{"id":695,"date":"2012-07-25T22:35:45","date_gmt":"2012-07-25T19:35:45","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=695"},"modified":"2012-07-25T22:35:45","modified_gmt":"2012-07-25T19:35:45","slug":"ucucularda-diyabet","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=695","title":{"rendered":"U\u00e7ucularda Diyabet"},"content":{"rendered":"
\n

\"\"<\/a>Diyabetik bir u\u00e7ucu i\u00e7in en b\u00fcy\u00fck kayg\u0131, akut hipoglisemiye ba\u011fl\u0131 beyin i\u015flev bozuklu\u011fu ve inkapasitasyondur. Bu nedenle askeri havac\u0131l\u0131kta ins\u00fcline ba\u011f\u0131ml\u0131 tip-1 diyabetli (DM) u\u00e7uculara u\u00e7u\u015f g\u00f6revi verilmez. Diyabet, ABD Hava K. u\u00e7ucular\u0131n\u0131n 1995-99 periyodunda u\u00e7u\u015ftan kesin olarak ayr\u0131lmalar\u0131n\u0131 gerektiren 5 hastal\u0131ktan birisi olmu\u015ftur. ABD Kara havac\u0131l\u0131\u011f\u0131nda bu tan\u0131y\u0131 alanlar\u0131n %78\u2019i kal\u0131c\u0131 bi\u00e7imde u\u00e7u\u015ftan \u00e7\u0131kar\u0131lmaktad\u0131r.<\/p>\n

Sivil havac\u0131l\u0131k istatistikleri:<\/strong> 1969-1976 y\u0131llar\u0131 aras\u0131nda 1232 Hintli pilottan 90\u2019\u0131 (%8) DM nedeniyle u\u00e7u\u015ftan ay\u0131r\u0131lm\u0131\u015f, u\u00e7u\u015ftan \u00e7e\u015fitli nedenlerle ayr\u0131lanlar\u0131n %38\u2019ini DM grubu te\u015fkil etmi\u015ftir. United Airlines\u2019in 28 y\u0131l\u0131 kapsayan bir raporunda da u\u00e7u\u015ftan ay\u0131r\u0131lan pilotlar\u0131n %9.7\u2019sinin DM\u2019liler oldu\u011fu a\u00e7\u0131klanm\u0131\u015ft\u0131r. Japon Havayollar\u0131n\u0131n 1986 tarihli raporuna g\u00f6re, 2071 pilotun 92\u2019sinde (%4.7) DM bulunmu\u015ftur.<\/p>\n

Hem FAA, hem de JAA, diyabet tan\u0131s\u0131 alan 1. ve 2. S\u0131n\u0131f u\u00e7ucularda hi\u00e7 tolerans g\u00f6stermemekte ve u\u00e7u\u015ftan ay\u0131rmaktad\u0131r. Ancak 3. S\u0131n\u0131f u\u00e7ucular i\u00e7in 2002 y\u0131l\u0131ndan itibaren ABD, \u0130ngiltere, Kanada ve Avustralya\u2019da bir yumu\u015fama \u00e7er\u00e7evesinde, d\u00fczenli tedavi g\u00f6rmek ve 6 ayda bir kontrol ko\u015fuluyla u\u00e7u\u015f verilmektedir. Kanada daha ileri giderek, ticari havayolu u\u00e7aklar\u0131nda birden fazla pilotlu kokpitte DM\u2019li bir pilotun u\u00e7mas\u0131na izin vermektedir. Bug\u00fcn bu esnek yakla\u015f\u0131m askeri havac\u0131l\u0131kta da kendini g\u00f6stermekte olup, iki pilotlu askeri u\u00e7aklarda DM\u2019li bir pilotun u\u00e7abilece\u011fi \u00f6ne s\u00fcr\u00fclmekte; \u0130srail Hava K\u2019de bunun y\u0131llard\u0131r uyguland\u0131\u011f\u0131na dair raporlar yay\u0131nlanmakta, \u201ckan \u015fekeri fark\u0131ndal\u0131\u011f\u0131 e\u011fitimi\u201d ile ki\u015fisel semptomlar\u0131n tan\u0131n\u0131p \u00f6nlem al\u0131nabilece\u011fi \u00fczerinde durulmaktad\u0131r.
\nKan \u015fekeri fark\u0131ndal\u0131\u011f\u0131 e\u011fitimi<\/strong> (Blood Glucose Awareness Training-BGAT)<\/p>\n

ABD\u2019de bir merkezde diyabetik ki\u015filerin hipoglisemi belirtilerini erken seviyede tan\u0131tma ve kendi belirtilerini \u00f6\u011fretme \u00e7al\u0131\u015fmalar\u0131 yap\u0131lmaktad\u0131r. Belirtiler ins\u00fclin konsantrasyonu, kan \u015fekeri d\u00fc\u015fme oran\u0131 gibi nedenlerle de\u011fi\u015febilir; ayn\u0131 ki\u015fide bile belirtiler her seferinde farkl\u0131 olabilir. Hatta belirtileri fark edebildi\u011fini iddia eden insanlar\u0131n bir\u00e7o\u011fu laboratuvar ortam\u0131nda ba\u015far\u0131s\u0131z olmu\u015flard\u0131r. Yani \u015fiddetli bir hipogliseminin meydana gelme riski azalt\u0131lsa bile tamamen ortadan kald\u0131r\u0131lamamaktad\u0131r. Ayr\u0131ca hastalar hipoglisemi belirtilerini fark edip bir \u00f6nlem almaya ba\u015flad\u0131klar\u0131nda, reaksiyon zamanlar\u0131 uzam\u0131\u015f, performanslar\u0131 azalm\u0131\u015f ve k\u0131smi bilin\u00e7 kayb\u0131 ya\u015famaya ba\u015flam\u0131\u015f olabilirler; hipoglisemi d\u00fczeltildikten sonra dahi bilin\u00e7 bozuklu\u011fu 30 dakika devam edebilir. Hipoglisemi, geli\u015fimi ve semptomlar\u0131 itibariyle hipoksiyle b\u00fcy\u00fck benzerlik g\u00f6sterir. Kargo u\u00e7aklar\u0131ndaki gibi hipoksik kabinlerde belirtiler de artar, belirtilerin d\u00fczelme s\u00fcresi de uzar.
\nHavac\u0131l\u0131kta temel kayg\u0131lar:<\/strong> DM uzun vadede, kalp, beyin ve periferik damar hastal\u0131klar\u0131 (MI, CVA, \u00fclserasyon, gangren, retinal kanamalar, k\u00f6rl\u00fck), n\u00f6ropatiler, b\u00f6brek yetmezli\u011fi, vs. yapabilir. Ama DM\u2019li bir pilot i\u00e7in en riskli durum hipoglisemiye ba\u011fl\u0131 bilin\u00e7 kayb\u0131 ve konvulsif n\u00f6bet gibi akut inkapasitasyon durumlar\u0131d\u0131r. Sava\u015f u\u00e7a\u011f\u0131 pilotlar\u0131, hava muharebesi veya e\u011fitim s\u0131ras\u0131nda yo\u011fun fizik aktivite i\u00e7ine girerler; bu periyotta akut periferik glikoz harcanma art\u0131\u015f\u0131na paralel olarak, hem hipoglisemi riski, hem de uzun d\u00f6nem ins\u00fclin duyarl\u0131l\u0131\u011f\u0131 artar. Askeri havac\u0131l\u0131kta pilotlar\u0131n uzun s\u00fcreli gece ve g\u00fcnd\u00fcz n\u00f6betleri, uykusuzluk, kutup, \u00e7\u00f6l, orman gibi zor ko\u015fullardaki g\u00f6revleri s\u0131ras\u0131nda, kan \u015fekeri \u00f6l\u00e7\u00fcm\u00fc, ins\u00fclin kullan\u0131m\u0131, ara \u00f6\u011f\u00fcn al\u0131m\u0131 kolay olmaz; bu zorluklar y\u00fcz\u00fcnden hipoglisemik ataklar \u00e7\u0131kabilir. \u00d6zellikle 2 ki\u015filik kokpitte di\u011fer pilotun y\u00fck\u00fc bu durumlarda \u00e7ok artabilir ve gerekti\u011finde kontrol\u00fc almas\u0131 gerekir. Bu nedenlerle DM olan ki\u015fileri u\u00e7u\u015f g\u00f6revlerine al\u0131rken \u00e7ok dikkatli d\u00fc\u015f\u00fcnmek gerekir. Yani bu ki\u015filerin u\u00e7mas\u0131 imkans\u0131z de\u011fildir ama olduk\u00e7a da zordur. U\u00e7u\u015fta as\u0131l inkapasitasyon nedeni hipoglisemidir; ama hiperglisemi<\/strong>nin de, g\u00f6rme bozukluklar\u0131 ve s\u0131k idrara \u00e7\u0131kma ihtiyac\u0131 bi\u00e7iminde rahats\u0131zl\u0131k yaratabilece\u011fi bilinmelidir.
\nY\u00f6nergeler:<\/strong> Tip-1 diyabeti olan 1. S\u0131n\u0131f u\u00e7uculara, JAR FCL-3.175 (d), 2. S\u0131n\u0131f u\u00e7uculara da JAR FCL-3.295 (d)\u2019ye g\u00f6re u\u00e7u\u015f verilmesi m\u00fcmk\u00fcn de\u011fildir. FAA\u2019n\u0131n tip-1 diyabette uygulad\u0131\u011f\u0131 protokol\u00fcn ana hatlar\u0131 \u015f\u00f6yledir:<\/p>\n

1.<\/strong> Ba\u015flang\u0131\u00e7taki Sertifikasyon:<\/p>\n

a) Ki\u015fi son 5 y\u0131l i\u00e7inde 2 veya daha fazla hipoglisemik epizot g\u00f6stermemi\u015f olmal\u0131; son 1 y\u0131l i\u00e7inde bilin\u00e7 kayb\u0131, n\u00f6bet, kognitif i\u015flev bozuklu\u011fu hik\u00e2yesi olmamal\u0131.<\/p>\n

b) Diyabet \u00f6yk\u00fcs\u00fc i\u00e7eren t\u0131bbi dosyas\u0131n\u0131n bir kopyas\u0131n\u0131 yan\u0131nda bulundurmal\u0131,<\/p>\n

c) Tedaviyi s\u00fcrd\u00fcren uzman taraf\u0131ndan haz\u0131rlanm\u0131\u015f dosyada \u015fu bilgiler olmal\u0131d\u0131r:<\/p>\n

\u2022 Biri en az 90 g\u00fcn \u00f6ncesine ait, iki HbA1c veya HbA1 de\u011ferleri,<\/p>\n

\u2022 Aday\u0131n uygulad\u0131\u011f\u0131 ins\u00fclin dozaj\u0131n\u0131 ve diyeti g\u00f6sterir belge,<\/p>\n

\u2022 Kalp, beyin, periferik damar hastal\u0131\u011f\u0131 veya n\u00f6ropati varsa a\u00e7\u0131klanmas\u0131,<\/p>\n

\u2022 G\u00f6z uzman\u0131nca \u00f6nemli bir g\u00f6z hastal\u0131\u011f\u0131n\u0131n olmad\u0131\u011f\u0131n\u0131n belgesi,<\/p>\n

\u2022 Hastal\u0131\u011f\u0131 ve \u00f6zellikle hipoglisemi kontrol\u00fc hakk\u0131nda bilgi sahibi olmas\u0131,<\/p>\n

\u2022 40 ya\u015f \u00fcst\u00fcndeki ki\u015filerde egzersiz stres testleri belgeleri,<\/p>\n

2.<\/strong> Sonraki A\u015famada Sertifikasyon:<\/p>\n

a) Ki\u015fi kan \u015fekerinin takibi ve belgelenmesi i\u00e7in yan\u0131nda glukometre bulundurmal\u0131, \u00f6l\u00e7\u00fcm de\u011ferlerini, tedavi de\u011fi\u015fikliklerini ve komplikasyonlar\u0131 FAA\u2019ya bildirmelidir.<\/p>\n

b) 3 ayl\u0131k bir aradan sonra m\u00fcdavi hekim durumu yeniden g\u00f6zden ge\u00e7irir. HbA1 veya HbA1c testleri ile g\u00fcnl\u00fck kan glikoz de\u011ferleri yorumlan\u0131r; durum stabil de\u011filse u\u00e7u\u015f verilmez<\/em>.<\/p>\n

c) Y\u0131lda bir g\u00f6z uzman\u0131nca da g\u00f6z hastal\u0131\u011f\u0131 olmad\u0131\u011f\u0131 tespit edilmeli, ayr\u0131ca istirahat ve eforlu EKG testleri yap\u0131lmal\u0131d\u0131r.<\/p>\n

Haz\u0131rlayanlar:<\/strong> Dr. Muzaffer \u00c7eting\u00fc\u00e7, Dr. Abdullah \u00d6ks\u00fcz, Dr. H\u00fcseyin Karabayram<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Diyabetik bir u\u00e7ucu i\u00e7in en b\u00fcy\u00fck kayg\u0131, akut hipoglisemiye ba\u011fl\u0131 beyin i\u015flev bozuklu\u011fu ve inkapasitasyondur. Bu nedenle askeri havac\u0131l\u0131kta ins\u00fcline ba\u011f\u0131ml\u0131 tip-1 diyabetli (DM) u\u00e7uculara u\u00e7u\u015f g\u00f6revi verilmez. Diyabet, ABD Hava K. u\u00e7ucular\u0131n\u0131n 1995-99 periyodunda u\u00e7u\u015ftan kesin olarak ayr\u0131lmalar\u0131n\u0131 gerektiren 5 hastal\u0131ktan birisi olmu\u015ftur. ABD Kara havac\u0131l\u0131\u011f\u0131nda bu tan\u0131y\u0131 alanlar\u0131n %78\u2019i kal\u0131c\u0131 bi\u00e7imde u\u00e7u\u015ftan \u00e7\u0131kar\u0131lmaktad\u0131r. Sivil havac\u0131l\u0131k istatistikleri: 1969-1976 y\u0131llar\u0131 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-695","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/695","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=695"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/695\/revisions"}],"predecessor-version":[{"id":697,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/695\/revisions\/697"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=695"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=695"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=695"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}