Flying with a chronic condition: diabetes, thyroid, coeliac and asthma on the roster, what the medical allows, how crew manage it and the honest limits

SAS, and I have a thyroid condition managed with medication, and the health threads on here cover asthma and the general medical. This is the wider chronic condition picture from crew who live with them, because the applicants with a diagnosis read the requirements with a specific fear and the answer is more nuanced than yes or no.

The principle

The cabin crew medical asks whether a condition would prevent you from performing the safety functions or would be dangerous to you in the cabin environment. A controlled condition with a stable treatment is, at most regulators and airlines, acceptable with a note on the file and sometimes a review. An uncontrolled or unpredictable one is the problem. The conversation is with the aviation doctor, with the specialist's letter, and it is a conversation, not a form.

Diabetes

Type 2 controlled with diet or tablets: acceptable at most airlines with a note. Type 1 on insulin: the hard one, because of the hypoglycaemia risk on a long duty with irregular meals. Some regulators and airlines accept insulin dependent crew with a strict management plan and a specialist's assessment; some do not. EASA has moved towards case by case; the US carriers vary; the Gulf carriers are stricter. Crew with type 1 fly at some European carriers with continuous glucose monitors and a plan. Ask the specific airline's medical department in writing before the assessment.

Thyroid

Hypothyroidism on levothyroxine, stable: a non issue at every airline I know, mine included. A note, an annual blood test, the medication in the crew bag. Hyperthyroidism under treatment: a review until stable. The time zone question for the medication is the same as the pill thread: home time, an alarm.

Coeliac

Not a medical issue for the airline; a practical one for the crew member. Crew meals are not reliably gluten free and the coeliac crew carry their own food on every duty and eat carefully on layovers. The airlines' special crew meal options vary. It is manageable and it is tiring and the coeliac crew on my fleet are the best prepared people in the galley.

Asthma

The thread exists: mild, controlled, with an inhaler declared, acceptable everywhere. Severe or recent hospitalisation is a review. The cabin air is dry and the asthma crew manage it with the inhaler and the humidity routine.

Epilepsy, heart conditions, mental health medications

Epilepsy is generally disqualifying unless seizure free for a long period off medication, at most regulators. Heart conditions are case by case with the cardiologist. Mental health medications are the subject of Paul's thread and the honest answer is: declare, the aviation doctor reviews, many are acceptable, some need a period of stability.

How crew manage it

The medication in the crew bag with a spare in the suitcase and a copy of the prescription. The specialist's letter in the file. The condition told to the purser at the briefing if it could matter (the type 1 crew tell every purser; the thyroid crew do not need to). The routine that the roster cannot break: the medication on home time, the food carried, the blood tests booked around the roster.

The honest limits

Some conditions end the application and the aviation doctor is the one who says so. But far fewer than applicants fear. Controlled is the word. Ask in writing. Bring the letter. And do not hide a condition to pass the medical, because the condition will find you on a 14 hour sector and the hiding will end the career that the honesty would have kept.