AACE 25th Annual Scientific & Clinical Congress:

Diabetes Management When Crossing Multiple Time Zones During Air Travel

airplane flying around the worldPeople with diabetes who cross multiple time zones during air travel are at risk for diabetes-related complications. This topic was presented by Rahul Suresh during the American Association of Clinical Endocrinologists (AACE) Annual Scientific & Clinical Congress in Orlando, FL May 25-29, 2016.

Rahal Suresh is a physician-in-training in internal medicine and aerospace medicine at the University of Texas Medical Branch in Galveston, TX.

Domestic and international air travel can be a stress and anxiety-provoking time, especially for people with Type 1 or Type 2 diabetes. People with diabetes face the potential for complications that include hypoglycemia and the effects of dehydration. Dehydration, especially if severe, may trigger diabetic ketoacidosis when insulin is not properly adjusted. Furthermore, the potential for a complication doesn't end when the flight arrives, but may extend upwards of 24 hours after landing.1

How common are diabetes-related complications? Mr. Suresh stated, "Each year, millions of people with diabetes travel by air, with an estimated 10 percent suffering from in-flight diabetes-related complications during air travel."

About the Study
"Air travel on flights across multiple time zones disrupts the normal timing of meals and medication dosing, increasing the risk that travelers with diabetes will incorrectly dose their medication. Our goal was to develop a concise and updated set of recommendations for safe management of diabetes during air travel across multiple time zones," said Mr. Suresh.

Suresh et al queried medical journal databases for articles about air travel and diabetes. The authors searched national diabetes organizations and related websites for travel recommendations, such as pre-flight planning, differences in cabin pressurization, the effects of altitude changes on adjusting medications (insulin and oral), and insulin pump use.

Recommendations
"When people with diabetes travel, they must be sensitive to their insulin regimen," said Mr. Suresh. Clinicians should inform their patients with diabetes who travel—especially internationally—about insulin availability, concentration variations and other differences to help avoid hypoglycemia or other complications. Clinicians can remind patients:

  • The day before a flight to pack extra supplies in their carry-on bag to help manage diabetes during the flight and stopovers.
  • Know the direction of flight (eg, East, West), number of time zones to be crossed and travel time (eg, number of hours).
  • No dose adjustment is recommended for short- or rapid-acting insulin.
  • Pre-mixed insulins are not recommended as they are difficult to titrate.

Eastward Travel: Withhold sulfonylureas, nateglinide, repaglinide. Reduce dosing of intermediate/long-acting insulins in proportional to the number of hours lost during travel.

Westward Travel: Divide the number of insulin doses to cover the longer travel day.

Insulin Pump Use
When using an insulin pump, caution is necessary as cabin depressurization may cause unintended dosing that may increase the risk for hypoglycemia. It is recommended the pump be disconnected prior the plane's ascent and descent. However, the pump may be reconnected at flight altitude.

Conclusion
During a discussion after Mr. Suresh's presentation, he indicated the need for additional research to help educate clinicians and their patients with diabetes. Newer devices require study in conjunction with their use during air travel to help patients effectively and safely manage this complex disease.

Source
Suresh R, Pavela J, Mathers C, Belacazar LM. Addressing diabetes management during air travel crossing multiple time zones. Abstract #281. American Association of Clinical Endocrinologists (AACE) Annual Scientific & Clinical Congress, Orlando, FL, May 25-29, 2016.

Reference
1. Pinsker JE, Becker E, Mahnke CB, Ching M, et al. Extensive clinical experience: a simple guide to basal insulin, adjustments for long-distance travel. J Diabetes Metab Disord. 2013;12:59. 2013 Dec 20, doi: 10.1186/22516581-12-59.

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