Extensive clinical experience: a simple guide to basal insulin adjustments for long-distance travel

Abstract

Long-distance travel across multiple time zones presents unique challenges for patients taking insulin, requiring adjustments in both timing and dosage of basal insulin when several times zones (≥5) are traversed. Travel across the International Date Line adds to the confusion, as existing resources and dosing calculators often do not account for the date change. We review recommendations from available guidelines and dosage calculators used for long-distance travel basal insulin adjustments and then present our patient handouts which allow for a safe, specific, single dose adjustment for eastward and westward travel. The included handouts are easy to use and can be freely reproduced for use in diabetes clinics.

Management of Diabetes During Air Travel: A Systematic Literature Review of Current Recommendations and their Supporting Evidence

“…The minimum number of time zones crossed before travelers need to adjust their insulin schedule or dose was not specified (6,14,(29)(30)(31)35,39,44,48) or was not consistent, varying from 2 (15,43), 3 (51-53), 5 (10,45,47,54,55), 6 (11,12,32,34,37,(40)(41)(42)46), to 7 time zones (16,36,38,56,57). One author (52) cited the American Diabetes Association's 2004 Insulin Administration Practice Guideline, which recommends travelers receive advice on insulin adjustment when crossing 3 or more time zones (7).…”

“…Thirteen articles mentioned insulin pumps; 4 of these made general travel recommendations or device precautions for air travel (20,27,33,46), and 9 offered more specific recommendations regarding insulin pump therapy during air travel (12,13,38,42,45,53,55,58,59). Commonly made recommendations included checking blood glucose frequently (12,13,58) and carrying sufficient injectable insulin for backup, in case of pump failure (13,38,45,58).…”

“…Six publications either recommended continuing the usual basal rate and premeal bolus regimen during travel or did not specify changes (12,38,42,46,54,56). Of these 6, 3 did not mention if or when to adjust the pump clock setting to local time (38,42,54), 2 advocated adjusting the pump clock upon arrival to local time (45,55), and 1 suggested waiting 3 days before switching to arrival time zone (12). Aldasouqi et al (59) suggested gradually changing the pump settings "according to multiple cofactors" to account for physiologic adaptation but did not provide specific recommendations.…”

Travel Guidance for People with Diabetes

“…Exposing to the sunlight raises your blood sugar and follows with dehydration, so use sugar free drinks [24,25,26].…”

“…If the sickness takes 1-2 days with vomiting and diarrhea you might need to change your treatment or extra medicine. In this case, check for ketones in urine (if you take insulin) if positive call your physician immediately [2,26].…”