Special Needs Travel Health

Adjusting Your Insulin and Diabetes Medications to Changes in Time Zones
-- By Matthew Rusk, M.D.

If you take diabetes medications and you're flying across multiple time zones, you may need to adjust your doses. The best advice is to ask your doctor for help and keep in mind the following points.

If you use insulin injections:

• When traveling across more than five time zones the most important concern is to avoid hypoglycemia. Patients should consult their physicians for an insulin schedule--this is particularly true if you're flying across more than six time zones.



• When flying from north to south, no changes in insulin regimen are generally required unless multiple time zones are crossed.³



• When traveling from west to east, the day becomes shorter. Patients should take the usual dose of insulin on the day of departure but on the next day they should take only a portion of their usual morning dose determined by their physician. Patients should then monitor their blood sugar more regularly and use a sliding scale schedule for high readings.



• When traveling from east to west the day will be prolonged. In this situation travelers should take the usual AM dose of insulin on the day of departure. On flights covering more than five time zones they should check their blood glucose periodically use sliding scale insulin as directed by their doctor. On the morning of the next day after arrival the normal dose can be resumed

If You Use an Insulin Pump:

Make sure to bring extra batteries and supplies. In case of equipment failure, it is also a good idea to bring a supply of syringes and a long acting insulin such as ultralente. Patients should receive detailed instructions from their doctors about dosing of long acting insulin should this happen. In general, insulin pumps do not set off airport metal detectors and are safe to use while in flight.

If You Take Oral Diabetes Medications (diabetes pills):

This situation is considerably more straightforward. In general, medications should be taken according to the local time schedule. It is also extremely important to keep regular meals according to the local time. Allowing the blood sugar to run high in this situation is also safer than risking hypoglycemia. While many diabetics on oral medications do not monitor their blood sugars, it is generally more important to do so while traveling since the sugar will be harder to control.

³ Benson E, Metz R. Management of diabetes during intercontinental travel. Bull Mason Clin 1984-85; 38 (winter): 145-51.