FAQ Answer

Diabetes - I have diabetes, is there any special advice for diabetic people who wish to travel by air?

Should I discuss my trip with my diabetes team? Air travel should not pose significant problems for travellers with well-controlled diabetes. Pre-planning is important and discussion of the travel itinerary, four to six weeks in advance, with your GP or treating specialist team plays an important part in preparation for travel. What should I pack? Passengers may carry essential liquid medicines such as insulin for the period of their trip. These are permitted in larger quantities above the 100ml limit for liquids, but will be subject to authentication. Passengers must have obtained the prior agreement of the airline with which they are travelling and with their departure airport. For diabetic passengers who use insulin pumps and/or continuous glucose monitoring (CGM) devices, it is essential that they speak to the airline to obtain precise advice on the use of such devices on board the aircraft. Passengers must also take with them supporting documentation from a relevant qualified medical professional. It is essential that diabetic passengers carry adequate equipment (glucose meters, lancets, batteries) and medication in their hand baggage. It is also important that insulin not being used in the flight is not packed in the hold baggage as this may be exposed to temperatures, which could degrade the insulin, in addition there is also the potential that luggage may be lost en-route. It is useful to have simple carbohydrates to treat hypoglycaemia including glucose tablets or sweets. It may also be useful to pack longer lasting carbohydrates such as snack bars or biscuits in case of delayed meals. What should I do on-board? Frequent blood glucose monitoring is essential. Avoid excess caffeine and alcohol as these can affect diabetes control including your warning of hypoglycaemia. If you are travelling North or South there is no need to change the timing of your insulin or other medications. Similarly keep to your regular regimen if you are crossing fewer than 5 time zones. Travelling West means that your day will be longer – you may need more insulin; Travelling East means that your day will be shorter – you may need less insulin. As noted above, it is best to discuss this with your diabetes team in advance. If you use oral medicine, it may be easier to skip one dose rather than take two doses close together. A short period of slightly high glucose levels will not cause harm. Insulin pumps There have been some concerns about possible effects of airport security screening equipment on insulin pumps. Unfortunately the different pump manufacturers do not all give the same advice. This varies from assurance that the pumps can safely go through any screening equipment, including X-ray equipment, to advice that the equipment may be affected by even the low-dose X-ray equipment used in some whole body scanners. If you use an insulin pump, it is therefore important to contact the manufacturer of the particular pump that you use for advice. It is also sensible to contact your airline and the airports you will travel through to find out their requirements if the manufacturer advises that your pump cannot go through some screening equipment. Changes in the cabin air pressure can have an effect on insulin delivery. The reduction in cabin air pressure when the aircraft climbs may lead to a slight increase in delivery of insulin as a result of the formation or expansion of air bubbles in the insulin syringe or tubing. This might be sufficient to cause symptoms of hypoglycaemia. A more severe impact could be seen in the (very rare) event of sudden decompression of the cabin at altitude. A slight reduction in insulin delivery is also possible during descent. You should discuss the best way to manage this with your doctor. At my destination Should you run out of insulin and need to source this locally, remember the strength may be different as many countries still use U-40 or U-80 as opposed to the U-100 used in the UK. Some safety advice for illness Always continue taking your insulin, even if you’re not eating. Test for ketones if your blood glucose levels are above 14mmol/L Positive ketone tests always require treatment with extra insulin If you are unable to eat because you are ill, you can obtain carbohydrate from sources such as high-energy drinks (eg, Lucozade), fizzy soft drinks, squashes and milky drinks.