I am a T1 on an insulin pump + Dexcom CGM. I have noticed that when I take a cross country plane flight (DC to California) that a few hours after the flight I will run in the 300's or 400's even if I do not eat any dinner. Is it the dehydration associated with altitude causing this? I have begun to drink 8 oz of water for each hour in the air and have noticed a little improvement, like only hitting 300. (I do not get high during the 6 hour flight.)
I would like to travel from DC to Bora Bora, however, I'm afraid that I will be in DKA in a 3rd world country after I get there. Also, how can I take a 20 hour flight or two 10 hour flights and not sleep and just drink water? Is this something a brittle T1 just cannot do?
Excellent question. I do a great deal of traveling myself, and have noticed similar patterns.
During the descent from a high altitude, the air pressure in the plane increases. This can sometimes cause insulin to contract and produce an air pocket near the end of the tubing. As a result, air (rather than insulin) will be delivered for a period of time. The best way around this problem is to temporarily disconnect from your pump during the descent portion of the trip, and upon landing, deliver a small prime dose until drops appear at the end of the tubing. Once the prime dose is complete, you can then reconnect to the pump.
As far as very long flights, it is certainly doable. Many of my clients use a temporary basal increase to handle to prolonged period of inactivity on overseas flights. And if your basal program includes a pre-dawn "peak", it is usually best to keep the pump's clock matched to the time in your departure city until you arrive at your destination and establish your new sleep cycle.
If you're looking for more pointers relating to pump use, feel free to contact my practice (Integrated Diabetes Services). We offer consultations to pump users worldwide.
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