Flight Tips: This is your captain speaking...
I've always known that traveling places special demands on patients with diabetes. Unexpected changes in airline schedules, poor timing of meals, and limited food selection are just a few of the common problems. As a physician with diabetes, I try to be sensitive to these issues. Well, last month, I was tested!
I have worn an insulin pump since 1980 and have found it to be advantageous with my hectic schedule. Perhaps at no other time was this more apparent than when my wife Ruth and I were returning from a recent trip to Carmel, California.
The day of our trip back home to Seattle, I ate breakfast at 8:00 a.m. following a blood glucose measurement of 106 mg/dl. At 11:00 a.m., we boarded a plane in Monterey which was to take us to nearby San Francisco to catch a connecting flight. Our trip was supposed to end in Seattle at 3:30 in the afternoon.
Unfortunately, that was not to be. The captain announced that we would not be able to land in San Francisco because of fog. We circled over San Francisco for over an hour before finally diverting to San Jose where we were hustled off for a 60 minute bus ride to the San Francisco airport.
There was absolutely no food on that first plane and I had no chance to eat between getting on the plane and getting on the bus in San Jose. I didn't have any hypoglycemia since my pump delivered normally with the "basal" insulin which I always receive. (Certainly, had I been using any other regimen, such as NPH and regular insulin, I would have been required to have a meal since this all happened during lunch time.)
Anyway, in San Francisco, we went immediately to the gate because there was a chance we could get on the next plane to Seattle on "standby". We waited approximately 60 minutes and eventually were allowed onto the plane at 5:30 p.m. Remember, I had not had any food since 8:00 a.m.!
Finally at 6:00 p.m. we were fed dinner. I had my usual supper time "bolus" of insulin following a blood glucose result of 136 mg/dl.
Then, 15 minutes prior to landing the captain informed us the Seattle airport was closed due to fog. Two hours later we got off the plane, but instead of landing in Seattle, we had been diverted to Portland, Oregon! Now, we were to be bussed from Portland to Seattle.
We claimed our luggage and hurried to the busses (again). Of course, there was no time to think about stopping in a restaurant for even a snack. It was now 10:30 p.m. and I was suddenly very thirsty. I was afraid my blood sugar was high, but after several repeated checks with my meter, I realized there must be another explanation for my thirst.
At 1 a.m. we arrived in Seattle. During the preceding 16 hours I had eaten only one meal but did not have any hypoglycemia or a single blood glucose measurement over 200.
I learned several points from this trip:
- You can never be over-prepared, even for what appears to be a short trip. We did have some food with us, but it would not have been enough to prevent hypoglycemia through a 16 hour trip if I hadn't been using an insulin pump. Nevertheless, I will continue to advise my patients to always be well prepared for any trip with blood glucose monitoring equipment, food, and insulin (and perhaps bottled water), which leads me to my second point.
- One can get very dehydrated while traveling by air. I had assumed that my extreme thirst was caused by a high blood sugar level. I later learned that this is a common result of flying. The cabins of commercial airlines are very dry and I had been in a plane for a great many hours!
I hope that my experience in coping with these unavoidable and all too common glitches can serve as fair warning. Be prepared when you travel, and if possible use a pump!
Dr. Irl Hirsch
Medical Director of the Diabetes Care Center at the University of Washington in Seattle.
