Travel and diabetes

Travel across time zones:

• Eastward travel will shorten the day, and generally mean a temporary reduction in insulin doses, whereas westward travel will extend the day, and possibly increase insulin requirements
  • however, adjustments to insulin doses are rarely necessary if patients are crossing fewer than five time zones (1)
• insulin use during travel
  • use of a continuous subcutaneous infusion of insulin can provide a flexible regimen for managing diabetes during air travel. However this is not used by the vast majority of UK insulin treated diabetics
    • for most patients, multiple-daily injections of insulin will also allow flexibility with reduced or additional dosing
    • conventional twice-daily fixed-mixture regimens may cause some problems as timing of meals and injections cannot be varied significantly
      • however, given that tight glycaemic control is unnecessary during travel, changing insulin regimens (e.g. from twice-daily to multiple-daily injections) is unlikely to be necessary
• oral medication for type 2 diabetics
  • metformin with meals should cause no significant problem
  • a twice-daily regimen with a sulphonylurea may require a dose adjustment to avoid hypoglycaemia

Advice for the diabetic traveller:

• tell their airline that they have diabetes in case of unexpected hypoglycaemia
• carry a letter from a doctor confirming the need for insulin and needles on the plane
• request for specific 'diabetic' in-flight meals is unnecessary (such meals may actually have insufficient carbohydrate and so might increase the likelihood of hypoglycaemia). A better option is a vegetarian meal that contains complex carbohydrate, such as rice or pasta
• insulin treated diabetic travellers should be advised to store insulin in hand luggage and to carry extra carbohydrate and insulin in case of unexpected delays
• insulin treated patients should test blood glucose concentrations regularly, ideally every 4-6 hours
• diabetic travellers should be advised that glycaemic control can be relaxed during air travel and healthcare professionals should keep advice as simple as possible, with adjustments in regimens being restricted to those necessary to avoid hypoglycaemia and ketoacidosis
• suggested items to pack for air travel:
  • blood glucose meter (with enough blood glucose strips) *
  • sufficient insulin, syringes and lancets for the entire trip *
  • a cool bag to store the insulin
  • for pump-users
    • sufficient pump supplies, plus an extra supply of short-acting insulin in case of pump failure *
  • urine testing strips for ketones
  • sufficient supplies of other prescription medications *
  • rapid-acting carbohydrate e.g. glucose tablets)
  • complex carbohydrates (e.g. cheese crackers, cereal bars)
  • a diabetes identification card
  • travel insurance documentation
  • * ideally, duplicate supplies should be taken in separate bags
• transportation and storage of insulin in hot countries
  • in the UK, insulin remains active when left at normal room temperature for up to 28 days. However, in warmer climates, insulin should be refrigerated or, when carried around, kept in a cool bag
  • note that insulin is absorbed more rapidly in hot weather or following physical activity. This can possibly result in hypoglycaemia and travellers should be told about this risk

Reference:

1. Drug and Therapeutics Bulletin 2005; 43(10):73-77.