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Preparation key to diabetes management during air travel
ORLANDO, Fla. — The mismanagement of diabetes during air travel can lead to adverse consequences, including hypoglycemia during eastward travel and hyperglycemia or diabetic ketoacidosis during westward travel, according to a speaker here.
“Travel disrupts people’s normal routines, whether that’s their diet or their [insulin] dosing times,” Rahul Suresh, MD, MS, a second-year resident at the University of Texas Medical Branch in Galveston, said during a press conference at the AACE Annual Scientific & Clinical Congress. “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.”
Rahul Suresh
Research on diabetes and air travel is limited, Suresh said, but anecdotal evidence suggests that up to 10% of travelers with diabetes encounter complications in flight, often related to hypoglycemia. Additional studies have noted that, of all severe complications that occur causing the diversion of aircraft, almost 2%, or one in 50, are due to diabetes, Suresh said. Currently, Suresh said, there is a lack of available data detailing why people with diabetes encounter these complications in flight.
“This is not something that airlines like to divulge,” Suresh said. “But what we do know is that when people travel, especially those who are on insulin, if they are not attentive to their insulin regimen, [they] can over- or under-dose their insulin.”
Insulin dosing errors can occur if a traveler is not eating enough or taking insulin too early, which can happen most often when a person is traveling east across time zones, Suresh said.
“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 you’re next dosing time is early,” Suresh said. “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]”
In an analysis of nine peer-reviewed articles and two diabetic nursing guidelines, Suresh and colleagues identified six recommendations based on a combination of expert opinion and one prospective cohort study. Recommendations were updated to address general preparation advice, cabin environment and equipment, medication adjustments and insulin pump use.
Suresh and colleagues recommended no dose adjustment for short- or rapid-acting insulin; however, during eastward travel, intermediate- and long-acting insulins should be reduced in a dose proportional to hours lost. During westward travel, correction scale insulin with rapid-acting insulin can be used, or the dose to be administered during travel can be given as divided doses to span the longer travel day. Pre-mixed insulins are discouraged, Suresh said, due to difficulty in titrating effects. Sulfonylureas and glinides should be held during eastward travel.
For travelers on insulin pump therapy, caution needs to be exercised, Suresh said. Cabin depressurization may lead to up to 1 unit of unintended bolus dosing, increasing the risk for hypoglycemia.
“Insulin pumps, theoretically, have the risk for bubbles and extra bolusing when they are used during ascent or descent,” Suresh said. “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.”
Bringing backup medication is advised, the researchers wrote, and traveling patients should be informed of the differences in concentration and varying availability of international insulin products. – by Regina Schaffer
Reference:
Suresh R. Abstract #281. Presented at: The American Association for Clinical Endocrinologists Annual Scientific & Clinical Congress; May 25-29, 2016; Orlando, Fla.
Disclosure: Suresh reports no relevant financial disclosures.