December 2, 2008
Question from Johnson City, Tennessee, USA:
We just booked a flight to Los Angeles leaving Christmas Day. This will be our first flight since our daughter’s diagnosis of diabetes. What are the rules for flying with a diabetic child? She is 14 years old and uses the NovoPen Junior and Lantus.
Since your daughter receives Lantus (long-acting insulin glargine) and NovoLog (rapid-acting insulin aspart), then I will jump to the logical conclusion that she is on a “basal-bolus” insulin plan and that the amount of NovoLog she receives at meals hinges on her carbohydrate count while her Lantus dose is fairly fixed, and that she has a “correction formula” to adjust for high glucose readings. The basal-bolus insulin plan allows for insulin adjustments in one’s routine and flying involves adjustments, such as change in time zones.
With those givens, then your daughter is on a pretty perfect plan for travel. I would make no adjustments to her basal rate or her insulin-to-carbohydrate ratios for meals and snacks. You may check her glucose on the plane if you like (is this a four hour or so non-stop flight?), especially if she eats a snack or meal on the plane. Dose her accordingly. Given that she will be relatively inactive in flight, I probably would not give aggressive corrections, unless the glucose were above 300 mg/dL [16.7 mmol/L], but your own diabetes doctor might suggest otherwise, depending on your correction formula.
You may travel with your diabetes supplies – keep them in your easy to reach carry-on bags. While probably not necessary, it might be helpful, just in case, to have a letter from your doctor that indicates that you are traveling with prescribed diabetic supplies including a glucose monitor, needles, and insulin. It is also a good idea to keep such supplies in an original container. (Having said that, I have never had any problems myself or for my patients traveling with diabetes supplies.) The insulin pens or vials will need to go in a separate clear plastic baggy during security. I would take off any needles to your pens as there could be the possibility that air pressure changes in flight could then otherwise cause insulin to be expelled from a pen with the needle on.
[Editor’s comment: See also our web pages on Traveling with Diabetes and Flying With Diabetes. Travelers with Disabilities and Medical Conditions specifically includes the following statement about permitting people with medical conditions to have “Liquids including water, juice, or liquid nutrition or gels…” This is important because some people with diabetes use juice to treat low blood sugars and need extra water when their blood sugar is elevated.