Difficulties with insulin and travel highlighted at US clinical congress

A series of recommendations have been issued to help people manage their diabetes better as they travel on holiday.
According to Dr Rahul Suresh, who is from University of Texas Medical Branch in Galvesto, there is anecdotal evidence that suggests up to 10 per cent of travellers with diabetes often encounter short term complications during a flight.
He said the direction of travel can play a huge part in the person’s condition with a heightened risk of hypoglycemia during eastward travel, while hyperglycemia and diabetic ketoacidosis (DKA) can affect more people when they move west. DKA occurs when the body lacks sufficient insulin.
Speaking at the American Association for Clinical Endocrinologists Annual Scientific and Clinical Congress, he said: “Travel disrupts people’s normal routines, whether that’s their diet or their [insulin] dosing times.
“In order to avoid complications with medication dosing, insulin and other diabetes medicines have to be taken at certain times, with respect to carbohydrate intake and overall calorie intake.”
Travelling across time zones might be part of the problem for people as they lose track of the correct dosage times for their medication, Suresh said.
He added: “When you travel east, you shorten the length of your day, and if you aren’t attentive to your watch and change your destination time zone, now your next dosing time is early.
“Similarly, when you go west, your day lengthens, and as a result, people may have gaps in their insulin coverage, causing hyperglycemia. In type 1 diabetics, you can develop [diabetic ketoacidosis].
The research team analysed nine peer-reviewed articles and two nursing guidelines. They also looked at six different recommendations and gave an update to the recommendations.
Note that this is a US research team and therefore UK advice should take precedence. Your diabetes health team can help you to make the right decisions so that you do not expose yourself to greater risk of too high or low blood sugar levels or ketoacidosis.
Suresh noted that pre-mixed insulin would present additional problems as it combines both quick and long acting insulin.
Insulin pumps have an advantage in that they allow the basal rate of insulin to be changed at any time. However, insulin pumps also present a different difficulty.
Suresh states: ‘Insulin pumps, theoretically, have the risk for bubbles and extra bolusing when they are used during ascent or descent. The recommendations are to disconnect the pump on ascent, remove any air bubbles once you arrive at altitude, and then reconnect the pump so that it can continue to function’.
If you are on a pump, please talk to your pump team about how to safely manage your insulin delivery during flights.