10 minute read
Out of the blue
When Jack Kofoed spent a few of his school years in London, each lunchtime he’d watch the Concorde as it flew over. Years later, his dream of becoming a pilot eventuated and he was well on his way to working for an airline. That is until some unruly blood tests were returned.
Four years ago, Jack was living a successful and comfortable life on the Gold Coast, running a new car dealership as well as racing cars. One part of his career had him looking after a luxury dealership that was located just past Gold Coast Airport. Driving past it every day revved up his desire to fly, so he packed up his life and returned to Auckland to study aviation fulltime.
Jack condensed the two-year course into 12 months. His prior experience of working in higher management, six days a week, had created a concentrated and well-practised work ethic. When he wasn’t in class, Jack says he would camp at the airport from 8 to 6 each day, keen to grasp opportunities. ‘Whenever someone didn’t show up for a plane, I’d manage to grab it. I don’t think it’s a hard thing to do if you love it and you’re in a position where you can do it. I think it’s pretty amazing, so why wouldn’t you be there all the time?’
Then the time came to renew his medical certificates. Blood tests were taken, including HbA1c. Blood pressure and eyes were checked, including scanning of the retinas. All seemed straightforward until Jack noticed the doctor asking questions about his sleep, how often he felt thirst and dehydration, and whether there was diabetes in the family. Then a finger prick test showed a higher than normal blood sugar. Within an hour of walking in for the test, Jack’s medical was gone and he was grounded. Suddenly, there were GP and specialist appointments to go to. The doctors thought it was
odd for Jack to have diabetes as there weren’t any markers in his family history and he was fit and healthy. Four months later, a specialist ordered a different blood test, one that the GP hadn’t looked for. The GAD (Glutamic Acid Decarboxylase) blood test had found the presence of autoantibodies. These indicate an immune system attack, which can point to LADA or T1 diabetes.
Jack says he had no idea. ‘The true definition of “out of the blue”.’
But being a glass half-full person, Jack says, if ever there was a good time to be diagnosed, this had to be it. It was during the early months of 2020 and right at the beginning of the Covid-19 pandemic. Much of the world was in lockdown, and many commercial airline pilots were losing their jobs.
Latent Autoimmune Diabetes in Adults is a slow-progressing form of diabetes. Sometimes known as Type 1.5, LADA is a slow-onset form of type 1 that can be misdiagnosed as type 2.
NEW DIAGNOSIS
Like many, Jack had heard that diabetes rules you out of flying. This belief was echoed back to him by his family and in-laws, as well as his GP. He says that, while that information was disheartening, what hurt more was that he had given up his successful life in Australia. He had sold up and moved back to Auckland with his partner to chase his dream and at that one medical renewal, it had all slipped out from under him.
Jack looked at how he could improve his health in the hope that one day he could get his licence reinstated.
EXAMINING FOOD
Jack looked at what he was feeding his body. A friend put him onto an alternative health practitioner who offered DNA tests that highlight which foods your body is receptive to and intolerant of. They also offer an insight into which foods help with insulin sensitivity.
He discovered that, even though kumara has a high sugar content, due to his particular DNA, it didn’t have nearly as much an effect on his blood sugar as potatoes did. A similar issue was discovered with pasta. Jack found that, if he ate
a bowl of normal pasta, it would send him high, whereas glutenfree pasta, with the same amount of carbs, did almost nothing to his blood sugar. The alternative health practitioner had found Jack carried a celiac gene that indicated he could be sensitive to gluten.
EXERCISE
Each and every day, Jack likes to do some form of exercise. ‘Riding bikes, squash, tennis, anything endurance based, with a high heart rate, I’m all about it. Exercise, to me, is probably my foundation, next to diet, and mental health as well. Those three things make diabetes so easy, as long as they’re in check.’
Gym sessions help with his mental health as well. ‘The weights don’t have an effect on diabetes, but I’m single now, and I’m not the biggest bloke, so I kind of need to have something there so I don’t go on a date and get blown over by a gust of wind.’
GETTING THAT LICENCE BACK
While learning what he could about his diabetes, Jack went searching for a precedent – pilots who had been able to retain their licences after being diagnosed.
In 2002, Canada became the first country to allow insulintreated people to fly with a Class 1 (commercial) certificate. This was done on a case-by-case basis, under close supervision, and employed a protocol of twice-hourly blood glucose monitoring. The UK followed, a decade later, but it has only been in the last few years that New Zealand, has allowed it, via individual assessments. Currently, there is less than a handful of pilots living, and flying, with diabetes in New Zealand Aotearoa. This success is entirely due to CGMs (Continual Glucose Monitors). Worldwide, aviation has adopted the technology and created frameworks around it, and it was this technology that has saved Jack’s dream.
‘The whole basis of getting a medical in NZ is having a CGM. I can set the alerts where Civil Aviation wants them to be. Say, it goes from 5 to 6, and it did it in fewer than five mins, then my phone will go off, prompting me to take action.’ Civil Aviation has established all the settings they want Jack to use.
He uses a CGM that has an app, so he can read his levels in real time. When flying, Jack’s phone is Bluetoothed to his headset so he can immediately take action. ‘I can’t imagine managing this on insulin without having that situational awareness that a CGM gives. It’s an investment I can’t really ignore. It allows me to do what I do.’
ONWARDS AND UPWARDS
‘Once Civil Aviation was happy with the CGM data, then it was just a matter of having my retinas scanned, photographed, new blood tests (not just one but consistent trends), HbA1c, cholesterol, cardiovascular risks, liver function and kidney function. They looked at fitness and then personal management, and your mental state, because it does take quite a toll on it.’ Jack says Civil Aviation is quite a pedantic beast when it comes to how they evaluate everybody and who they have up in the air. But he is amazed at how encouraging they were. ‘They were on the phone to me, encouraging me to go for Class 1, once they started to see the data and see how they could control it and mitigate the risks themselves.’
Every three months, Jack must send Civil Aviation a 90-page report, generated from the CGM app. The report shows his blood sugar activity and the time it’s taken to return to normal. Also noted are all the alerts his phone has given off in that time frame. They get to see the time stamp, trends, and percentage of time in certain areas. He also logs his flights – when he started the engine, took off, landed, and turned off the engine, so they can see exactly where his levels were during the entire flight.
This close monitoring has helped Jack stay on track with his food intake and exercise. ‘It’s like having a little angel on your shoulder, but it’s Civil Aviation. It holds you accountable. Full Big Brother, but it’s a good thing. It’s data for them to make decisions on.’
He can’t change the parameters that Civil Aviation has set, so if it starts going low in the early hours, his phone alarm will go off. ‘Sometimes, I get woken up by my phone at 3am, thinking a bomb has gone off. It’s not good if you’re having a nice dream.’
PASTA
Jack stayed off insulin for a year and half after his diagnosis. ‘I was super strict with diet, and the exercise I do is for insulin sensitivity, which really helped me. It just got to a point when it was so hard for me to control, so I gave in.’ He is on a small dose of long-acting insulin. If he’s doing a lot of cardio, he takes a smaller dose.
‘I see people on social media where they take pride with being able to eat as much sugar or carbs as they want because, for their mental health, they just want to feel like the diabetes isn’t in their way. I respect that. But for me it is so much easier to not be chasing it. I enjoy a forced healthy life.
‘You only need a CGM for a month to see what foods work for you and what you like. Your diet doesn’t have to be that strict. I love pasta, and I thought that was a thing of the past.’
THE FUTURE
‘Study never stops. I’ve just got my commercial licence now, so I’ve ticked that box.’ There’s a couple more ratings for Jack to get, and he needs to double his flight hours, which he estimates will be achieved within the year. He says only once that is accomplished will Air New Zealand look at his CV. ‘Whether or not they give me a call is a different story. Ideally, they’ve read Diabetes Wellness and they’ve seen me and their name in there and go, “We’ll call him up early!” ’
WHAT IS LADA?
This type of diabetes has been referred to as type 1.5, or slow onset diabetes, because it is a form of type 1 diabetes but at early diagnosis often gets confused with type 2 diabetes. LADA, or Latent Autoimmune Diabetes in Adults, is diagnosed during adulthood like most cases of type 2 diabetes.
However, LADA is an autoimmune disease, like type 1 diabetes, and sooner or later the insulinproducing beta cells in the pancreas will be destroyed. Eventually, insulin is needed for survival, usually within a few months to years of type 2 diagnosis, if it has not been diagnosed properly with GAD antibody tests.
Some features of LADA may include:
• being slim or at least not overweight
• a history of autoimmune problems
• no ketoacidosis at diagnosis
• a positive GAD antibody test (blood test).
The patient may need insulin relatively soon after initial diagnosis – usually within months to years.
