Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-82

Figure 11. Travelling through time zones: Advice for patients regarding insulin

Goals

Arrive at your destination without having high or low BG levels. Change to local destination time and activities as soon as possible so you can acclimatize quickly.

General principles

If you are travelling in North America, where the time difference is no more than 3 hours, you do not need to make many adjustments. The 3-hour time difference will not make a big impact. Just spread out your meals and insulin as near as possible to normal. If you use intermediate- or long-acting insulin for basal insulin and you are travelling through more than 3 time zones, you will need to change your basal insulin dose and/or time. Travel east (lose hours, shorter day): usually need less intermediate- or long-acting insulin and less sleep Travel west (gain hours, longer day): need more insulin and extra meal(s) If you use CSII (a pump), you will need to change the time on the pump to match local time when you arrive. You will not need to reduce the amount of basal insulin. You may need a different rate of basal insulin because of different activities. Stay on the local (departure) time and schedule until the travelling is actually over and you arrive where you will stay. Change your watch to local time when you arrive and change to local meal and sleep schedules as soon as possible. Discuss specific plans with your care team. You need to know exact travel plans to plot out changes required:  departure time  length of time in the air, stopovers  times meals are served Travel east to Europe: you will lose 5 to 7 hours or one-third of a day. It is usually best to reduce your bedtime dose of your basal insulin (e.g. NPH) by one-third on the travel day (usually on the plane crossing the Atlantic at night). Travel west from Europe : you will gain 5 to 7 hours and your day will be longer. When you arrive home in you will need to have an extra meal and an extra dose of rapid or short insulin to match the meal and avoid running low on insulin. The dose will need to last about 5 to 6 hours, until you return to your usual routine. If you use premixed insulin : speak to your doctor or diabetes educator. The same principles apply, but the doses have to be calculated. If you can take rapid or short insulin by itself, you may use this on the westward travel day. If not, a small dose of the premixed insulin may be used. On the eastward trip, reduce the evening dose as noted above.  arrival time (local time and date)  plans for the day after landing Examples:

Developed by the Leadership Sinai Centre for Diabetes