Flying

Flying across a number of time zones in a relatively short period can lead to confusion about what insulin to take at what time and with which meals.

What advice should patients be given if on a basal bolus regimen and are travelling west?

Travelling west effectively lengthens the day. Prandial insulin can be taken as frequently as needed i.e. each time a meal is provided on the plane. Ideally, dose adjustment is performed by the patient according to carbohydrate counting principles.

If the patient is only crossing two or three time zones (i.e. extending the day by just a couple of hours) the normal dose of basal insulin should be taken before departure and at the destination at the same (local) time as usual e.g. before bed.

If they are crossing five or more time zones this option is not viable as it may result in the patient going for a significant period of time without background insulin in their system, although this is less of a concern for those with T2DM on insulin as endogenous production is likely to tide them over. We normally advise our patients to continue to take their basal insulin at the same times of day as usual (advise the patient to keep their wrist watch on UK time) and if they are going to be at the destination for a significant period of time then the injection can be moved by one hour each day to bring it to a more convenient (local clock) time.

However, this is very general advice and will not be suitable in every case. The policy of perfection is for each patient to contact their diabetes nurse specialist with the precise details of their schedule and to arrive at an individualised plan for changing their insulin regimen as they travel.

What advice should patients receive if they are on a basal bolus regimen and travelling east?

Travelling east effectively shortens the day. Prandial insulin can be taken as frequently as needed i.e. each time a meal is provided on the plane. Ideally, dose adjustment is performed by the patient according to carbohydrate counting principles.

If the patient is only crossing two or three time zones (i.e. shortening the day by just a couple of hours) the normal dose of basal insulin should be taken before departure and at the destination at the same (local) time as usual e.g. before bed.

If they are crossing five or more time zones this option is not viable as it may result in the patient effectively 'double-dosing' for a period of time and increasing the risk of hypoglycaemia. We normally advise our patients to continue to take their basal insulin at the same times of day as usual (advise the patient to keep their wrist watch on UK time) and if they are going to be at the destination for a significant period of time then the injection can be moved by one hour each day to bring it to a more convenient (local clock) time.

However, this is general advice and will not be suitable in every case. The policy of perfection is for each patient to contact their diabetes nurse specialist with the precise details of their schedule and to arrive at an individualised plan for changing their insulin regimen as they travel.

What advice should patients be given if on a twice daily biphasic regimen and travelling west?

Travelling west effectively lengthens the day. If the patient is only crossing two or three time zones (i.e. extending the day by just a couple of hours) the normal morning dose of insulin should be taken before departure and then the afternoon/evening dose at the destination at the same (local) time as usual e.g. with the evening meal.

If they are crossing five or more time zones this option is not viable as it may result in the patient going for a significant period of time without background insulin in their system, although this is less of a concern for those with T2DM as endogenous production will usually cover this gap. We normally advise our patients to continue to take their insulin at approximately the same times of day as usual (advise the patient to keep their wrist watch on UK time). In practice this will mean taking the second dose of the day with a meal close to the usual evening-meal time (UK time) while travelling.

At the destination, this practice should be continued while adjusting to local time and moving the breakfast and evening-meal times (and corresponding doses of insulin) towards local times by one to two hours each day.

However, this is general advice and will not be suitable in every case. The policy of perfection is for each patient to contact their diabetes nurse specialist with the precise details of their schedule and to arrive at an individualised plan for changing their insulin regimen as they travel.

What advice should be given if a patient is on twice daily biphasic regimen and travelling east?

Travelling east effectively shortens the day. If the patient is only crossing two or three time zones (i.e. shortening the day by just a couple of hours) the normal morning dose of insulin should be taken before departure and then the afternoon/evening dose at the destination at the same (local) time as usual e.g. with the evening meal.

If they are crossing five or more time zones this option is not viable as it may result in 'double-dosing' and increased risk of hypoglycaemia. We normally advise our patients to continue to take their insulin at approximately the same times of day as usual (advise the patient to keep their wrist watch on UK time). In practice this will mean taking the second dose of the day with a meal close to the usual evening-meal time (UK time) while travelling.

At the destination this practice should be continued while adjusting to local time and moving the breakfast and evening-meal times (and corresponding doses of insulin) towards local times by one to two hours each day.

However, this is general advice and will not be suitable in every case. The policy of perfection is for each patient to contact their diabetes nurse specialist with the precise details of their schedule and to arrive at an individualised plan for changing their insulin regimen as they travel.

What advice should be given to patients if they have T2DM treated only with tablets?

On the day of departure and while travelling they should take their medication at the usual times (advise them to keep their wrist watch on UK time). After the first night at the destination they should then switch to local time.

The only slight caution with this policy is if travelling east and shortening the day by a significant amount there is a small risk of sulphonylurea-induced hypoglycaemia by taking two doses of SU too close together, in practice this isn't usually an issue however.

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