That's Just Plane Crazy

Luggage? Check.
Boarding pass? Check.
Passport and credit cards? Check.
All your fluids sequestered into 3oz. containers and in a Ziploc baggy? Check and check.

While most people go through the more common airport checklists, diabetics have a few atypical tic-boxes to consider. Such as a note from your current doctor explaining that you are a diabetic and that you need to carry your liquid medication. And that the medicine needs to be kept cool in a container that will most likely have some kind of jelly or liquid inside. Insulin pump wearers especially need to be weary when going through security because you must NEVER put the pump through the X-ray machine. Every insulin pump wearer knows
the routine at security.

"Hello, I have an insulin pump."
"Is that a phone? It goes on the belt."
"No," holding it out in my hand and lifting my shirt, "Its my insulin pump. I can't remove it."
          "Who's bag is this?"
          "Mine."
          "Step over here sir."
Now we go through the pat-down, swab, and search. Finally finished with the inquisition, we're cleared and ready for takeoff. But just because you're through security, it doesn't mean your worries are over. Maybe you should be concerned about your insulin pump or pen and whether it will work properly on the plane.... whoa, wait a minute. Why wouldn't it work?

Well, for quite a while now, I've noticed that my blood glucose becomes erratic during flights and that the longer the flight, the greater the trouble I should expect. I was told several years ago that the changes in my insulin delivery (pens at the time and a pump later on) were only in my mind. One physician suggested I was just airsick. I stopped asking about blood glucose in flight for two reasons.
(1) I don't travel in the air often enough to care.
(2) I actually do tend to get a bit airsick.

Fast forward to present day and I'm flipping through "Diabetes: Technologies and Therapeutics", when I come across an article... "Hitting the Dartboard from 40,000 Feet". Its an editorial on the research article by King et al, "Changes in Altitude Cause Unintended Insulin Delivery From Insulin Pumps: Mechanisms and implications." The editorial was free... the article was not.

One of the possible problems for diabetics wearing insulin pumps is that the change in air pressure could possibly change the delivery of insulin because of changes in the plastic's shape at high altitude. This is a tentative statement and the editorial is quick to point out that King used relatively low numbers of test patients and that the experiments were carried out on the ground in specialized chambers, not in the sky.

For me, the experiments indicate something a bit more significant. I was told that it wasn't possible. Now, 6 years later, there is evidence that it is possible. My point is that diabetic care and technology is rapidly changing and very challenging. When a patient enters the office with a statement like, "My blood sugars go all wacky when I fly," maybe the doctor could take the time to listen and research.

Its true that motion sickness could play a role. Possibly inactivity and air pressure changes combined. Maybe the airline food? Who knows!!! The real bottom line for me was that blood sugars can fluctuate during airplane travel and diabetics with pens or pumps should be aware and test more frequently. Just letting diabetics know that it is possible, even plausible, helps diabetics prevent a problem before it happens.