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Tales From The Air

There’s a ritual I follow every year.  Right around this time, I go through my calendar from the previous year and compile an automobile travel log for tax purposes.  A big chunk of my travel involves trips to/from the airport for flights far and wide in order to attend conferences, participate in advisory meetings, and present to patients and healthcare providers.

2016 was a busy travel year.  Twenty six trips in and out of Philadelphia International Airport.  For those keeping score, that’s an average of a trip every other week.  I’ve come to know all the best places for parking, grabbing a bite to eat, and even going to the bathroom.  For example, you can’t fly through Chicago’s airports (O’Hare and Midway) without stopping at Nuts on Clark for some of the world’s best popcorn (free samples are always offered).  Heck… I’m on a first-name basis with one of the TSA agents at Terminal B here in Philly.  Among frequent travelers like me, the B stands for Burrito Elito – the best food in the whole terminal.

Remember when you were young, and a trip was actually fun?  No long airport security lines, actual meals in coach class, and packing meant little more than throwing some socks, underwear and a toothbrush into your handy-dandy Scooby-Doo suitcase (yes, I actually had one of those).  Nowadays, travel involves more hassles than most of us are equipped to handle.  And having diabetes just adds to the fun.  Luckily you have me, Mr. “Platinum-Status Flier,” to share a few pointers for making travel a bit more bearable and enjoyable.



Unless you’re flying first class, the food served on flights is sparse and gross.  And even in first/business class, there are usually no meals served unless a flight is longer than three hours.  Of course, if you’re willing to fork over your credit card, you can get a stale, tasteless “meal in a box” for the price of a five-star dining experience.  My advice:  plan ahead.  Bring snacks from home and stow them in your carry-on bag.  If it’s going to be a long flight, buy a cold meal at the airport (plan an extra 10-15 minutes for this) and carry it on with you.  Fruit, sandwiches, salads and wraps are easy to carry on-board.  Don’t forget napkins, utensils and condiments!



vegetable tray

Not This:




reminder notePacking is a combination of art and science.  I really don’t like to check luggage.   Besides the cost, there is the added delay when checking in at the airport, the risk of the airline losing the bag, and worst of all, the interminable wait at the conveyor belt upon arrival (you can tell, I’m a very patient guy).  So I’ve become very good at consolidating my stuff.  For short flights where small jets with tiny overhead space are common, a canvas duffel-type bag is ideal.  That way, you won’t have to turn your carry-on bag over for checking at the last minute.  For longer flights (or trips that last more than a couple of days), learn to maximize the space in your carry-on bag and “personal carry on”.  These days, the personal carry-on can be almost as large as your carry-on bag; it just has to be able to fit below the seat in front of you.


Whether you check a bag or not, be sure to pack two complete sets of everything you need to manage your diabetes for the length of the trip.  Two meters with strips & lancing pens, two sets of insulin, two sets of batteries, two bottles of glucose tablets, two sets of pump supplies, and so on.  Put one set in your “personal item” bag, and the other set in your carry-on luggage (or your checked luggage).  That way, if one of your bags in lost, stolen or confiscated, you have the other as a fall-back.





When it comes to getting through security with minimal hassles, I have one word for you:  PRECHECK.  If you fly more than once or twice a year, TSA’s precheck service is well worth the time and investment.  But be sure to enter your precheck ID (also called a KTN – Known Traveler Number) when you book your flight, or you may not have access to the precheck service at the airport.  Precheck holders at most domestic airports can bypass the long lines and go through standard metal detectors rather than having to use the full body-scanning equipment.


In terms of our diabetes “stuff,” I have found it helpful to draw as little attention to it as possible.  I have never had a standard metal detector set off an alarm because of an insulin pump (with the clip/case removed), infusion set or CGM sensor that I was wearing, but the full-body scanners catch them every time.  And that means having to be pulled aside so that security can dust your hands and check for explosives.  If you wear a tubed pump, simply remove the clip, put the pump in your pocket and walk on through the standard metal detector.  The rest of your diabetes stuff should be tucked away in your carry-on bag and sent through the bag scanner.  Despite what the manufacturers’ legal teams put in the fine print, diabetes equipment (meters, strips, pens, pumps, infusion sets, CGM receivers, insulin, etc…) can pass through luggage scanners unnoticed and undamaged




BG management during a flight can be a little tricky.  On flights that last more than a couple of hours, there is a tendency for blood sugars to rise due to the lack of physical movement.  I’ve found that a modest temporary basal increase on my pump works nicely to keep me steady on long flights.  Then there is the issue of altitude.  Most aircraft cabins are pressurized to 10,000 feet.  When planes go above this level (soon after takeoff), the air pressure in the cabin will be less than the pressure within your pump’s insulin reservoir.  This can cause a little bit of insulin to move through the tubing and into your body.  During descent, the opposite can occur:  a small amount of insulin can flow from the tubing back into the reservoir.  The amount can vary, but from experimentation (yes, I brought test pumps onto a flight!), I’ve seen a few tenths of a unit move in/out under these conditions.  For those who are very sensitive to small amounts of insulin, this can cause a noticeable BG drop after takeoff, and a rise after landing.  For those on larger doses, the blood sugar change may be barely noticeable.  Tubed pump users who want to avoid this problem should disconnect from their pump during the takeoff (ascent) and landing (descent) phases of their flights, and prime their tubing before reconnecting to purge out any air that may have formed in the tubing.





The two main sources of stress during air travel are time-related:  rushing to make a flight, and unexpected delays.  You have a lot of control over the first.  Give yourself more than enough time to make your flight, even if it means having to kill some time at the airport.  Bring things to do, or just take a walk at the airport.  I always bring some work to do (I happen to be writing this post while waiting for a flight), along with crossword puzzles to keep my brain occupied before and during flights.  Free wifi is offered at most airports, so you can check email, watch movies, or just do some pleasure surfing.


To minimize the stress of delays, use common sense.  When connecting flights are required, be sure you have more than enough time to make the connection (an hour or more is best).  When booking flights, check the on-time-arrival rating for that particular flight.  Choose flights/routes that have at least 90% success rates whenever possible.  And think about when you need to be at your destination (both leaving and returning).  Booking the last flight of the day leaves you no options in the event your flight is cancelled.  Flights that leave first thing in the morning offer several benefits:  Less traffic getting to the airport, fewer chances for delays (due to inbound flight problems), and plenty of options later in the day in case your flight is cancelled.


And say what you will about airline employees being surly, unhelpful and under-appreciative.  They are people just like you and me, subject to overwork, underpay, their own challenges and frustrations.  The Golden Rule definitely applies.  Smile and pay a compliment whenever possible.  It will make you feel a helluva lot better than complaining.


Happy Flying!

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