Dr. Peter Gott offers sound medical answers to reader questions in the new Lifestyles section...
Dear Readers:
My apologies to those who have sent in questions to this column and are awaiting answers. I am in the middle of a trip and have found I forgot to bring the folder containing the questions. So this month, I'm forced to develop my own topic.
Please continue to send questions, and I will do my best to address them in a timely fashion. Regardless, having just gone through airport security, I think a review of traveling with diabetes would be appropriate. As well, I do recall a patient recently asking about how she should adjust her pump for a trip to Israel.
Concerning packing, as I have said in the past and I cannot stress enough, always be prepared. I suggest figuring out what you will need for supplies and then pack double. For example, if you use one insulin pen every three days and you will be gone for one week, then pack four pens. When I mention supplies, I include insulin, needles, pump supplies, sensors, glucagon and blood strips. When I prepare for a trip, I find it both safe and effective if I assume each bag may be lost. Thus, I make sure that all bags have some supplies and this includes any companion's luggage.
CONSULT DOCTOR
Food for low sugars should be easily attainable at all moments of travel. A patient in perfect control may have unanticipated issues with crossing through time zones or boarding flights. I found as I flew out of Plattsburgh on a rather small plane that my carry-on bag was stowed in the wing. Thankfully, this was a heated area, but as we neared our destination, I felt — and my sensor confirmed — that my sugar was dropping. In this case, I suspended the pump and treated the low sugar after landing, but the prudent move would have been to carry some form of carbohydrate on my person.
Crossing time zones is always complicated. There are many factors that need consideration for insulin dosing, and I suggest that you speak to your physician prior to departure. I have always changed my pump to the local time soon after landing. However, I have the security of the continuous glucose sensor — and the fact that my insulin rates in the pump are very similar — so a few hours' time change does not have a significant effect. There are many people who, while in different zones for brief periods, do not alter their dosing strategies or pump settings.
EMPLOY CAUTION
Those patients using medications that are dependent on native insulin production have a less-confusing issue. These medications can be adjusted rather quickly as the patient adapts to the time difference. Popular medications such as Byetta, Symlin, Januvia, Actos, Metformin and oral sulfonureas are dependent on the patient's ability to produce insulin. Any time insulin is used, caution must be employed to make the proper changes. Clearly, the destination, hour change, types of therapy and duration of stay have a significant impact on proper medication adjustment for traveling, and I highly recommend discussion with your physician concerning the best way to handle the situation. Everyone's diabetes is very different, and hence time-zone adjustment needs to be customized. Regardless, with aggressive blood testing and proper treatment of low sugars, many folks can figure out which method works best.
So the moral of my story is the following: Carry food on your person, pack lots of extra medications and supplies, stow them in many places, and discuss how to best change your tactics for different time zones with your doctor. In the case of an emergency in the United States, most pharmacies will help you out, many pump companies have representatives throughout the country, and you should always carry a medication list (with doses and frequency), and your doctor's contact information.
Dr. Jonathan Beach, who has lived with diabetes himself since age 4, heads the Northeast Center for Diabetes Care and Education at Urgicare of the Northeast in Plattsburgh. Send questions to him for this column, which runs the second Tuesday of every month, to: The Northeast Center for Diabetes Care and Education, 79 Hammond Lane, Suite #2, Plattsburgh, NY 12901 or
diabetescenter@urgicarenortheast.com
