Air travel across multiple time zones poses challenges for diabetes management
Did you know that about 10% of travelers with diabetes report that they’ve had a diabetes-related complication during air travel? This is serious stuff, because a major problem could cause a flight to need to be diverted and the person with diabetes to be hospitalized. Let’s take a look at some guidance on how to avoid problems with diabetes management during long distance travel.
An abstract from the AACE (American Association of Clinical Endocrinologists) annual meeting earlier this year discusses how researchers looked for articles on diabetes and air travel, and searched websites of national diabetes organizations for patient-oriented advice on the subject. The researchers were interested in specific issues pertaining to diabetes care for air travelers: general preparation advice, cabin environment/equipment, medication adjustments and insulin pump use.
They found nine peer-reviewed articles and two diabetic nursing guidelines. Of the six recommendations that they identified, five were based upon expert opinion, and one was based upon a prospective cohort study.
The recommendations were as follows:
- For short/rapid acting insulin, no dose adjustment is recommended.
- When traveling east, intermediate and long acting insulins should be decreased in dose proportional to the hours lost.
- When traveling west, correction can be given with rapid-acting insulin, or the dose to be given during travel can be given as divided doses to span the longer travel day.
- Because of difficulty in titration, pre-mixed insulin use is discouraged.
- During eastward travel, sulfonylureas and glinides should be held
- Insulin pumps can be used per usual basal and bolus dosing. Caution is needed for cabin pressure issues.
When using an insulin pump during air travel, cabin depressurization can cause an unintended bolus, leading to hypoglycemia. This is seen upon ascent. The pump should be disconnected prior to ascent and descent. Visible air bubbles that form during ascent should be removed prior to reconnecting the pump when altitude is reached. It’s advisable to bring backup medication, and when traveling internationally, be aware that there can be differences in concentration as well as varying availability of international insulin products.
At Integrated Diabetes Services, we recommend that you consider bolusing just before takeoff for the basal you will miss in the upcoming hour, then stay disconnected for that hour. When you reach altitude, purge any air out of the reservoir and tubing, and reconnect at the end of that hour. Your ears will “pop,” telling you when the plane is starting to descend. Again, bolus for the insulin that will be missed in the upcoming hour, and disconnect. (Don’t forget to reconnect at the appropriate time!) People who are more insulin sensitive are more vulnerable to these effects, while those who are more insulin resistant may not notice a difference. We also recommend that you keep your pump clock set on your starting time until you are getting ready to go to bed at your destination, and then switch it to local time, since this is when your body’s circadian rhythm will begin to reset.
Remember, too, that pump and CGM companies recommend that your devices not be exposed to any form of x-ray or the full body scanner. However, we are unaware of anyone’s pump ever being damaged by exposure to this type of equipment. You can use the TSA Cares program when you are flying within the US to make screening go a bit more smoothly; contact them at https://www.tsa.gov/travel/passenger-support at least several days in advance of when you will start your travel.
Air travel requires some extra thought and effort with diabetes, but these tips will help you to navigate it with more stability. Safe travels, everyone!