Insulin Adjustments Through Time Zones

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Gervais Mosley
5 years ago
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Travel Guidelines Insulin Adjustments Through Time Zones While talking to patients about travel it is extremely important that travel is well understood by the educator first.

1 Travel Guidelines Insulin Adjustments Through Time Zones While talking to patients about travel it is extremely important that travel is well understood by the educator first. Planning adjustments for travel through time zones is designed to avoid both hyper- and hypoglycemia. There are many ways to help patients with insulin adjustments for travel however, the key is finding a system that is simple for the educator to communicate and therefore easy for the patient to understand and apply. When travelling within North America or less than 3 hour time change (which is 3 time Travelling East When travelling east you lose hours and the day becomes shorter. Patients will usually need less intermediate or long acting insulin and less sleep on the travel day. For example, a patient travelling east from Canada to Europe will lose 5-7 hours on their travel day. It is usually best to reduce the bedtime dose of basal insulin by 1/3 on the travel day (5-7 hours is about 1/3 less of the day). Travelling West When travelling west you gain hours and the day becomes longer. Patients will usually need more insulin and extra meals on the travel day. For example, a patient travelling west from Europe to Canada will gain 5-7 hours on their travel day. When they arrive in Canada they should have an extra meal and will then require an extra dose of rapid or short acting insulin. The dose will last for about 4-6 hours assisting blood sugar control for the remainder of that day. Then they will return with their usual routine.

2 World Time Zones Using Time Zones On the map above, time is labeled along the bottom edge. Every time zone represents 1 hour. Document the time zone the patient is departing from and the time zone they will be arriving in. The difference between these two is the time change (the numbers of hours that will be lost or gained on the travel day). Please note that if the patient crosses the International Date Line (this is the bright bold red line on the far left and right of the map) the patient will lose time if travelling west (ie. Travelling from Vancouver to China) and gain time if travelling east (from Vancouver to China)(normally it is the opposite). This is accounted for by counting time zones from west to east (envision the map as circular and you are counting around). This is often only the case for patients travelling to or from North America, China and Australia. Calculating Insulin Adjustment The insulin dose change required will be based on the total difference in hours between local time and destination time. For example, if the patient is flying east taking 1/3 of the day (ie. 5-7 hours in duration), total basal insulin for the day should be reduce by 1/3 or 33%. If the time difference were greater, the reduction would be greater. 2

3 Be Prepared Expect the Unexpected Patients should: Have an adequate supply of food and fluid on the plane and allow for unexpected delays and stop overs Carry all insulin and monitoring supplies with them not leave it in their checked baggage Carry a letter on them from their physician stating that they have diabetes and require insulin Know where to seek medical help at their destination if required Take supplies for treating hypoglycemic episodes and sick days 3

4 Case Study Insulin Dose Adjustments for Travel Caitlin is travelling to China this summer to meet her old university room-mate, Cheng. Caitlin has Type 1 Diabetes and has never flown outside of North America. She has made an appointment to see you today for help preparing for her travels. She is current on a QID insulin regimen taking 40 units Lantus insulin at bedtime (around 10pm each night) and takes 15 units Humalog before each meal. What would you recommend she do about her insulin doses when she is travelling to China? What should she do coming home? Answer: The time difference between Calgary and China is 14 hours which is approximately half a day. Travelling to China Caitlin will cross the international dateline meaning she should reduce her Lantus by half and take 20 units on her travel day. Coming home from China she will gain 14 hours on her day. She will probably eat one or two extra meals and should make sure to take 15 units of Humalog with those extra meals. Caitlin is going to visit her sister in Barcelona for Christmas. She has Type 2 Diabetes and has never flown outside of North America. She has made an appointment to see you for help in preparing to travel. She is currently on basal insulin and oral medications. She takes 55 units of Lantus at bedtime (around 10pm each night) and gluconorm 2mg at each meal. What would you recommend she do about her insulin and oral medication dose travelling to Barcelona? What would you recommend she do travelling home? Answer: The time difference between Calgary and Barcelona is 8 hours which is one third of the day. Travelling to Barcelona Caitlin will lose 8 hours and should reduce her Lantus by 1/3 taking 18 units on her travel day. Coming home from Barcelona Caitlin will gain 8 hours on her day. She will probably eat an extra meal coming home and should take her 2mg gluconorm with the extra meal. 4

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Sick Day Guidelines and Ketone Testing

Sick Day Guidelines Sick Day Guidelines and Ketone Testing 6 Steps for Sick Days (All Patients) 1. Prevention: Get influenza vaccination yearly and pnuemococcal vaccination if >65 years old. Eat a healthy