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Living with Diabetes

Insulin and Air Travel

Introduction

Air travelHolidays are great and you’ll be glad to hear, thoroughly recommended for people who have diabetes! Air travel is a therefore common occurrence for people who receive insulin therapy. This leaflet aims to discuss some of the planning which is best done before your trip.

Are there any problems associated with Air Travel ?

  • increased security at Airports. Needles and Lancets have to be ‘declared’
  • crossing time zones affects timing of injections
  • meals on board aircraft may not be suitable
  • dehydration is common

These problems can be overcome by planning ahead for your journey.

What should I pack?

Your diabetes supplies should be carried in your cabin bag. Cargo holds are subject to extremes of temperature which can cause insulin to deteriorate. Furthermore check-in baggage may get lost.

Security officials at airports may not always accept a written prescription or letter from your doctor, though it is recommended you carry one anyway.

According to aviation regulations all insulin vials/pens/cartridges should have a professional, preprinted pharmaceutical company label affixed which clearly identifies the medication.

Lancets for blood glucose monitoring should be capped and clearly labelled.

Glucagon kits should also have the original preprinted labels attached.

Checklist

  • Insulin, pens/syringes, lancets and test strips to last your trip
  • Blood glucose meter
  • Glucagon kit
  • Glucose tablets
  • Medication for vomiting and diarrhoea
  • Complex carbohydrates – e.g. breakfast bars, snacks in case meals are delayed
  • Short acting insulin for sick day management
  • Card or bracelet which identifies you as someone who has diabetes
  • Insurance documents

On board the aircraft

  • Avoid alcohol
  • Drink plenty of fluids
  • Monitor blood sugars regularly (every 4 hours recommended)
  • Ideally take your insulin at meal time rather than half hour before.

What should I eat ?

It is best not to request a ‘diabetic diet’ as the ‘diabetic’ meals may not have sufficient carbohydrate for your requirements. These may be suitable for people with type 2 diabetes rather than those with type 1 disease. Take the regular meal offered and supplement your carbohydrates if necessary with snacks.

Crossing Time zones

When flying it is best that you do not change the time on your wrist watch. Travelling North or South does not require any change in your 24 hour schedule.

Travelling East will shorten your day and you may therefore need less insulin.

Travelling West will lengthen your day and you may therefore need more insulin.

This is a ‘rule of thumb’ which does not always apply especially on long-haul flights.

What is the ideal insulin regime ?

A basal bolus regime is probably the best insulin regimen to be on apart from insulin pump therapy. Ideally this should use HumalogR or NovorapidR as short acting insulin.

What are time zones ?

The Earth is divided into 24 perpendicular wedges known as time zones. The Greenwich time zone is taken as the reference zone and is referred to as Greenwich Mean Time (GMT). The more time zones you cross, the more complicated the insulin regime becomes.

Some examples of how to manage your insulin

For example if you are taking off from Heathrow Airport, travelling West to the New York in the United States. The time at your destination is five hours earlier in the day. Therefore when you arrive you have five more hours to get through before it’s time for bed.

If you are on a twice daily isophane and soluble:

  • Take your usual morning dose on the morning before you leave. Keep your wristwatch reading London (GMT) time.
  • Time your evening meal at the usual time (approx 10 hours after the morning dose).
  • Take the full dose of soluble insulin with half the dose of isophane at this time.
  • At dinner time in New York (say 6pm which would be 11 pm GMT), take the remaining half of the isophane insulin with your full dose of soluble insulin.
  • The next morning resume your usual daily dose.

If you are on a twice daily mixture e.g. Human Mixtard 30:

  • Take your usual morning dose, the morning before you leave.
  • Time your evening meal at the ‘usual time’  as above. Take half the dose of insulin at this time
  • Take the remaining half of your dose, when it is dinner time in New York.
  • The following morning resume your usual daily dose.

If you are on a basal bolus regimen:

  • For example on three doses of Novorapid or Humalog with Glargine at bedtime.
  • Take your usual dose of Glargine the night before you leave.
  • Take your doses of pre-meal insulin as you normally would.
  • Time your dose of Glargine for your usual injection time (say 22:00 h), taking half your dose at this time.
  • Take the remaining half-dose of Glargine at bedtime in New York (i.e. 3 a.m. GMT). This way your 24 hour requirement of Glargine stays the same, though the dose is split to help deal with the time change.
  • Use extra soluble insulin (humalog or Novorapid) to cover extra meals during the flight based on how much carbohydrate you eat.

These are simply illustrations as there can never be a comprehensive account of insulin management to cover every travel itinerary. Discuss your travel plans in detail with your diabetes nurse.

 

Dr Nishan Wijenaike
Consultant Physician
West Suffolk Diabetes Service
October 2003