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April Blackwell, working at NASA.

If you ever wondered what it might be like being a space engineer monitoring outer space stations and rockets while also living with type 1 diabetes (T1D), look no further than April Blackwell in Houston.

Diagnosed at age 11, Blackwell is an aerospace engineer and NASA flight controller who has dreamt of being an astronaut for most of her life.

With the newly-independent U.S. Space Force making headlines and the Netflix series “Space Force” trending, it’s pretty thrilling to hear from one of our own in the Diabetes Online Community (DOC) about her real-life work in outer space.

Here is Blackwell’s story, in her own words…

To give you the proper context for my T1D diagnosis, I have to tell you about my kindergarten career choice. At age 5, after observing how enamored my father was with space, I decided I was going to be an astronaut. By about third grade I had checked out all of the library books on space, started building model rockets, checked the newspaper each day for space clippings, and perfected my countdown sequence to include the proper terminology. It’s safe to say I was hooked, for better or worse.

The “worse” came in sixth grade at the tender age of 11.

By this point I was six years into my astronaut ideology — I had already attended several local summer space camps, went to junior high for accelerated math classes, and had decided I would apply to MIT when the time came for college.

But that winter break I struggled with insatiable thirst, frequent urination, and unbearable fatigue. The doctor’s visits are a bit of a blur now, but I recall a week of daily pediatrician visits where I joked about being able to “pee on demand.” Eventually, I remember a fingerstick accompanied by a strange look on the nurse’s face, and after all that, a serious conversation between my doctor, me, and my parents about the diagnosis: type 1 diabetes.

Even today, a diagnosis of T1D is an automatic disqualification on NASA’s astronaut application.

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April Blackwell

Astronauts are subjected to physically and mentally demanding scenarios with ultimate consequences for months at a time on board the International Space Station, so they have to be top-notch humans. And I don’t fault NASA for literally choosing the best of the best. But, where did that leave 11-year-old, freshly-diagnosed-with-diabetes me? It left me wondering if I should find something else to be interested in and focus on. The problem was I just couldn’t get interested in much else. Space. Is. My. Passion. Full stop.

So, instead of giving up on space because of T1D, I doubled down in my efforts to follow my passion, astronaut wings or not. I listened and learned, I picked up a few mentors along the way, I excelled at school, I joined and led groups like marching band and newspaper, I pushed my own envelope, and never used diabetes as an excuse. When it came time for college I made a financial decision to use a full-ride scholarship and enrolled at Arizona State University in, what else, aerospace engineering!

I finished up my bachelor’s degree right around the time the space shuttle program was winding down. NASA was pivoting to a new set of rockets and the funding stream wasn’t as robust. Through a random set of circumstances, I found myself applying, interviewing, and being selected as a Flight Test Engineer working on experimental Army helicopters. It was quite the leap for someone who had dreamed of working on rockets and spacecraft her entire life, but I firmly believe everything happens for a reason, so I was determined to find the reason embedded here.

During the interview process, I tried to make it clear that I had T1D as I knew this could present barriers when faced with attaining a medical clearance. Everyone assured me they would stand behind me and work through the process, which is great because it really did turn into a process.

It was during this time that I started incorporating stories about diabetes on my blog and specifically all the hurdles associated with getting an FAA medical clearance. I did my own internet searching too, stumbling upon the DOC. I didn’t find much to guide the specific situation I was facing, but I did find lots of fellow T1Ds experiencing all the emotions I had mostly kept to myself over the last decade. It was so nice to read parallel stories and gain nuggets of knowledge to motivate me during the trial I was slogging through.

After 6 months of back and forth letters with the black-box FAA doctors in Washington, D.C., I was finally granted a Special Issuance FAA Class III Medical Clearance and was allowed to fly onboard the experimental test helicopters as a Flight Test Engineer.

My fellow engineers and the test pilots themselves always championed for me and made sure I got good use out of that medical clearance. During my 3 years at the flight test directorate, I flew over 250 hours in experimental Army helicopters, experienced the special operations dunker trainer (basically, two days straight of drowning alive), and was certified in the altitude chamber and parachute course. I learned how to fit all my diabetes equipment in a flight suit and the men I flew with always supported having a T1D on their flight crew.

Ironically, I received a call to interview with NASA while I was away at a training course at the Naval Test Pilot School (literally, one of the coolest experiences of my life). A few days later I was in Houston, delivering an example presentation and doing a tour of interviews with several prospective flight control disciplines. The rest is history — we sold our house in Huntsville, Alabama, and moved to Houston.

Being a flight controller is another job that requires attaining a medical clearance. This time the baseline is similar to an Air Traffic Controller medical — physical examination, EKG, hearing test, eye test, bloodwork, urinalysis, and a full medical history discussion.

But this time I could interface directly with the doctors making the determination to grant me a waiver or not (of course, T1D requires a “waiver”). On top of the clinical qualification, I also had to get a letter from my endocrinologist describing my diabetes control over the past year, including A1C results to back up any claims, as well as a letter from my ophthalmologist detailing any pertinent findings following my yearly eye dilation. I’m happy to report that my NASA doctor granted me a flight controller waiver and has continued to do so every year since my initial certification.

At this point, you may be wondering, “So, what does she do at NASA?” My official title is International Space Station (ISS) Attitude Determination and Control Officer, our console callsign is “ADCO.” After 2 grueling years of training, I get to sit on the console in mission control and make sure Isaac Newton keeps the ISS straight and level.

Our group also plans all the attitude maneuvers for dynamic operations, watches telemetry from the equipment that calculates and maintains the attitude onboard, sends commands to prepare for or execute ISS maneuvers, and troubleshoots anomalies real-time. We provide support 24/7/365, which means occasionally I am watching over ISS while most of you are sleeping.

I like to think I am uniquely prepared for this rocket-science job because I already have years of experience making plans (and backup plans) with diabetes onboard, watching telemetry streaming from my own body, inputting insulin pump commands to deliver a bolus or correction, and troubleshooting diabetes technology failures 24/7/365.

I’m also so happy that my diabetes management is mostly on autopilot now using the Tandem t:slim x2 insulin pump and a Dexcom G6 CGM. I feel the freedom to really focus on my work, be a contributing member of the flight control team, and most importantly, keep our crew safe.

And that astronaut kindergarten career choice? Well, it has a new trajectory to be the first T1D in space!

Perhaps. I don’t think NASA will ever allow T1Ds in the astronaut corps because honestly, they don’t need to. But, I do think there will be a push for medically imperfect humans to be allowed on commercial spaceflights in the near-ish future. I actually wrote my grad school thesis on this very subject — detailing the tests, feasibility, and safety of T1D astronauts.

Haha. Some parts are incredibly accurate. Since NASA is funded by the government there is always a bit of nervousness/anticipation every 4 years. For the most part, we try to keep politics on the sidelines and focus on our missions but it creeps in every so often. Also, the “space is hard” motto is pretty spot-on.

Check out Spot the Station and type in your location. You can actually see ISS with the naked eye when it passes over your area. I encourage you to go outside and wave — I might be at the helm in mission control when you see her!


Diagnosed with type 1 at age 11 in 1998, April Blackwell lives in Houston and works as an Aerospace Engineer and NASA Flight Controller. You can read more about her diabetes adventures at her blog, Nerdy April.