Above the Clouds with Diabetes: From Pathophysiological Considerations to Practical Recommendations for Safe Flights.

Vasdeki, Dimitra, Georgios Tsamos, Kleoniki I. Athanasiadou, Vasiliki Michou, Evangelos Botsarakos, Michael Doumas, Kalliopi Kotsa, and Theocharis Koufakis. Above the clouds with diabetes: from pathophysiological considerations to practical recommendations for safe flights. 26:87-98, 2025. The prevalence of diabetes mellitus has been following an increasing trend in the last decades, leading to a growing number of travelers with diabetes seeking pretravel advice from medical professionals. This narrative review summarizes the existing evidence on the intriguing association between diabetes and air travel, analyzes safety and certification protocols, and provides practical recommendations for the management of diabetes during flights. During air travel, individuals with diabetes face challenges arising from inappropriate dietary options, restricted access to medications and healthcare services, disruption of medication dosing intervals, and exposure to hypobaric conditions in the airplane cabin. In addition, people with diabetes, especially those treated with insulin, have traditionally been considered ineligible to become professional pilots. However, this approach gradually changes and numerous countries are now implementing strict protocols to determine the eligibility of pilots with diabetes to operate flights. Given the increasing use of technology and new drugs in daily clinical practice, there is a need for further research in the field to shed light on existing knowledge gaps and ensure safe flights for people with diabetes.