Pietro Marsala remembers, as a child, his father bribing him with trips to the flight deck midflight when they flew to Italy every summer to see family.

“I was the best kid in the world for two weeks,” Marsala said. “It would be just me and my dad in there with them. This was before 9/11. I’d be in awe of everything going on. I looked at them like they were superheroes.

“I loved the way they carried themselves in the terminals, the equipment they fly and their passion. I was in awe of it all. I developed my passion for flying there.”

That passion never died, but a diagnosis of type-1 diabetes almost derailed his dreams.

For pilots who dreamed of flying airplanes commercially, a diabetes diagnosis meant having to give it up. That is until November, when the Federal Aviation Association reversed course and began issuing first- and second-class medical certificates required for commercial flying to people with diabetes, like Marsala, a Scottsdale resident.

Why the change? A combination of advancements in diabetes technology—and a ton of heart and perseverance from the people who use it.

Practice makes perfect

When Marsala was 11, he spent hours on his Microsoft flight simulator, giving him his first taste of flight. As time progressed, he developed his passion for flying.

“I would spend hours on it,” Marsala said. “I’d have my parents and brother behind me in the office and act like my passengers. They couldn’t stand more than 30 minutes of being there.

“Then it would be just me in the room. It’s so realistic and it’s in real time. I would take off from Chicago and fly across the Atlantic Ocean, put it on autopilot and set the alarm for Spain. I had a couch in the office, where I’d sleep. I’d wake up and pick up where I left off and turn autopilot off.”

When he entered high school, Marsala thought maybe he wasn’t smart enough to be a pilot. He was indecisive until he went on a tour of a flight school at Deer Valley Airport.

“I saw I could learn to fly in sunny Phoenix, Arizona, at Deer Valley Airport, so I went out there,” Marsala said. “I fell in love. The rest is history. I started taking flying lessons, doing my training and working on my commercial flight training. Right in the beginning of it, they diagnosed me with type-2 diabetes.”

The diagnosis came after he lost 10 pounds in a week, he was thirsty and urinated frequently. Marsala was devastated to be diagnosed with a chronic illness at 21. Ten to 11 months later, he started “feeling weird” again and was re-diagnosed as a type-1 diabetic.

“I didn’t fit the bill of a type-2 diabetic,” he said. “I was fairly fit and pretty young. That was the hardest day of my life, to go back on insulin, a career-ending drug.”

Not ready to give up

Marsala, who was licensed to instruct, was still determined to be a commercial pilot. The FAA allowed pilots with diabetes to obtain third-class medical certificates, enabling them to fly privately and flight instruct. But they can’t earn first- and second-class medical certificates required for commercial flying.

The FAA believed pilots with diabetes who suffered from severe high or low blood sugar during a flight would endanger the passengers and the aircraft. With continuous glucose monitoring technology from companies like Dexcom, users can see their blood glucose levels at any given moment and know if their levels are trending up or down so that they can proactively make educated treatment decisions.

A continuous glucose monitoring device is a small wearable technology that is placed on a person’s lower abdomen and automatically sends a user’s blood glucose levels to a receiver, smartphone or Apple Watch every 5 minutes. The Dexcom system also has built-in alerts that proactively notify patients and their family and friends before their blood glucose reaches potentially dangerous levels.

“It’s great because it sends to a cloud and I’m able to print these reports from my receiver,” he said. “It constantly records blood sugar.”

He and his friend decided to take a trip to Washington, D.C., in 2015 and while they were there, Marsala inquired with the FAA’s Dr. James DeVoll. He was turned away, so instead Marsala sent DeVoll an email. Surprisingly, he received a response.

“Two hours later, I received a response when I was at dinner that he’d like to meet me,” he recalled. “The next day, at noon, I went up there and I was overly excited to meet him. He said he didn’t have too much time, but we ended up talking for about an hour and a half.”

Marsala showed DeVoll he was stable in flight and the FAA said they were going to consider type-1 diabetics on a case-by-case basis. However, no one had been certified yet.

“I was pleasantly aggressive,” he said. “I made an Excel spreadsheet to prove I’m stable in flight.”

On November 7, the FAA decided to allow pilots with insulin-treated diabetes to apply to fly commercial airliners. The FAA’s reversal came after a series of lawsuits issued by the American Diabetes Association in partnership with diabetic pilots. Another factor that played a role in the FAA’s decision making is the advancement of medical technology.

Marsala sent records from a cardiologist, endocrinologist and optometrist, and he was certified in April.

“I knew we were close, but I didn’t know when it was going to come,” he said. “I was driving, and my watch goes off. It was an email from the FAA. I thought, ‘Holy cow. This is it.’ It required a password, so I did that, and I scrolled to the bottom—not even reading the whole thing. It said I was first-class medical certified.

“Eight long years. I didn’t give myself a chance to enjoy the moment. I immediately called my doctor, thanking him and still crying at the time. I thanked him for believing in me and trust me. He changed my life forever. He said, ‘If I didn’t shed a tear when I sent out that email, I would have been lying.’ I knew it meant a lot to him as well.”

Now comes the task of looking for a job in the time of COVID-19, when many flights are grounded.

“I hope things pick up pretty quickly,” he said. “There’s so much uncertainty around the whole industry, but the biggest obstacle is over.”