How To Travel With Diabetes?

How To Travel With Diabetes
Before You Go –

  1. Visit your doctor for a checkup to ensure you’re fit for the trip. Make sure to ask your doctor:
    • How your planned activities could affect your diabetes and what to do about it.
    • How to adjust your insulin doses if you’re traveling to places in a different time zone.
    • To provide prescriptions for your medicines in case you lose or run out of them.
    • If you’ll need any vaccines.
    • To write a letter stating that you have diabetes and why you need your medical supplies.
  2. Just in case, find pharmacies and clinics close to where you’re staying.
  3. Get a medical ID bracelet that states you have diabetes and any other health conditions you may have.
  4. Buy travel insurance in case you miss your flight or need medical care.
  5. Order a special meal in advance for the flight that fits with your meal plan, or pack your own.
  6. Packing:
    • Put your diabetes supplies in a carry-on bag (insulin could get too cold in your checked luggage). Think about bringing a smaller bag to have at your seat for insulin, glucose tablets, and snacks.
    • Pack twice as much medicine as you think you’ll need. Carry medicines in the original pharmacy bottles, or ask your pharmacist to print out extra labels you can attach to plastic bags.
    • Be sure to pack healthy snacks, like fruit, raw veggies, and nuts.
  7. Airport security:
    • Get an optional TSA notification card pdf icon external icon to help the screening process go more quickly and smoothly.
    • Good news: people with diabetes are exempt from the 3.4 oz. liquid rule for medicines, fast-acting carbs like juice, and gel packs to keep insulin cool.
    • A continuous glucose monitor or insulin pump could be damaged going through the X-ray machine. You don’t have to disconnect from either; ask for a hand inspection instead.
  8. Visit CDC’s Travelers’ Health site for more helpful resources.
  • Doctor’s letter and prescriptions
  • Snacks and glucose tablets
  • Extra insulin and diabetes medicines

Can I fly if I have type 2 diabetes?

Travelling for people with Type 2 diabetes is the same as for people without diabetes. However, like everyone, you must plan efficiently before travelling by land, sea or air. General precautions when travelling with type 2 diabetes • Prior to the trip, schedule an appointment with your diabetes team as you will need to bring a letter on medical stationary stating you have diabetes and you will be carrying equipment for control of same i.e. medication, or meter, lancets, insulin if used. • Carry identification saying you have Diabetes especially if you are taking Diabetes medication that could cause hypos or low blood sugars. You may be able to get a small card from your diabetes team to carry in your wallet stating you have diabetes and who to contact in the case of an emergency. • Bring a written prescription with generic terms of medication you are taking in case you need to get extra supplies or need to visit a doctor when abroad. Photocopy all your relevant important documentation and give a copy to your travelling companion or keep a copy in separate luggage you are bringing. • Remember to always bring more medication with you than needed for the duration of the holiday in case the holiday is extended for unforeseen reasons. Carry medication in its’ original packaging obtained from the pharmacy. If you are on insulin bring spare insulin (2-3 times the normal amount you would use during this timeframe) and spare insulin pens. • More frequent testing may be necessary so you will need at least double your normal amount of glucose testing strips for the same timeframe plus a spare glucose meter. Always split your supplies into two bags and if possible, give one set to a travelling companion in the event your luggage getting lost. • Look at your travel plans and check what vaccines are necessary. For information on what countries may need vaccines see Tropical Medical Bureau www.tmb.ie, They can provide you with detailed information on vaccines, malaria prevention and the latest health news tailored to your travel plans. It is important to note that there are no special restrictions for vaccinations due to diabetes. Furthermore, it is more important for a person with diabetes to actually get the recommended vaccinations, since illness will mean more difficult consequences associated with diabetes control. No precautions will give absolute protection, so, if you develop a fever, or feel ill while travelling or up to three months on return, seek medical assistance immediately. • Check on the basic forms of carbohydrates eaten in the countries that you are visiting. While away, it should be possible to select familiar food such as rice, pasta, bread, biscuits and fruit. You may need to schedule an appointment with your dietician to discuss the carbohydrate content of some of the basic foreign foods you may come across while away. • Update yourself on you Sick Day Rules/Management and how to manage in the event of illness and discuss this plan with your travel companions. • Be Responsible and if you are at risk of hypoglycaemia (low blood sugars) always carry quick acting carbohydrate (such as glucose sweets) in the case of one occurring. Be aware of your hypo causes and symptoms and treat as necessary. Advise your travel companions about hypoglycaemia, its causes, and symptoms and how to treat a hypo event. • If travelling to a hot climate it may also make you more at risk of hypos as the heat makes you more sensitive to insulin. If this happens you may need to reduce your insulin dose or eat extra carbohydrate to prevent this. • Alcohol may also lower your blood glucose level often the ‘morning after’. To reduce this risk avoid drinking on an empty stomach, drink in moderation and you may need to take an extra carbohydrate snack before going to bed. • Make sure your travel companions have all emergency contact numbers and home contact numbers to hand if needed. • Changing normal routines may mean that your diabetes isn’t as controlled as normal. You may be more active or less active, you may be eating different foods or having more treats than normal. The climate and alcohol may play a part too as mentioned earlier. The extra excitement of doing something new or travelling can also increase your blood sugar levels. You may need to test your blood sugar more often to keep an eye on things as you are out of your normal environment to avoid very high or very low blood sugar levels. • If you are travelling to an area that is likely to experience very extreme temperatures, check with your meters manufacturers about limits on the reliability of their machine. Travel Insurance You are advised to obtain full health insurance with comprehensive cover. Check what insurance cover you have or will need and the geographical area of cover. Read all the small print in the policy so that you know what you will be covered and what will not. Make sure your policy will cover you in case of an A&E diabetes related matter while abroad. Remember that ordinary holiday insurance or backpackers insurance booked through your travel agent may not cover your diabetes as it may be considered a pre-existing condition. Check with the travel agent about the extra premium required ensuring coverage of your condition. Contact ERM on 01 8454361 for information on comprehensive travel insurance scheme through Diabetes Ireland. If you have private Irish health cover, speak to your provider about their travel insurance. If you are an EU citizen and need medical assistance while in another EU country, you need to bring a European Health Insurance Card. For more details, see https://www2.hse.ie/services/ehic/ehic.html Travelling by Air Most insulin pump manufacturers recommend that you do not expose your pump to x-ray equipment. Request a “walk through” or hand wand inspection. It is important to have some kind of identification on your person showing that you have diabetes. More often than not it will not be required as the airport security have become well accustomed to recognising insulin and medical equipment on the monitors over recent years. However, if you experience difficulties boarding a plane, have the matter referred to the airport police. Regulations state that vital medical equipment can be held as hand luggage within the passengers view on all flights. Keep insulin supplies in your hand luggage, as there is a danger of freezing in the airline luggage containers at high altitude. Please note: If your trip involves crossing time zones, talk to your diabetes team about the necessity to adjust insulin. While travelling by air, people with a medical condition, including diabetes, are not permitted to use any exit seat. The main reason stated by relevant authorities is that passengers with diabetes should have access to their medications, blood testing equipment and extra snack supplies throughout the flight so be careful when booking your airline seat. Generally, meals supplied to passengers on planes are preferably fine for people with diabetes. However, if you desire, long haul flights or flights greater than two hours in duration, may supply diet specific meals with confirmation reservation needed 24 hours before departure. Although these diabetic meals may be available they usually contain limited carbohydrates. However make sure that you have adequate carbohydrates packed in your hand luggage to cover all eventualities in case they do not serve food in-flight. Do not put your food supplies in the overhead compartments. There is nothing worse than being on a turbulent flight when you are not allowed to move from your seat to access your bag from the overhead compartments. Travelling by land When travelling by land, remember that closed vehicles parked in direct sunlight can get very hot inside the vehicle, so it may be more appropriate to put your supplies in a cooler bag in the boot. If you suffer from travel sickness, medication, which is available without a prescription, may be purchased. Travel sickness can mask the symptoms of high or low blood sugars therefore you may need to check your blood glucose levels more often. Vomiting can cause hypoglycaemia and dehydration so plan ahead and try to avoid these unnecessary risks. If you do feel sick, continue to take your medications and take carbohydrates in a liquid form ie sip on flat full fat soft drink, 7up or equivalent. Follow your Sick Day Rules/Management and seek medical assistance if not responding. Driving in foreign countries If you are planning to drive while on holiday, you should ensure that your driving licence is valid for the duration of your trip and that you are covered by your travel insurance policy for driving, especially when abroad. Refer to the section of driving https://www.diabetes.ie/living-with-diabetes/living-with-type-2/driving-type-2-diabetes/ to review recent safety and licencing guidelines for Class 1 and Class 2 drivers. Diabetes and Altitude Up to 7000 feet above sea level, it is unlikely that you need to be concerned with altitude levels affecting your blood glucose levels. Most meters are guaranteed for reliable readings up to 16,000 feet and within a temperature range of 18-30 degrees centigrade. Outside these ranges, meters can give incorrect high or low readings, or even stop working completely. Check your meter manufacturer about the height and temperature ranges of your meter. Keep meters close to the body for optimum temperature operation. Insulin and Hot (>25 degrees C) /Cold weather (<3 degrees C) It is important that your insulin supplies are kept at the correct temperature. In a hot climate, it is a good idea to request a room with a fridge or to bring your own cool box or a ‘frio' bag. ‘Frio' bags are activated by cold water and are reusable every 48 hours. If a fridge is not available or you do not have a cooler box, keep the insulin in the coolest and darkest part of the room and if warm, cover it with a cold wet cloth. In normal conditions, it is acceptable to carry a preloaded insulin pen on your person to use during the day. However, in extreme sunshine, you may need to bring a cool box or ‘frio' bag with you during the day. For those people considering backpacking trips, Frio bags are the most convenient way to carry insulin. In cold climates, insulin should not be allowed to freeze. In freezing conditions, keep your insulin or pen injector in the inner pocket of your clothing or bag. You must examine the insulin for crystals and discard the insulin if any are found. Even if it looks okay, you should test your blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged or ineffective. Keeping the needle on your insulin pen, when exposed to temperature changes between injections leaves an open passage to the insulin, allowing insulin to leak out and/or air to leak in when exposed to extreme temperatures. Tips to avoid ‘holiday tummy'

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• Avoid tap water, even when brushing your teeth. Avoid ice cubes in unclean environments Be careful of milk, cream and mayonnaise (including anything that might have these products in it for example coleslaw) Ensure juices are diluted with reputable water supplies Be vigilant when sampling Cold buffets- remember that anything that needed washing will have been washed in cold tap water. Shellfish for example sushi. Salads Raw food

Water Intake With diabetes you will be more sensitive to dehydration so always drink plenty of fluids when in a hot climate. If you do not drink enough when outdoors in a hot climate your insulin (if taking insulin) will be absorbed more slowly. Later, when you rehydrate, more insulin will be absorbed and you may be at risk of having a severe hypoglycaemia.

  • Bottled water from a reputable company with the seal intact is the best source to keep hydrated.
  • You may need to contact your diabetes team to clarify any issues on insulin absorption, sites, exercise and temperature prior to travelling.
  • NB – paying the extra cost for air conditioning may be beneficial to help prevent night time glucose fluctuations.

Foot care Foot care is another important issue to keep in mind when travelling abroad. Consider if in a hot climate, you may be wearing summer shoes. Ensure any footwear you will be wearing has been broken in prior to departure. Never walk in your bare feet especially on hot sand as if you have sensory neuropathy (reduced feeling in your feet), you may not be aware of the true temperature of the sand and could burn yourself without realising it.

There may be shells and broken glass on the beach and by wearing footwear it avoids accidental injury. Also, ensure your feet are protected from the sun, by applying sun block. Again, if neuropathy is present, you may not feel sunburn until blisters develop. If you get a minor cut on your foot, keep the area clean and cover it with a sterile dressing.

Observe for signs of infection such as redness, pain, heat, exudates (leakage) from the wound. If these signs are present you may need to seek medical attention to get anti-biotics. Final Tip It is a good idea to have a few phrases in the local language for example; I have diabetes, please give me something sweet, and please call a doctor.

You should always have some identification on you stating you have diabetes. We recommend you buy a bracelet that you like from a Jewellers and have it engraved and this will support you long-term. Carry the contact details of your travel insurance with your passport. For longer vacations Have the contact details for the Irish Consulate of the area you are visiting.

Have the contact details for the national diabetes association of the country you visit – see http://www.idf.org/membership And finally, remember that blood glucose is measured in mmol/L in Ireland but in mg/dl in many other countries for example in the Unites States.

Can I travel with metformin?

What Can I Bring With Me on the Plane Am I allowed to bring my diabetes supplies with me on the plane? Yes. TSA specifically states that diabetes-related supplies, equipment and medications, including liquids, are allowed through the checkpoint once they have been properly screened by X-ray or hand inspection.

Arrive at the airport 2-3 hours prior to flight Review TSA’s website for travel updates Download Whenever possible, bring prescription labels for medication and medical devices (while not required by TSA, making them available will make the security process go more quickly) Consider printing out and bringing an optional, Pack medications in a separate clear, sealable bag. Bags that are placed in your carry-on-luggage need to be removed and separated from your other belongings for screening. Keep a quick-acting source of glucose to treat low blood sugar as well as an easy-to-carry snack such as a nutrition bar Carry or wear medical identification and carry contact information for your physician Pack extra supplies Be patient with lines, delays, and new screening procedures

What are some examples of items that are permitted through security?

Insulin and insulin loaded dispensing products (vials or box of individual vials, jet injectors, biojectors, epipens, infusers and preloaded syringes) Unlimited number of unused syringes when accompanied by insulin or other injectable medication Lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, meter-testing solutions Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter and needle)—insulin pumps and supplies must be accompanied by insulin Glucagon emergency kit Urine ketone test strips Unlimited number of used syringes when transported in Sharps disposal container or other similar hard-surface container Sharps disposal containers or similar hard-surface disposal container for storing used syringes and test strips Liquids (to include water, juice or liquid nutrition) or gels Continuous blood glucose monitors All diabetes related medication, equipment, and supplies

Do I need to have my prescription with me? While TSA does not require you to have your prescription with you, having it may expedite the security screening process if you are subject to additional screening. What if my insulin, liquids, and gels are more than 3.4 ounces?

Despite the general rule prohibiting passengers from bringing most liquids and gels through security, people with diabetes may take their insulin, other medications such as Smylin, Byetta, and Glucagon, and other liquids and gels, including juice and cake gel, through TSA checkpoints, even if they are in containers greater than 3.4 ounces. Although TSA does allow multiple containers of liquid or gel to treat hypoglycemia, as a practical matter you may want to consider alternative forms of carbohydrates, including glucose tablets, hard candy, or raisins. All medical liquids in containers greater than 3.4 ounces must be removed from your carry-on luggage and declared to TSA. They should not be placed in the quart-sized zip-top bag used for non-medical liquids. Under normal conditions, insulin can safely pass through X-ray machines at airport terminals. If you have concerns about X-rays, you can request hand inspection. Also, insulin never should be placed in checked baggage. It could be affected by severe changes in pressure and temperature. Inspect your insulin before injecting each dose. If you notice anything unusual about the appearance of your insulin or you notice that your insulin needs are changing, call your doctor.

: What Can I Bring With Me on the Plane

Does high altitude affect type 2 diabetes?

Cedars-Sinai scientists have found an inverse association between altitude and diabetes and between altitude and obesity. Men living at high altitudes (between 1,500 and 3,500 meters) have been shown to have lower prevalence of diabetes and obesity than those at lower altitudes (below 500 meters).

Researchers are interested in pursuing the mechanisms behind this association between geographic elevation and diabetes. Studies are being conducted to elucidate the effects of high altitude on insulin secretion and insulin sensitivity. Adults in the United States living in high altitudes have better glucose homeostasis, which is associated with lower odds of having diabetes, than those living at altitudes below 500 meters.

To determine whether this association is related to altitude, complex analysis using mixed-model logistic regression to control for multiple risk factors and potential confounders was performed. The association persisted after adjusting for several covariates, suggesting that altitude does have an effect on diabetes prevalence.

  • Orison Woolcott, MD, is a project scientist focused on investigating the effect of high altitude on glucose homeostasis at the Cedars-Sinai Diabetes and Obesity Research Institute (DORI).
  • Woolcott is looking at the prevalence of obesity and diabetes in high-altitude populations to determine which attributes related to altitude lower the prevalence of both conditions.

Atmospheric changes that occur as altitude increases include lower oxygen tension, lower humidity, higher radiation, lower temperature and lower barometric pressure. Isolating the effects of these environmental factors related to high altitude may reveal novel therapeutic methods for treating diabetes and obesity.

Do you need a letter to fly with diabetes?

Medical Letter – If you are travelling with medication or medical devices you should obtain a letter from your GP or diabetic specialist in order to transit through security/customs. This letter can also help if you need to replace lost/damaged/stolen medication or seek medical attention abroad. This letter should detail:

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all prescribed medication all necessary monitoring and dispensing equipment the necessity of carrying medication, insulin, needles, syringes etc in hand luggage diabetic team contact details in case information or advice is needed during long trips

There may be a charge for this service, an undated letter is helpful as it can then be used for future travel.

How long can insulin be left unrefrigerated?

Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work.

How do diabetics take insulin on a plane?

Planning to travel? This information covers your journey, time zone changes, while you are away, travelling with an insulin pump or a continuous glucose monitoring system and also includes Frequently Asked Questions. Travel Advice:

Make sure your travel insurance covers your diabetes and list any medications you may be on. Do you need a European Health Insurance Card? Find out if vaccinations are recommended for your area of travel If you are on insulin or injectable therapies contact the Diabetes Centre (01904 726510) or your GP for a travel letter prior to your journey. This states that you need to carry needles, insulin and hypo treatment in your hand luggage. Take identification in the form of an insulin passport or medi-alert. Check the availability of medications, especially insulin, in your country of travel. Some may have different names. Take the contact number for the Diabetes Centre (01904 726510 Take extra supplies of medications, needles, testing strips, lancets etc. and a spare blood glucose meter (if possible). Some countries may measure blood glucose levels differently- mg/dl rather than mmol/l – so be careful. Take illness management advice and ketone testing equipment (if appropriate) Consider purchasing a cool bag, such as a FRIO bag, for injectable therapy if you are travelling somewhere hot. Seek advice from your GP or the Diabetes Centre, as necessary, prior to travel.

The Journey:

If you have a travel partner split supplies between your hand luggage in case your bags are lost/stolen. Always carry insulin and/or other injectable therapies in your hand luggage as they may freeze in the hold. Place pen devices, lancets, test strips and needles in a transparent plastic bag in your hand luggage. Keep your travel letter with this. If you are on any treatment that may cause hypoglycaemia carry glucose with you. Jelly babies or glucose tablets are ideal as fluids such as Lucozade and Coke maybe taken off you. Always carry some starchy food such as biscuits as follow up treatment and in case of delays. If you are travelling alone consider informing the in-flight team of your diabetes, especially if you are at risk of hypoglycaemia. You do not need to order a ‘diabetic meal’ on the plane.

Time Zone Changes :

If you are on insulin you may need to adjust the timing of your injections. If the time difference is less than 4 hours then just continue your injections at your usual times If the difference is greater than 4 hours you will need to adjust the timing of your injections.

Insulin Regime Traveling West (Longer Day) Traveling East (Shorter day)
Once daily long acting (e.g Lantus, Humulin I, Degludec) Keep to UK time during the journey. Once you arrive at your destination move injection to usual time (e.g bedtime)
Twice daily mixed insulin (e.g. Humulin M3, Humalog Mix 25, Humalog Mix 50, NovoMix 30) Take your normal morning and evening insulin whilst travelling. Take half usual insulin dose with a meal when you arrive. Take your normal morning and evening insulin whilst travelling.
Once or twice daily long acting insulin (e.g. Lantus, Levemir, Degludec) + rapid acting insulin with meals (e.g. Humalog, Apidra, NovoRapid) Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time, but if this is greater than 12 hours since your last injection you may need to give a small amount of rapid acting insulin to control blood glucose levels Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time but if this is shorter than 12 hours since your last injection you may need to give a smaller amount of your rapid acting insulin with your last meal.
If you inject long acting insulin twice daily keep injections roughly 12 hours apart

While you are away :

Keep monitoring. Blood glucose levels maybe significantly different due to temperature, food and activity levels. Be careful of hot sand or hot tiles especially if you have nerve damage. Wear sandals or swim shoes- small cuts can easily become infected and cause blood glucose levels to rise. If you are on any treatment that may cause hypoglycaemia be aware that alcohol may increase this risk. Have a starchy snack before bed and do not give any extra insulin to cover for alcohol. A travel guide can give you an idea of the kinds of food available locally. It is a good idea to have a knowledge of local carbohydrates. ‘Carbs and Cals’ do an American and Portuguese edition. They also have an app for smart phones.

Pumps and CGMS :

If you have an insulin pump or continuous glucose monitoring system (CGMS) you should contact your airline a couple of weeks before you travel. Failure to notify the airline of medical devices in advance, can potential result in you being unable to take your pump or CGMS on board. There is caution about pumps and CGMS that operate wirelessly. You may need to be prepared to remove these and administer insulin with a pen during the flight. There is some difference in advice from manufacturers as to whether insulin pumps can go through x-ray machines and full body scanners. It is best to check with your pump manufacturer prior to travel. Take insulin pens with you in case of any problems with your pump.

Can you carry insulin needles on a plane?

Needles, syringes and lancets –

  • Needles and any other sort of insulin delivery devices are permitted on airplanes.
  • BUT, carrying a prescription, letter from your doctor, or pharmaceutical label for your supplies with you is a good idea—especially when traveling abroad as to avoid any language barriers.

Does flying affect blood sugar?

Introduction – Diabetes mellitus (DM) is a chronic metabolic disease that requires constant medical care, in which an individual cannot benefit from carbohydrates, fats, and proteins because of insulin deficiency or problems in the use of insulin. Continuous education of healthcare professionals and patients is essential to reduce the risk of acute complications of the disease and to prevent its chronic sequelae, which have a long-term and expensive treatment regimen.

Treatment and follow-up of diabetes should not only reduce the complications of the disease from a medical perspective but also focus on the obstacles that may occur in the professional life of diabetic patients. In recent years, it is estimated that diabetic individuals travel as often as any other healthy individuals, attributed to the rapid increase in diabetes prevalence and increasing popularity of air travel ( 1 ).

The issuance of flight certificates under certain conditions to pilots with diabetes has also made this issue important for flight personnel. Complications that may develop in diabetic passengers and pilots during the flight may threaten the safety of both passengers and pilots.

Therefore, guidelines for diabetic passengers and pilots during a flight have become increasingly important in the recent years. Air travel results in encountering a hypobaric situation. During a flight, the height is usually around 10,000 to 13,000 m (~30,000 to 42,000 feet), and the cabin pressure is at a level of 0.75 atm, which is 75% of the pressure measured at sea level.

Some glucometers have been reported to be affected by changes in altitude, and it was determined that glucose levels were calculated approximately 1%–2% lower against each 300 m/1000 feet rise ( 2 ). Lower oxygen pressure leads to the detection of lower glucose values than actual and incorrectly the risk of monitoring hypo- or normoglycemic values.

  • The reason is that many glucometers use the glucose oxygenase method, which is dependent on oxygen in the environment ( 3 ).
  • Although this does not cause a serious problem in patients using oral antidiabetic medications; on long-duration travel, additional medication needs may arise, especially in patients using insulin.

The relationship between diabetes and aviation is a controversial issue. There is a conflict between individual rights and aviation security. Pilots, whose diabetes is under control only with diet and exercise, usually get flight clearance ( 4 – 6 ). Over time, some diabetic pilots, whose diabetes is controlled with oral antidiabetics, also began to be given flight certificates.

  1. Traditionally, although aviation and insulin use are considered incompatible with each other, diabetic pilots who have been using insulin in recent years, even in a small number, have been actively working, and this number is increasing around the world ( 7, 8 ).
  2. The most important concern for diabetic pilots is the effects of hypoglycemia, which may occur during flight, on flight performance ( 9 ).

This can lead to difficulty in decision-making, orientation disorder, deterioration of cognitive functions, confusion and even loss of consciousness. In pilots with type 2 DM whose diabetes is controlled only with diet and exercise, the risk of hypoglycemia is no greater than in non-diabetic individuals.

However, this risk increases significantly in diabetic pilots using sulfonylurea group oral antidiabetics or insulin. In addition, the risk of hypoglycemia is tripled in pilots, in whom a strict control was targeted for the prevention of diabetes complications ( 10, 11 ). Loss of consciousness or confusion caused by severe hypoglycemia during a flight could be catastrophic ( 12 ).

Hyperglycemia is another problem that pilots should pay attention to in terms of flight safety. It causes serious complications that may affect the pilot’s flight ability in the long run. Short-term issues in the form of visual impairments, refractive changes, and frequent urination could also be a complication of hyperglycemia.

There is also a risk of developing ketoacidosis and progressing to coma, if left untreated ( 10, 13 ). Furthermore, long-term complications such as ischemic heart disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy may also affect the pilot’s flight health ( 8 ). Today’s aviation conditions impose additional problems on diabetic pilots.

In particular, pilots who operate commercial flights often experience serious fatigue, irregular daily programs, and irregular nutrition away from home. In addition, the pilots need to make changes in their insulin treatment on flights with meridian changes ( 14 ).

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Why are doctors hesitant to prescribed metformin?

What about side effects? – The safety profile for metformin is quite good. Side effects include nausea, stomach upset, or diarrhea; these tend to be mild. More serious side effects are rare. They include severe allergic reactions and a condition called lactic acidosis, a buildup of lactic acid in the bloodstream.

How long do diabetics stay on metformin?

1. How long does it take metformin to work? Metformin is a long-term medication. While not everyone with diabetes needs to take medication forever, many people will continue taking metformin for life.

What weather is best for diabetics?

Effects of warm weather on diabetics – During warmer months, it is especially important for people with diabetes to stay properly hydrated, Dehydration can cause blood sugar to rise as the glucose in your blood becomes more concentrated. High temperatures can also cause blood vessels to dilate, which can enhance insulin absorption, potentially leading to low blood sugar.

What is the danger zone for type 2 diabetes?

What is considered low blood sugar? – For the average person with diabetes, low blood sugar means anything under 80 mg/dL (for pregnant women, who need to have tighter control, low blood sugars are anything under 60 mg/dL). Very low blood sugars are any readings under 40 mg/dL.

How high is a diabetic spike?

– Blood sugar levels fluctuate all day long. When you eat food, particularly foods high in carbohydrates like bread, potatoes, or pasta, your blood sugar will immediately begin to rise. If your blood sugar is consistently high, you need to talk with a doctor about improving your diabetes management. Blood sugar rises when:

you’re not taking enough insulinyour insulin isn’t lasting as long as you think it isyou’re not taking your oral diabetes medicationyour medication dosage needs to be adjustedyou’re using expired insulinyou’re not following your nutritional planyou have an illness or infectionyou’re taking certain medications, like steroidsyou’re under physical stress, such as an injury or surgeryyou’re under emotional stress, such as trouble at work or home, or with money problems

If your blood sugar is usually well managed but you’re still experiencing unexplained blood sugar spikes, there might be an acute, or more recent, cause. Try keeping a record of all the food and drinks you consume. Then check your blood sugar levels according to your doctor’s recommendations.

Carbohydrates: Carbs get broken down into glucose very quickly. If you take insulin, talk with your doctor about your insulin-to-carb ratio. Fruits: Fresh fruits are considered healthy choices for people with diabetes by the American Diabetes Association (ADA), but they do contain a type of sugar called fructose that raises blood sugar. Fresh fruits are a better choice than juice, jellies, or jams. Fatty foods: Fatty foods can cause what’s known as the “pizza effect.” Taking pizza as an example, carbohydrates in the dough and sauce will raise your blood sugar immediately, but the fat and protein won’t affect your sugars until hours later. Juice, soda, electrolyte drinks, and sugary coffee drinks: These all affect your sugars, so don’t forget to count the carbs in your drinks. Alcohol: Alcohol raises blood sugar immediately, too, especially when mixed with juice or soda. It can also cause low blood sugars several hours later. Lack of regular physical activity: Daily physical activity helps insulin work more effectively. Talk with your doctor about adjusting your medication to fit your workout schedule. Overtreating low blood sugars: Overtreating is very common. Talk with your doctor about what to do when your blood glucose level drops so you can avoid swings in your blood glucose levels.

How to travel to Europe with insulin?

Separate insulin and diabetic supplies from your other belongings and let the security agents know before your bags go through the screening process. An X-ray machine might damage your insulin pump or continuous glucose monitor. Consider asking for a hand inspection instead.

How much insulin can I carry-on a plane?

Know what is and isn’t allowed by the TSA guidelines: Prescription medicine with a name that matches the passenger’s ticket; up to 8 oz. of liquid (insulin) or low blood sugar treatment gel and up to 4 oz. of non- prescription liquid medications are permitted. pack them in your checked luggage.

How do diabetics take insulin on a plane?

Planning to travel? This information covers your journey, time zone changes, while you are away, travelling with an insulin pump or a continuous glucose monitoring system and also includes Frequently Asked Questions. Travel Advice:

Make sure your travel insurance covers your diabetes and list any medications you may be on. Do you need a European Health Insurance Card? Find out if vaccinations are recommended for your area of travel If you are on insulin or injectable therapies contact the Diabetes Centre (01904 726510) or your GP for a travel letter prior to your journey. This states that you need to carry needles, insulin and hypo treatment in your hand luggage. Take identification in the form of an insulin passport or medi-alert. Check the availability of medications, especially insulin, in your country of travel. Some may have different names. Take the contact number for the Diabetes Centre (01904 726510 Take extra supplies of medications, needles, testing strips, lancets etc. and a spare blood glucose meter (if possible). Some countries may measure blood glucose levels differently- mg/dl rather than mmol/l – so be careful. Take illness management advice and ketone testing equipment (if appropriate) Consider purchasing a cool bag, such as a FRIO bag, for injectable therapy if you are travelling somewhere hot. Seek advice from your GP or the Diabetes Centre, as necessary, prior to travel.

The Journey:

If you have a travel partner split supplies between your hand luggage in case your bags are lost/stolen. Always carry insulin and/or other injectable therapies in your hand luggage as they may freeze in the hold. Place pen devices, lancets, test strips and needles in a transparent plastic bag in your hand luggage. Keep your travel letter with this. If you are on any treatment that may cause hypoglycaemia carry glucose with you. Jelly babies or glucose tablets are ideal as fluids such as Lucozade and Coke maybe taken off you. Always carry some starchy food such as biscuits as follow up treatment and in case of delays. If you are travelling alone consider informing the in-flight team of your diabetes, especially if you are at risk of hypoglycaemia. You do not need to order a ‘diabetic meal’ on the plane.

Time Zone Changes :

If you are on insulin you may need to adjust the timing of your injections. If the time difference is less than 4 hours then just continue your injections at your usual times If the difference is greater than 4 hours you will need to adjust the timing of your injections.

Insulin Regime Traveling West (Longer Day) Traveling East (Shorter day)
Once daily long acting (e.g Lantus, Humulin I, Degludec) Keep to UK time during the journey. Once you arrive at your destination move injection to usual time (e.g bedtime)
Twice daily mixed insulin (e.g. Humulin M3, Humalog Mix 25, Humalog Mix 50, NovoMix 30) Take your normal morning and evening insulin whilst travelling. Take half usual insulin dose with a meal when you arrive. Take your normal morning and evening insulin whilst travelling.
Once or twice daily long acting insulin (e.g. Lantus, Levemir, Degludec) + rapid acting insulin with meals (e.g. Humalog, Apidra, NovoRapid) Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time, but if this is greater than 12 hours since your last injection you may need to give a small amount of rapid acting insulin to control blood glucose levels Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time but if this is shorter than 12 hours since your last injection you may need to give a smaller amount of your rapid acting insulin with your last meal.
If you inject long acting insulin twice daily keep injections roughly 12 hours apart

While you are away :

Keep monitoring. Blood glucose levels maybe significantly different due to temperature, food and activity levels. Be careful of hot sand or hot tiles especially if you have nerve damage. Wear sandals or swim shoes- small cuts can easily become infected and cause blood glucose levels to rise. If you are on any treatment that may cause hypoglycaemia be aware that alcohol may increase this risk. Have a starchy snack before bed and do not give any extra insulin to cover for alcohol. A travel guide can give you an idea of the kinds of food available locally. It is a good idea to have a knowledge of local carbohydrates. ‘Carbs and Cals’ do an American and Portuguese edition. They also have an app for smart phones.

Pumps and CGMS :

If you have an insulin pump or continuous glucose monitoring system (CGMS) you should contact your airline a couple of weeks before you travel. Failure to notify the airline of medical devices in advance, can potential result in you being unable to take your pump or CGMS on board. There is caution about pumps and CGMS that operate wirelessly. You may need to be prepared to remove these and administer insulin with a pen during the flight. There is some difference in advice from manufacturers as to whether insulin pumps can go through x-ray machines and full body scanners. It is best to check with your pump manufacturer prior to travel. Take insulin pens with you in case of any problems with your pump.

Does type 2 diabetes qualify for disability?

The short answer is “Yes.”

Under most laws, diabetes is a protected as a disability. Both type 1 and type 2 diabetes are protected as disabilities. People with diabetes can do any type of job, sport or life goal

People with diabetes of all types are protected as people with qualifying disabilities. But being protected from discrimination does not mean that diabetes has to put the brakes on life! People with diabetes are able to drive race cars, fight fires, play contact sports and generally do whatever they need to follow their dreams.

Diabetes Protections at School Diabetes as a Disability in the Workplace Diabetes and Law Enforcement Diabetes and Access to Public Places

If you are an attorney or advocate with questions about diabetes-related cases or legal questions, see Attorney Materials for detailed legal materials and memoranda.

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