Planning For Air Travel And Holidays With Your Insulin Pump
A team of researchers from Australia, led by Bruce R. King, FRACP, PhD, studied the effect of changes in altitude on insulin pumps and found that "atmospheric pressure reduction causes predictable, unintended insulin delivery in pumps by bubble formation and expansion of existing bubbles." 1 The last thing anyone with type 1 diabetes who travels on an airplane wants is "unintended insulin delivery," so Dr. King and his team prepared guideslines for safe air travel while using an insulin pump. The guidelines, shown below, may also be downloaded as a PDF.
Plan Outline and Check List
1. See your diabetes team 2. See your doctor 3. Pack your supplies 4. Plans A. Pump failure B. Sick day C. Hypo D. Management during flight 5. Good travel insurance 6. Contact details Your Name Your Doctor Diabetes Centre Diabetes Educator Pump Company Pump Rep
See your diabetes team 4-6 weeks before travel and review the following:
- How your control is going
- Address any problems
- Pump failure plan
- Ring pump rep/company
- Start insulin injections
Time Insulin Type Dose Breakfast Lunch Dinner Bedtime
- Review sick-day plan
- If you feel sick, have ketones, or BGL is not coming down, then change the pump cartridge, line and site
- Check BGL and ketones every 2 hrs
- Give corrections for BGLs
- Use temporary basal rates as directed
- Drink lots of fluids / water
- If concerned then see a doctor or contact your diabetes team
- Diabetes alert bracelet
- For airport security
- Summary of your health history incase you need to see a doctor while away.
See your local doctor
- Review other health issues
- Do you need immunizations?
- Plan a first aid kit to take with you
Travel InsurancePurchase travel insurance that will cover any medical expenses (including hospital admission) from a reputable insurance company. Carry the company contact details with you. Consider insuring the insulin pump.
Make up two sets of supplies you need for the trip and keep each set of supplies separate (incase you lose one set). At least one set of supplies should be in your carry-on luggage. We suggest:
- Two glucometers, strips and lancets
- Insulin (short and long acting)
- Pump supplies (cartridges, lines, sites and batteries)
- Spare pump (ask your pump company)
- Written pump settings
- Hypo kit (glucose tablets and glucagon)
- Syringes, insulin pens, needles
- ketone test equipment
Leave everything in its packaging for airport security (especially insulin, glucagon, glucose tablets). Putting the supplies in the check in luggage is safe (the temperature in the cargo bay is 8-18 degrees C).
Before the flight
12 hours before the flight change the pump cartridge, line, site and battery. This will ensure everything is working throughout the flight. It is hard to change a pump site on a moving plane.
Do not order airline "diabetes meals." They are very low in carbohydrates and designed for T2DM. Airline menus usually contain a selection of suitable meals.
Going through airport security
- Ensure that when you dress there is nothing that will set off airport security i.e. metal in belt buckles and shoes.
- Get to the security points early to allow for extra checks if required.
- Keep your pump on you as you walk through security because the conveyor belt uses x-rays that may affect your pump.
- Place all other items on the trays that are passed through the conveyor belt scanners.
- Have your doctor's letter with you.
Security is not concerned by the small volume of fluid in the insulin vials but leave the vials in their packaging with printed pharmacy labels. Security swabs for drugs or explosives are safe and do not affect the pump.
Pumps on planes
The pressure changes that occur when flying will affect insulin delivery from your pump. You need to:
- Only have 1.5mLs of insulin in the pump for the travel.
- Disconnect the pump just before takeoff.
- 30 minutes after takeoff the plane should be at cruising altitude (if in doubt ask the cabin crew), take the cartridge out of the pump and remove any bubbles. You can then reconnect and use the pump.
- If there is an airplane emergency, immediately put the oxygen mask on and then disconnect the pump. After the emergency is over, check the cartridge for bubbles, then reconnect and use the pump.
- When the plane has landed then disconnect the pump and prime the line with a 2 unit bolus. You can then reconnect and use the pump.
Continuous glucose sensors / monitors
The transmitter unit can interfere with airline navigation equipment. It must be disconnected from the sensor before entering the plane.
During the flight
- Drink lots of water.
- Check your BGL every two hours.
During long flights the airline tries to run the environment so you arrive fresh. Try to follow their suggestions.
- Eat at their meal times
- Sleep when they turn the lights down
Your pump basal rates are set to match what you are doing. If you cross time lines during the flight then change the pump's clock regularly to match what you are doing i.e. if you are about to eat diner then change the pump clock to your usual dinner time, if your are going to sleep then change the pump clock to your bed time.
When you arrive at your destination change the pump clock time to the local time.
To avoid jet lag we recommend
- Drink lots of water, eat good meals and look after your health.
- Normalize your day by:
- Going for walks outside.
- Stay awake through the day.
- Go to bed at your normal time and stay in bed till the next morning.
Dr Bruce King
MBBS FRACP PhD Paediatric Endocrinologist
John Hunter Children's Hospital
Newcastle NSW Australia 2310
1 Changes in Altitude Cause Unintended Insulin Delivery From Insulin Pumps: Mechanisms and implications
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