Warrior 481 Gets a Useful Load Increase

I recently received an email from a friend whom I had not spoken with in a long time. He noted that I did not seem to be posting much in 2025 and thoughtfully wondered if I was OK. It was a good observation, I had suspended my flying for a time in the first half of 2025 due to a medical issue. This post is about what happened, what I did about it, and how it's going.

[Disclaimer: I am neither a physician nor an Aviation Medical Examiner (AME). While I am happy to share my experience in case it is helpful to others, please speak with your own physician if you are experiencing similar challenges.]

Miss Atomic Bomb

I was seated in an exam room whose decor utterly failed in its attempt at exuding a warm, homey vibe. I arrived planning on a routine check-in with a physician's assistant and did not expect any bombs to be dropped. The day was March 4, 2025.

"You're diabetic," stated the PA.

Castle Bravo nuclear test, 01 March 1954, public domain photo from the US government.

She continued impassively. "I'm putting you on metformin. Avoid eating refined sugar, white bread, and pasta. Any questions?"

Literally dozens. 

I stared at her in surprise. It was not great news for anyone to receive and particularly not great for a pilot. I was certain that she had no idea of the broader implications of delivering this message to someone in love with flight.

She paused for half a beat and, when my mental gridlock did not break sufficiently for me to ask her anything, she resumed speaking. "No questions, then? OK, come back in three months for a follow-up. Most people don't tolerate metformin well until they adjust to it. That will take a few weeks, so be sure to pick up some Imodium." With that, she was on to the next patient.

Later that day, I diligently searched for information about managing type 2 diabetes. Most sources I consulted began with a statement to the effect of, "If you've been diagnosed with type 2 diabetes, your healthcare provider has already shared a diet and exercise plan with you."

Nope. In fact, on a later visit to the patient portal, I read the PA's notes from the appointment and became incensed when I read, "Patient has been counseled on an appropriate diet and exercise regimen." This grossly overstated the information conveyed.

The more I researched, the more dissatisfied I became with the PA's rushed and poorly-delivered diagnosis. At least she warned me about the side effects of metformin (if you know, you know), but there should have been much more discussion about the road ahead.

For Reasons Unknown

Type 2 diabetes is also known as insulin resistant diabetes, a name that gives better insight into what underlies the condition. Unlike type 1 diabetes that requires patients to take insulin, those with type 2 already make insulin, but their bodies cannot utilize it properly, leading to high blood sugar. High blood sugar is problematic for a number of reasons including damage to eyesight, particularly worrisome for pilots. Metformin is one of several drugs that help patients utilize the insulin their bodies already produce. In some cases, type 2 diabetes can be managed solely through diet and exercise with weight loss being a significant factor in reducing diabetes risk. While the risk factors and management strategies are well known, the underlying root cause of the condition seems less understood.

Type 2 diabetes often develops in middle aged people -- it used to be called "adult onset diabetes” -- and is linked to obesity. The normal fasting range for blood glucose is 60 - 99 mg/dL. The impaired or "pre-diabetic" range is 100 - 125 mg/dL. The result that triggered my diagnosis was 153 mg/dL. 

Another important physiological metric is A1c. Hemoglobin is a tetrameric protein consisting of two alpha chains and two beta chains. Glucose can chemically adduct on the hemoglobin alpha chain, a reaction driven by excess glucose present in the bloodstream. Increasing blood glucose levels leads directly to a higher percentage of glycosylated hemoglobin, also known as A1c. Whereas blood glucose levels fluctuate throughout the day, the A1c value reflects an equilibrium correlated to average blood glucose content over time. The normal A1c range is less than or equal to 5.6%, the pre-diabetic range is 5.7-6.4%, and anything 6.5% or over is considered diabetic. My A1c level was 6.9%. For context, many of the drugs advertised to lower A1c claim to bring levels down below 7% and the FAA wants pilots to be below 9% before even considering special issuance of a medical certificate. So I had an issue, but I was not a lost cause.

It will not surprise any pilots to know that type 2 diabetics treated medicinally require a special issuance medical. In this case, "special" means "lots and lots of bureaucracy". Type 2 diabetes drugs particularly concern the FAA due to the risk of hypoglycemia (low blood sugar) events that could lead to loss of consciousness.

Oh boy. 

March 4, 2025 presented me with a lot of information to process.

All These Things That I've Done

I undertook a number of actions right away.

I grounded myself from flying. Minimally, I did not want to fly again until I understood whether my blood sugar was under control and what the side effects of the metformin were going to be. Exceptions included a couple of instrument proficiency flights with Gilead and Tom where each was willing to act as pilot in command (PIC) for the flight. This covered me legally, but also in case the metformin actually caused a low blood sugar event while flying. I never experienced one, but could not predict that at the start. I also withdrew from flying rides at the Williamson Flying Club pancake breakfast for the first time in a decade, which is why I manned the tower/Unicom this year instead.

It's a bit inside baseball, but I delved deeply into logbook arcana. The FAA draws a distinction between logging PIC time versus acting as PIC. Pilots record PIC time in their logbooks and are allowed to do so provided that they were rated for the aircraft being flown (exceptions exist, such as for solo student pilots). Additionally, every flight also requires an acting PIC, but that time is not explicitly recorded in logbooks. A valid medical certificate is required to act as PIC and I had chosen to stop exercising mine. As a result, I continued logging PIC hours in Warrior 481 during these flights with friends because, even though I was not acting as PIC, I still met the logging requirements for PIC time. The FARs can be weird sometimes.

I radically changed my diet. I actually read nutrition labels now and largely eliminated sugars and significant carbs from my diet. The key, as with most things, is moderation and I have applied some simple guidelines based on my research. I have largely cut out pasta (while we have experimented with whole grain pasta, it's just not the same), bread, and white rice.

To help me understand how my physiology responds to different foods, I purchased a month's worth of continuous glucose monitor (CGM) biosensors. I waited until I was on my new regimen for a month, then spent a month as my own guinea pig. I learned a lot about the way my body processes carbohydrates. For example:

1. White rice is the absolute worst. Every time I had some white rice, for example, with Thai or Chinese cuisine, I would experience a whopping glucose spike. Per the literature, the basmati rice preferred for Indian cooking only results in a modest glucose rise. So I can still soak up my curry with rice, I just need to be prudent about the type of rice and consume it in moderation.
2. I can nip a glucose spike in the bud with a brisk 15-minute walk. This was a huge learning that I validated many times over. Consuming anything even slightly questionable could be remediated with walking, even white rice.
3. Bread can be OK in reasonable amounts. I found that I could easily handle my favorite Dibella's sub on a 7-inch "everything roll" provided that I also did not indulge in the bag of chips I historically consumed with my sandwich. Small victories. 
4. Beer is an interesting case. It is high in carbohydrates (high glycemic index), but alcohol inhibits breakdown of complex sugars into glucose (low to moderate glycemic load). Thus, the effect of a single beer on blood glucose level is highly dependent on an individual's metabolism. With the CGM, I found that a single beer did not spike my glucose at all. Similar results were obtained with hard ciders. Once again, moderation is key.
   
   As an additional twist, alcohol is contraindicated for those taking metformin. However, most sources indicate that the amount of alcohol in a single beer is insufficient to cause a poor outcome, specifically a nasty condition known as lactic acidosis. (In a nutshell, the liver is so busy processing metformin that it cannot handle metabolizing the alcohol and bad things happen.)

I started exercising daily. I have never been a gym guy, but since my childhood on the farm, I have always found solace in the woods. I am fortunate to live within a couple miles of multiple interconnected parks with well maintained, densely wooded trails that wind up and down through the terrain along Lake Ontario. These wonderful parks have been my salvation. Since my diagnosis, I have hiked almost daily with a goal of at least 45 minutes, but often extending to an hour or more. I track everything with an Apple watch, which shows that my typical walking pace is 15-16 minutes per mile or about 4 mph.

Top of the hill, Gosnell Big Woods Preserve.

None of the trails are particularly long, one to two miles at the most, but there are enough of them twisting through the various parks that I can mix and match routes as much as I want without resorting to laps (boring!) or treading the same path every day (also boring). All of the parks are large enough that it is easy to forget that they exist in a suburb, they are generally not very crowded, and immersion in the wilderness definitely soothes mental stress.

Sometimes, I had company. Deer in the Whiting Road Nature Preserve in early April.

On one memorable day, a full grown doe came charging at me from around a bend in the trail. I do not know which of us was more surprised to see the other, but the look of distress on her face was priceless as she put on the brakes while simultaneously contorting herself into a high speed U-turn.

Scene from the Whiting Road Nature Preserve.

What I call the Grand Staircase of the Whiting Road Nature Preserve Red Trail. Dexterous feet recommended, especially when coming down the hill.

Near dusk on the Gosnell Big Woods Trail.

Finally, I transitioned from my Third Class FAA medical certificate to BasicMed. This required assistance from my primary care physician's office. In short order, I had agreement from a different PA (not the one who laid the diagnosis on me in such an unhelpful manner) to do the exam and from the doctor to sign it off. My physician as unfamiliar with BasicMed, but when I likened it to a DOT physical, that helped. This path just makes sense to me. I was already contemplating making this change because after 15 years of perfect compliance reports for my sleep apnea treatment, the FAA still demands onerous annual reports. The idea of adding another condition to an already convoluted process that has delayed my medical in past years was daunting.

When You Were Young

When I was a 20-something graduate student at Indiana University, I walked the nearly 2 mile distance to the lab every day at least twice (there and back again), sometimes four times if I returned to the lab after dinner. I did it briskly, so much so that I recall a morning when a shop owner in downtown Bloomington set aside his broom and offered to race me. There was a valley between home and the university, so I literally walked uphill both ways. I left graduate school a lean 170 lbs and almost immediately gained 10 lbs when I started driving to work every day instead of walking. I weighed 180 when I earned my pilot certificate in 2002.

23 years later when I received my diagnosis, I weighed 223 lbs.

Four months after diagnosis (as of this writing), I am down 30 lbs and now weigh about 190 lbs. I am back within the normal weight range for my height. My wedding ring and a lot of my old clothes fit again; I've been rediscovering these things set aside at the end of the previous decade. My Apple watch indicates that my cardiovascular fitness has increased significantly and my resting heart rate is already lower than it was. My energy level is higher. Physiologically, I am more like the young graduate student I once was than I have been in a decade. I have even been stopped at the airport and told, "You're looking trim these days!" by multiple casual pilot acquaintances, even those unaware of my condition.

Put in a way that pilots will uniquely understand, Warrior 481 has undergone a significant useful load increase.

Read My Mind

When I returned for the 3-month checkup in late May, my official weigh-in revealed that I was down 23 lbs. The PA that originally diagnosed me had left the practice (bye!) and I met with a different one. She entered the room, popped open her notebook computer, paused to read what was displayed, and beamed at me with a pair of bright eyes that did all the smiling for her above a surgical mask.

"Have you looked at your latest data in the portal?"

Of course I had. My glucose and A1c numbers were back in normal range, if on the high end. I was unsurprised by the glucose numbers after a month with the CGM and was fully aware that my morning fasting numbers were already in the normal range.

I shared with her my dismay about the lack of information received with my diagnosis. I explained to the new PA that I had done my own research, described the changes I made in diet and exercise, and mentioned the out of pocket purchase of the CGM and what I learned from it. 

When I was done, she smiled at me again with her eyes. "Most patients are not this engaged. You've done really well and are likely on track to reverse the condition. I don't know if you appreciate how huge this drop in A1c is! It's all due to the changes you've made." 

I took a breath to interject and, seeing this, she nodded with understanding and got herself ahead of what I was about to say. "Yes, of course we don't know how much of it is due to the metformin versus the changes you made. But I'm inclined to take you off the metformin altogether. I think we can control this with diet and exercise." 

While the idea of eliminating the medication was very appealing, I balked at it because I did not know what the contribution from the metformin actually was. We discussed and ultimately agreed to halve my metformin dose and check again in another three months. This seemed satisfactorily prudent to me. Moreover, the fact that she was willing to have an actual conversation with me about my health after that wholly unsatisfactory appointment in March restored some of my faith in that particular office.

Smile Like You Mean It

To say that I walked out of the doctor's office that day with an extra spring in my step would be an understatement. I understood that I would need to monitor my diet going forward, but if I could control the diabetes without medication, the path back to a Third Class medical seemed like it might be relatively easy. We'll see how that goes.

My first solo flight post-diagnosis, SDC to PNE. My hangar neighbor Steve was on short final at SDC in his Bonanza.

Philadelphia City Hall, just a block from where I stayed.

I was also quite happy to get back into the air again. My first solo flight was to Philadelphia (KPNE) where I was an invited speaker at a scientific conference. It was great to reach Philly so quickly, but the ride there was a rough one. I hit my head on the Warrior's ceiling at least once. When I arrived, Northeast Philly Airport was not only extremely busy ("Negative, Ghost Rider, the pattern is full") but everyone was landing with a gusty 20 knot crosswind. Still, it beat driving and the flight home two days later was much more enjoyable.

At the Runway Bar & Grill, Bradford, PA (KBFD) with the WFC on 10 May 2025.

At Potsdam / Damon Field (KPTD) in Potsdam, NY with the WFC on 07 June 2025.

During my time away from the cockpit, I realized that I genuinely missed many of my friends from the Williamson Flying Club. It has been great to get back out and fly with these people again, to both log and act as PIC simultaneously, and to share the experience by flying with others.

Graduation day! 14 June 2025, The Harley School, Rochester, NY. Photo by Dena.

Other big changes happening in this timeframe involved The Bear, who shed her braces and committed to a college for next fall. On 14 June 2025, she graduated from The Harley School, a magical place that fosters academic excellence while emphasizing community. The Bear was a student there for 15 years before receiving her diploma, a "lifer": twelve grades, one year of kindergarten, and two years in the nursery program. This delightfully weird little bubble has been her academic home since age 3. The entire school population is roughly 500 students, slightly smaller than the size of my graduating class and The Bear's school experience there was significantly different from mine in all the best ways. The Harley School is one of the major reasons why I have been largely unwilling to move away from Rochester since she first enrolled. I am so proud of what she has accomplished and am excited about the opportunities she will have in the next chapter of her life.

Somebody Told Me

So here I am, in a better place than where I started 2025, but with more work to do. The next follow-up will be in August. If my numbers stay in the normal range, I will likely be taken off the metformin altogether. I hope this is the case. In the meantime, the trails call nearly as much as the sky.

When I think about the amount of progress I've made, I keep coming back to what my friend and fellow aviator Ed said to me over lunch at the Airport Diner in Potsdam in early June. "A pilot certificate is a powerful motivator." He was so right!

For many of us who were effortlessly healthy when we were younger, it is sometimes easy to fall into the trap of thinking, “I don’t need to take care of myself in that way, it was never necessary before.” Don’t. Even just a few short years ago, my primary care physician opined that I could essentially eat whatever I wanted without any adverse effect. Age has a way of sneaking up on all of us. That’s what happened to me. Don’t let it happen to you.