Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-83

The total difference (in hours) between local and destination times will determine the amount of insulin dose change required. The example handout was developed for persons living in the Eastern Standard Time (EST) zone and illustrates the most common trip made in that region: east to Europe or the Middle East, where the time difference is usually five to seven hours. This represents about 33% (one-third) of the total day, requiring a reduction in the total basal insulin dose for the day by 33% on the eastward trip. If the time difference were greater, the reduction would be greater. On the return trip (or any westward trip), the day will be longer than 24 hours and extra insulin will be required. This is most easily provided as an extra injection of rapid- or short-acting insulin, but a dose of intermediate-acting or long-acting insulin may also be used. • If the person is using degludec as a basal insulin, no insulin dose adjustments are required. There needs to be a minimum of eight hours between injections. If an insulin pump is used, changes to the basal rates are not required; the pump will deliver the basal insulin continuously. On arrival, the time on the pump should be changed to match the new destination time. Meal insulin doses do not require adjustment, except as per usual carbohydrate counting adjustments and correction factors. In general, people often eat more, not less, while on vacation. Patients should be counselled about the need to be prepared for the unexpected: • Carry an adequate supply of food and fluid with them on the plane. Allow for unexpected delays or stopovers. • Carry all insulin and monitoring supplies with them; do not send supplies in checked luggage. Some airlines allow a carry-on bag for medical supplies only, in addition to the one personal bag and carry-on luggage. Patients should consult with the airline prior to departing if they need additional space for their supplies. • Carry a letter from their physician with them that they have diabetes and require insulin. Know where to seek medical help, if required. • Take supplies for treating hypoglycemic episodes and sick days.

Diabetes educators and patients alike seem to find the time differences the most confusing aspect of travelling. Diabetes educators may use the following graph to help plot travel times,