Transoceanic Travelers Need to Correct Insulin Timing

Air travel passengers crossing multiple time zones may have to adjust their insulin dose to protect themselves against episodes of hypoglycemia, according to a new study.

Researchers at the University of Texas Medical Branch (UTMB, Galveston, USA) conducted a review of PUBMED and MEDLINE databases for articles that discussed air travel and diabetes. In all, 99 peer-reviewed articles and two diabetic nursing guidelines were identified. The researchers found that about 2% of airline related diversions due to medical emergencies are due to diabetes complications, and that 10% of diabetics who travel will have a problem.

The researchers also made several recommendations. First, they stated that for short/rapid-acting insulin, no dose adjustment was needed. During eastward travel, intermediate/long-acting insulin should be reduced in dose proportional to hours lost. During westward travel, correction scale insulin with rapid acting insulin can be used, or the dose to be administered during travel can be given as divided doses to span the longer travel day.

They also discouraged the use of pre-mixed insulin, due to difficulty in titrating effects, and added that insulin pumps could be used per usual basal bolus dosing; however, cabin depressurization may lead to unintended bolus dosing, increasing the risk of hypoglycemia. The study was presented at the annual meeting of the American Association of Clinical Endocrinologists, held during May 2016 in Orlando (FL, USA).

“When people travel and are not attentive to their insulin intake they can either overdose or underdose their insulin. It can happen because they are taking their regular amount of insulin but not eating enough, or they are taking their insulin too early, usually if a person is traveling east across multiple time zones,” said study presenter Rahul Suresh, MD. “When traveling west, there may be gaps in diabetic complications causing hyperglycemia, which is important among patients diagnosed with type 1 diabetes.”

“When flying from the U.S. to Europe, for example, a person would be in danger of taking too much basal insulin due to a 6-hour time change, so they need to adjust their daily dose in the U.S. to 75% of normal,” added Dr. Suresh. “Therefore, when they take the full dose in Europe they haven't taken too much insulin. Similarly, when going west, patients with diabetes and on insulin may have to increase their dosages because the day can be longer.”

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University of Texas Medical Branch