flying and insulin could go together safely. A lot was hinging on this flight and those over the next few months, but all the careful planning and preparation had paid off. We had shown flying on insulin was both safe and manageable with the appropriate attentionto my diabetes care and regimen.”
A few months after his flight, Stephen had made his way to the captain’s seat, and today flies a Boeing 777 to Hong Kong, Shanghai, Beijing, and occasionally to Europe from Toronto. Although he has been back flying now for 12 years, Stephen can’t take his eyes off of his diabetes management, even for one flight.
“Transport Canada maintains stringent blood glucose control requirements pre-flight, during flight, and prior to landing. Six to 15 mmol/L is the overall target range. Blood glucose testing is required every hour in flight and thirty minutes before landing. Only 10% of readings can go below 5.5. You also have to be able to recognize a low blood sugar coming on,” explains Stephen. “Every year, I take a special aviation medical, and have to download and submit my last 30 days of blood glucose results to Transport Canada to have my medical certificate renewed.”
Technology has made diabetes management in the cockpit much easier. “You needed a shopping cart to move my glucose meter around in 1986,” laughs Stephen. Not one to shy away from new technologies, he began pumping in 1994 while living in Hong Kong, and was the first person with a Disetronic pump in Asia outside of Korea. In March of 2015, Stephen started using an Animas® Vibe® insulin pump with integrated Dexcom G4® PLATINUM continuous glucose monitoring (CGM).
“Until recently, continuous glucose monitoring wasn’t accurate enough for flying,” Stephen explains. “But with Dexcom , now there is nothing better to control my diabetes. When I fly to Asia, I work 18- to 24-hour days and go through 12 time zones, which plays havoc with my body’s circadian rhythm. I’m sleeping when I’m supposed to be eating breakfast, and I’m less sensitive to insulin when I’m tired. Without my pump, I couldn’t fly these long-haul routes. For me, it’s that simple.”
With his years of experience “flying on insulin,” and thousands of documented blood glucose results, Stephen has become a de facto, go-to consultant for pilots around the world wanting to get their licences reinstated. “I’m in touch with other pilots through an informal global network. I’ll give interested pilots information on regulations and targets, and tips on diabetes management—as much information as I can so they can go back to talk to regulators in their own country,” he says. He has successfully helped British and American pilots obtain medical certificates and licences.
Despite advances in regulations, Canadians with Type 1 diabetes still face barriers to obtaining private and commercial pilot’s licences. In February 2015, Transport Canada relaxed private pilot licence regulations. Those regulations now allow those with insulin-dependent diabetes to fly private aircraft, BUT Transport Canada has elected to only allow pilots taking long acting insulin to hold private licences. This is being challenged now. For someone seeking a commercial licence, they are currently out of luck: only those who held their commercial licence before a diagnosis of insulin dependant diabetes are grandfathered.
“I suspect Transport Canada (TC) won’t be able to prevent pilots with Type I from getting their private or commercial licences for much longer,” muses Stephen. “It’s the last bastion we have to cross. The UK has done it already; others aren’t far behind. If insulin dependent pilots can show good control, TC should be hard-pressed to say ‘no’ to those seeking to upgrade to a private or commercial licence.” Changes happen slowly though, so it may still be another couple of years to see those changes happen.
In the meantime, Stephen is looking forward to retiring from his 44-year aviation career in early 2017. He’d like to travel with his wife and spend time at his home in Niagara-on-the-Lake in Ontario, where he enjoys giving historical tours of the Old Town and the nearby Niagara River.
“Many of your readers will never have even thought about flying, but what I hope they can take from my experience, is that if you want something badly enough, it is worth all the hard work and dedication you can muster to make it happen,” says Stephen. “Diabetes did not stop me from doing what I wanted to do. Don’t let it stop you from living your dreams either.”