Diabetic pilots to fly commercial aircraft?
May 24, 2013, Emmet County, Mi. - Sitting in the pilot's seat of a Diamond DA-40XLS single-engine airplane, Jason Harmon, CTO & founding partner of Rockville, Maryland-based Get Real Health, is methodically running through the preflight checklist that occupies every pilot’s attention before taxiing out to the runway. Harmon’s checklist is just a hair longer than the standard routine, however, because it includes testing with the devices that will monitor his blood glucose levels throughout the flight.
Harmon's youth had two great preoccupations: aviation and computers. His high school years, in the 1980s, coincided perfectly with the budding personal computer revolution fueled by the likes of Steve Jobs and Bill Gates. (Harmon still has his now-ancient, museum-quality Atari computer and its various peripherals — including what must be one of the few functioning 5.25 inch floppy-disk drives in the area — in his modest office at Get Real Health, each component lovingly protected by its original vinyl dust cover.)
In his teens, Harmon played computer games and learned programming. Yet, his real love and dream career was flying. He earned his private pilot certification during high school and had his eyes set on a commission in the Air Force. Soon after graduation from high school, however, just as he was about to embark on his grand plan, he was diagnosed with Type 1 (also referred to as juvenile) diabetes — an incurable, chronic autoimmune disease. The diagnosis abruptly killed his professional flying plans.
"I was pretty crushed," recalls Harmon. "I had my whole life set with what I wanted to do. So, it was pretty devastating to be told I'd never fly again. It took a while to regroup and figure out what else I could do."
Thanks to his early computer experience, he was able to transition in 1991 to independent programming and consulting gigs. Then he landed a job in the IT department of The Discovery Channel in Bethesda, Maryland. Discovery needed to upgrade from its DOS database systems, and Harmon helped them modernize to client-server technology. When interactive TV came along, Discovery gave him the task of building and demonstrating prototype apps for it between 1994 and 1996.
After the interactive TV testing program ended, the dot-com era began, so Harmon went to work in the Internet development arena. In 1997, he took a job at a Bethesda, Maryland, company called USWeb (later called marchFIRST), heading up the group that created their delivery platform for software-as-a-service (SaaS) applications. He ran the platform architecture group there until 2000.
"Then the Internet bubble burst — and marchFIRST imploded fairly quickly," he recalls.
His stint at the ill-fated company proved pivotal, though, since that was where Harmon met Robin Wiener and Mark Heaney. The three decided to partner and form a new venture where they could call the shots and run the company as they saw fit. Thus was born iNetXperts. They changed the name to Get Real Consulting in 2006 — and then to Get Real Health in 2012.
Despite the career heartbreak that years ago diverted Harmon from aviation into technology, the setback he experienced arguably turned out to be fortuitous for others like him with Type 1 diabetes — as well as many other people who struggle with chronic diseases. The company he and his partners built has become a leader in healthcare IT, thanks particularly to their development of a product called InstantPHR™.
InstantPHR (PHR stands for personal health record) seamlessly connects to any provider health information system, empowering consumers to access health information, health tools, provider-directed care plans, connected health management devices, secure messaging, alerts and reminders across a common user interface spanning PCs, tablets, and smartphone OS platforms.
The tools pioneered by Get Real Health have not only empowered patients to manage chronic conditions at home and on-the-go in collaboration with their healthcare providers, they have also helped people with diabetes live much more normal and active lives.
Which brings us back to that Diamond DA-40XLS in which Harmon is sitting. He will be piloting the plane for Diabetes Formation Flight USA 2013, a flight of general aviation airplanes flown by Harmon plus fellow pilots with diabetes, including world record setting pilot Douglas Cairns (whose records include the shortest time to take off and land in all 50 U.S. states, and a record-setting flight from Barrow, Alaska, to the North Pole which resulted in the first landing of a light twin-engine aircraft on the polar ice, a feat which was documented in the “Top of the World” episode of Discovery Channel’s “Flying Wild Alaska”). The group will fly in formation from Pellston Regional Airport in northern Michigan to the EAA AirVenture airshow in Oshkosh, Wisconsin, on July 29.
Harmon and his colleagues can legally command an aircraft thanks to a 1996 change in Federal Aviation Administration (FAA) rules.
“The FAA recognized that advances in diabetes management and monitoring had enabled people to safely fly and protect against the risks of low or high blood sugar,” explains Harmon, “so I was one of the first pilots to get back my medical certification when they adopted the rule, which requires insulin-using diabetic pilots to follow a strict in-flight monitoring and management protocol.”
That FAA rule allows Harmon and his friends only to fly privately, however, not professionally — making the U.S. a bit of a laggard compared to Canada and the U.K., which allow people with insulin-treated diabetes to be commercial pilots.
“While the U.S. was the first nation in the world to adopt that private flight rule for diabetic pilots in ’96, this country has not yet opened up commercial aviation to us,” notes Harmon, who has single- and multi-engine as well as instrument ratings. “We’re trying to get that changed by demonstrating the perfect safety record that has been maintained by pilots with insulin-treated diabetes under this protocol since the FAA adopted its rule, even when flying record-setting extreme endurance flights.”
Harmon’s diabetes informs and complements his work at Get Real Health. And the company’s work equips him to participate in aviation at a more meaningful level than he might have imagined as a teenager, by demonstrating how technology can help turn a once-heartbroken young man into an active — and safe — pilot.
“My personal experience with diabetes has merged with IT,” he says, “but the tools we have developed help me demonstrate how I can fly safely by closely monitoring and keeping my blood sugar at a consistently safe level. I have very well-managed diabetes, with no complications or side effects. A lot of my doctors see me as a model case. Normal diabetes management is all about keeping your average blood sugar level as close to normal as possible without dangerous lows and highs. During flight, blood sugar is maintained at a slightly higher level to provide a safety margin against low blood sugar. It’s a very tight protocol.”
Harmon and his fellow pilots make record-setting endurance flights to show that this metabolic condition can be managed and that flying is safe. Harmon says that during a flight, each pilot also has to self-administer a blood test hourly during the flight. As an added measure of safety, he and his fellow diabetic pilots are each connected to a continuous glucose monitoring apparatus that will set off an alarm if a problem arises with their glucose levels. If blood sugar starts moving too low, it can be quickly corrected by consuming some sugary food (each pilot is required to keep a suitable supply of fast-acting carbohydrate in reach for every flight). If it starts moving too high, a small amount of insulin can correct it. These steps, combined with dietary restrictions, enable the pilots to maintain a solid glucose management program so they can keep their blood sugar at safe levels.
The American Diabetes Association has been educating the FAA and other authorities in support of a rule change to allow pilots with well controlled insulin-treated diabetes to fly commercial aircraft. The Air Line Pilots Association, International (ALPA) and the Aircraft Owners and Pilots Association (AOPA) have also been supportive of the change, Harmon says.
“Regulatory authorities are very risk averse — as they should be — but we're trying to get them to examine this based on real-world evidence, not on preconceptions,” says Harmon. “We want them to evaluate data on people who follow their protocol, not the general population of people with diabetes. We've even been willing to be guinea pigs and be tested under controlled conditions to provide solid evidence of just how effective this protocol is. As more and more countries implement these changes and the safety record becomes increasingly obvious, the argument against allowing us to fly commercially gets weaker over time.”