Managing T1D During Travel

Along the Way: tips for families traveling with the diabetes dragon

Travel can be stressful for anyone; travelling with diabetes can add additional worry. But with a little advance planning and prep, you can prevent common pitfalls and have a great, stress-free time away from home. Here are a few tips to reduce diabetes-related hassles (especially BG high and lows) during travel to your destination:

Frequent BG Checks

  • Do not assume that blood glucose patterns during travel will follow the same trends as they do at home. Heat, excitement, change in time zones, and change in activity levels (sitting for longer periods in a car or plane, or walking long distances through airports, for example) can all significantly affect blood glucose levels. The more often you check, the more easily you’ll be able to anticipate and avoid problems. Continuous glucose monitoring (CGM) is particularly useful for recognizing (and treating) atypical blood sugar patterns during travel.

Prepare for Lows

  • Carry a low blood glucose treatment with you at all times (candy, glucose tablets, juice, regular pop, for example).
  • It’s also wise to carry snacks (such as granola bars, crackers and cookies) with you at all times to avoid low blood glucose. This is particularly important for air travel, as flights may be delayed or you may miss a meal when rushing for a flight. You don’t want to be stuck on a plane with no access to necessary snacks.

Head off Highs

Prolonged inactivity (sitting in a car during a road trip that lasts several hours or more; sitting in an airplane for a long flight) means your child's body will use insulin less efficiently, which will likely lead to high blood sugar if you don't adjust their insulin dose.

  • Before making any changes, it's wise to first assess how much more insulin is needed by using all the usual insulin rates and ratios, and seeing how much your child's blood glucose rises, and how much extra insulin is needed to bring it back into range. Some kids need only a little bit of extra insulin; some kids need a lot. This may be a function of how active your child is on a typical day at home - if sitting still for a few hours isn't their norm, then insulin dosing has been set up for a high level of activity, and they may need relatively more insulin than if the usual doses are set up for a lower level of activity.
  • If you find that your child does in fact need more insulin while you travel, you can program a temporary basal rate on your child's insulin pump to match the duration of travel, or if your child receives insulin injections, you can give a proactive BG correction (or several, depending on how long your child will be sitting still).
  • A CGM (Continuous Glucose Monitor) can come in handy to show you when a BG spike begins and how high it rises. You can use this information to help you determine the timing and amount of any extra insulin:
    • Set a temporary basal rate on your child's insulin pump about an hour before you expect the spike to begin. Start with a small increase in the basal insulin rate to avoid lows. Increase the amount of the temp basal increase when experience shows you it's needed.
    • If your child receives insulin injections, give a proactive BG correction about 30 minutes before the expected rise. Keep the amount of the advance correction dose small to avoid lows. Check BG every hour or two and give additional doses of extra insulin as needed to correct high BG and avoid highs over the next few hours.
  • Remember that insulin lasts for 3-5 hours, so avoid unnecessary insulin stacking (adding more insulin before the insulin that has already been delivered has a chance to do its job). It's usually recommended to wait to give a second correction dose or insulin until 2 hours after the first one, unless you're willing to closely monitor BG and catch the fall (as outlined by d-dad Scott Benner in his Juicebox Podcast).

Tip from the Trenches

We find that on road trips of 3 hours or more, we need to set a temp basal increase of 40% on our son's pump, starting about 2 hours into the trip.

-Michelle

Crossing Time Zones

  • When travelling east, your travel day is shorter; when travelling west, your travel day is longer. Be sure to take this into account in terms of insulin delivery. You may need to adjust the time or amount of your insulin dose. Consult your child’s diabetes health care team for advice on insulin adjustment, especially if traveling across more than three times zones.
  • It is recommended to leave your watch (and pump, if applicable) on “home” time until you arrive at your destination, so that meal and snack times are not disrupted. Consult your child’s diabetes health care team if you are unsure when to change to the new time zone.
  • If your child wears an insulin pump, remember to change the time on the pump when you arrive at your destination (or along the way if crossing time zones very slowly by car, bus or train).

Tip from the Trenches

This one bit me after a long car trip – forgot to change the pump time once we got home and it made things wonky for a few days until I caught on.

~Mom of an 11-year old with diabetes

The above information was significantly modified with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

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