Diabetes in Modern Air Travel
Abstract & Commentary
By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center. Dr. Kemper reports no financial relationship relevant to this field of study.
Synopsis: Patient education may help to reduce the incidence of problems related to travel in those with diabetes mellitus.
Source: Burnett JC, et al. Long- and short-haul travel by air: issues for people with diabetes on insulin. J Travel Med. 2006;13:255–260.
These authors in Aberdeen queried 493 insulin-using diabetics presenting for routine care at the diabetes center regarding their experiences traveling abroad within the previous 12 months. Surprisingly, nearly two-thirds had some kind of air travel abroad in the previous year. Nearly half (44%) had traveled once or twice in the previous 12 months, and 24% had traveled > 10 times. The patients were grouped into those with short air flights (< 4 hrs) or long-haul flights (> 4 hrs).
One-tenth of each group experienced hypoglycemia either during the flight or within 24 hrs of arrival. Delays in air travel departure and landing times occurred in nearly one-third of subjects. While 91% carried some food with them during their flight, 10% reported problems with meals, including delays in obtaining meals and difficulty obtaining a pre-ordered diabetic tray. Of those with hypoglycemia, 31% were severe and required assistance. Unfortunately, in order to compensate for the possibility of hypoglycemia, many travelers reported deliberately experiencing hyperglycemia. This was 10-times more likely to be reported by individuals with long-haul flights.
While most insulin-using diabetics traveled with a companion or informed the airline staff they were using insulin, fully 15% told no one they were using insulin. Less than half had sought medical advice about managing their diabetes during travel.
Commentary
Air travel has just gotten harder, and with the latest restriction on food/fluids on board, except when declared medically necessary, I suspect many travelers with medical illness may experience more frequent problems. During a recent flight from San Francisco to Toronto, no meals were served, although a snack of Oreo cookies, granola bars, and cheddar fish crackers was available for $5, hardly a healthy snack, especially for someone with diabetes. The authors suggest that diabetes clinics consider incorporating travel advice into their routine diabetes education. Pre-printed educational pamphlets for diabetics, even for short flights, may be useful.
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