Travelers with Pre-existing Disease

Management of Diabetes During Air Travel: A Systematic Literature Review of Current Recommendations and their Supporting Evidence

“…1) based on expert opinion. Eleven publications recommended the continuation of (unspecified) oral medications at their usual prescribed doses without specific modifications for travel (11,12,(34)(35)(36)(37)(38)(39)(40)(41), although 1 cautioned patients not to miss meals while taking sulfonylureas (42), and another stated that travelers should be aware of the risk of dehydration (31). In contrast, 7 publications suggested adjustments to oral regimens for travel (10,32,(43)(44)(45)(46)(47), which included the use of rapid-acting oral agents (repaglinide or nateglinide) with meals to cover gaps during westward travel (10,43,45); making slight but nonspecified dose modifications depending on direction of travel (44,47); or foregoing 1 dose of an oral hypoglycemic when traveling east or if missing meals (32,43,46).…”

“…The minimum number of time zones crossed before travelers need to adjust their insulin schedule or dose was not specified (6,14,(29)(30)(31)35,39,44,48) or was not consistent, varying from 2 (15,43), 3 (51-53), 5 (10,45,47,54,55), 6 (11,12,32,34,37,(40)(41)(42)46), to 7 time zones (16,36,38,56,57). One author (52) cited the American Diabetes Association's 2004 Insulin Administration Practice Guideline, which recommends travelers receive advice on insulin adjustment when crossing 3 or more time zones (7).…”

“…Noninsulin agents Continue unadjusted (11,12,(34)(35)(36)(37)(38)(39)(40)(41) vs. make adjustments (10,32,(43)(44)(45)(46)(47) • Rapid-acting insulin formulations are preferable to regular insulin (12,32,33,42,48) Pen injectors may be ideal for travel (12,33,43) Eastward and westward travel:…”

“…Supplies should be in their original containers with official preprinted pharmacy or manufacturer labels (11,13,45,46,58,69,70).…”

“…Ambient cabin noise may diminish the ability to hear device alarms; frequent monitoring of the device while on-board the plane is recommended. a Medicines •Medicines, including insulin, should be carried on(10,11,13,14,31,35,36,39,(43)(44)(45)(46)53,58,(65)(66)(67)(68)(70)(71)(72)). • Carry sources of carbohydrates (snacks, glucose tablets, or gels).…”