Flying And Diabetes

Putting flying and diabetes together involve quite a few problems.

Though some are associated with the actual flight itself, it is actually getting onto the plane and out of the airport that causes the most glitches for a diabetic.

This has gone up in leaps and bounds since the terrorists chose to hijack planes and fly them into the Twin Towers.

Dealing with diabetic supplies.
The airport security has been increased at most airports and sharp objects are forbidden to be taken onto the plane in your hand luggage.

One can understand the reasons for this. Anyone would think twice about disobeying an instruction if the person issuing it was waving a syringe around that he claimed was full of some deadly substance that he would either spray into the air or inject into a passenger or the pilot unless his demands were met.

However this causes a bit of a dilemma for us innocent diabetics as we need our lancets and injection devices close at hand.

Fortunately airport authorities recognise this fact and have made special provisions for us, but it does make our lives that little bit more difficult. However, you can usually find out from your airline what you need to do to make your life easier.

Always check with your airline about the rules and regulations in regard to diabetic supplies.Don’t take for granted that what was in place the last time you flew will still be in place this time – things can change on a daily basis.

In fact, at the very moment I was writing this article there was the threat in the UK involving terrorists taking bombs onboard planes as component pieces hidden in drinking liquids and that resulted in extremely tight security measures, way beyond what we are used to.

The very latest advice issued after this event can be seen at these two sites
Diabetes UK
American Diabetes Association

Note –
DO NOT try to be funny when going through airport checks. It may seem amusing to you to make some snide remark about actually having a vial of dangerous bacteria hidden amongst your supplies but you will find that the screener is decidedly lacking in a sense of humour and you could well find yourself still on the ground when your plane takes off. Just do as you are asked, calmly and politely and with no fuss.

Below are some general tips:-
Get a letter, on official stationary, from your GP stating your full name, address and date of birth and that you have diabetes. Have him list the medications, insulin delivery devices (either syringes, insulin pen or pump) and the blood glucose testing equipment that you use and state that you will need to use these during the flight.

This letter is obligatory in the UK, Australia and Canada and solves most problems but is not sufficient in the US because of concerns over forgeries.

In some third world countries it can be useful in another way. It can stop hassles from suspicious and often corrupt customs officials who may claim that you are going to use your equipment for the administration of illegal drugs and either want to confiscate it or require a bribe to let you keep it.

In the USA you ABSOLUTELY MUST produce a vial of insulin with a professional, pharmaceutical pre-printed label that clearly identifies the medication before you will be allowed to take any of your supplies on board.

Do remember that the required label is usually stuck on the outside of the box that the vials come in so don’t throw the box away and just bring the vial. Keep it pristine, as it came from the pharmacy.

There is no ‘wriggle room’ here folks. Do as you are asked or you WILL NOT be allowed to take your supplies on the plane.

And before anyone else says it I will say it for them – yes, I have also thought of the fact that these precautions are really more trouble than they are worth, as I am sure any well organised terrorist cell will have someone on tap who can either make excellent forgeries of either a letter OR the labels on an insulin vial or have an obliging doctor sympathetic to their cause who can issue perfectly legitimate documentation for a fictitious diabetic. Hell, in this day and age of spiralling diabetes there is every chance the damn terrorist may actually BE a diabetic and have the genuine documents! However these measures do make it just that little more difficult for the casual fanatic and so are worth the small amount of irritation they cause us.

Type 2 diabetics who don’t use insulin but who need to test their Bg’s during flight may take their lancets onboard as long as they are capped and are accompanied by a glucose meter that has the original name embossed on it, such as ‘One Touch Ultra’ or ‘Accucheck’.

Glucagon, like insulin, must be in it’s original pre-printed pharmaceutically labelled container.

You need to notify the screener at the checkpoint (customs or security gate) that you have diabetes and are carrying your supplies with you. All your equipment will be screened, undergoing x-ray inspection .

In some airports you have the option of requesting a visual inspection of your insulin and diabetes associated supplies, but this request must be made before the screening process begins.

If you want a visual inspection then you need to have your medication and supplies in a separate pouch or bag (not mixed in with your other hand luggage) when you approach the screener at the walk-through metal detector.

The screener will probably ask you to unpack, display and repack your own supplies for this inspection. This is to prevent any damage or contamination of those supplies.

What can be taken through, after screening:-
1. Vials of insulin that are properly labelled.
2. Jet injectors, pens, infusers, and preloaded syringes, likewise with correct labels.
3. Unlimited quantities of unused syringes, as long as they are accompanied by correctly labelled insulin or other injectable medication.
4. Blood glucose testing equipment, including meters, lancets, test strips, calibrating solutions and alcohol swabs.
5. Glucagon emergency kit, again if probably labelled.
6. Ketone test strips.
7. Insulin Pumps and associated supplies, i.e. infusion kits, catheters, needles, spare plastic tubing, batteries and cleaning agents.
8. Unlimited quantities of used syringes, as long as they are contained in a proper Sharps disposal container or some such hard-surfaced container.
9. Medications in daily dosage containers.

Pump Users.
Most insulin pump manufacturers now state that their pumps can safely go through normal airport security systems, such as metal detectors and hand-wands. The Animas pump, in particular, has been found to go through these devices quite happily.

However not all airports use the same screening technology so you can, to be on the safe side, ask for a visual inspection. This does mean that your pump will be rather closely scrutinised and you will very likely be subjected to a full body ‘pat down’.

You will need to tell the screener that you cannot remove the pump as it is connected to a catheter that is surgically inserted under the skin.

In some countries the airport staff do not recognise a pump, they seem to think it is a mobile phone or pager and want you to remove it. For this reason it is wise to take documentation with you describing your pump.

Remember that like all other insulin delivery devices the pump and supplies must be accompanied by insulin with professionally printed pharmacy labels identifying the medication or manufacturer's name.

Remember to have spare supplies for your pump such as extra batteries, insulin, cannulas, reservoirs and lines. The ‘twice as much’ rule holds good here.

Don’t forget to take some other form of insulin device, such as a pen or syringes and suitable insulin in case your pump plays up and you cannot get it sorted out in a hurry (if at all!).

Other useful info.
The advice has always been to carry two lots of diabetic supplies in two different bags, in case one gets lost, something that is not all that unusual. The best way was to give one of the bags to your travelling companion, if you had one, to carry. This pays service to the concept of ‘not putting all ones eggs in one basket’

Modern security makes this much more difficult. A solution may be to go through the screening process and then separate some of the essential stuff that would be difficult to replace into another bag.

In reality it is only the insulin itself (and that includes pre-loaded pens and cartridges) that HAS to be taken with you as hand luggage because the temperatures in the cargo hold get to below freezing. Spare syringes, needles, meters and any other supplies can happily go in your main luggage, so you can separate them between a number of bags.

There have been occasions when insulin in cartridges or pre-filled pens has leaked out. For this reason you need to make sure you always carry a spare.

The reason for this is a change in cabin pressure. The higher the plane goes the lower the cabin pressure gets, the air pressure in the cartridge or pen is thus higher than the surrounding pressure and the insulin leaks as the pressures attempt to reach equilibrium.

Note – a statement from Eli Lilly, “Patients may see some small air bubbles form in the cartridge or pen when going from a higher to lower altitude, especially if the needle is attached. To resolve this problem, patients should prime the pen before the next dose”

It also helps to remove the needle immediately after each injection. Remember to remove all these air bubbles after you have landed at your destination. It is not that injecting this air is dangerous – air injected subcutaneously is harmless and quickly gets absorbed by the tissues but it does take the place of some of the insulin and you can end up giving yourself a few units short.

The air pressure within an insulin vial is also affected. It becomes higher than the cabin pressure but usually does not leak due to its rubber stopper. However one needs to take this change of pressure into account when filling your syringe.

You can deal with this in two ways:-
1. Instead of equalising the pressure in the vial as you normally do, by injecting an equivalent amount of air in as insulin removed, you may need to inject in only half the amount of air before withdrawing the insulin. You can generally feel if you have put in to little air as you will feel a ‘pull’ on the plunger when you try to withdraw your insulin. Stop there and put in a little more air.

2. Before drawing up your insulin remove the plunger from your syringe, push the needle through the rubber stopper, into the air space in the vial (do not get the tip into the insulin itself). Now wait for a few minutes and the air pressure should stabilise.

Then replace the plunger and proceed as normal.

Other factors to consider when flying:-
Time zone crossings and how they change your insulin requirements is quite a complex topic and I have separated it off to another page here - Diabetes And Time Zone Crossing.

Due to the cabin pressure dehydration is common on long flights. Learn to recognise the symptoms – dry eyes, nose, throat and skin.

Many folk do not drink enough because of the hassle of going to the toilet onboard. However drinking is essential. Carry at least two litres of water with you.

Alcohol can increase urination and thus dehydration, plus lower your blood glucose, unless it also contains carbohydrates to compensate for this, so be aware of these factors if deciding to take advantage of free in-flight drinks. Altitude can also increase the potency of alcohol.

Dressing for a flight is always interesting – do you dress to suit the climate at you point of departure or your destination?

The best idea is to wear layers of clothing that can be taken on and off as you need to adjust your temperature. Also remember to choose loose clothing as the reduced cabin pressure in an aeroplane causes the body to swell.

Change your position and walk up and down whenever you can, particularly on a long flight. One risks blood clots and deep vein thromboses if you remain stationary, especially in cramped conditions, for a long period of time.

And in case you thought this only applies to economy class passengers let me inform you that you are wrong – it can happen to those more fortunate business class passengers as well.

If you do not already take this, and many type 2 diabetics do, discuss with your doctor the possibility of you taking a low aspirin dose, around 75mg, as it thins the blood and helps prevent clots.

Taking your Bg’s during a flight.-
Meters have a tendency to suffer from accuracy problems at high altitudes. No meter will test accurately at over 10,400 feet.

As most large commercial aeroplanes, such as the Boeing 747, usually fly between 30,000 and 42,000 feet and smaller plans at around 15,000 feet it is very possible that your meter may not read accurately.

So it may be better to test just before you take off so you have some idea where you are re the status of your blood sugars.

On long flights you are very obviously going to have to test during the flight but remember to take into account the possible inaccuracy. If the meter says you are okay but you are feeling the signs of a hypo believe your body, not the meter.
Remember that if you are stressed by flying it may cause your blood glucose to rise.

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