Time Zones and Insulin

Advice on how to manage your insulin while travelling across time zones.


 Flying east-west or west-east across several time-zones adds complexity to eating and injecting insulin at the right time. Do you go by the time in your place of departure or your arrival when deciding when to inject? And, how do you change over from one to the other?

When there is a time difference between your departure point and your destination, if you use local time to decide when meals and injections are due this will make the time between some of your injections much more or much less than usual. This can cause you to have too little or too much insulin on board, so there is a risk of you becoming ill with high or low blood glucose. There are several ways around this. The method given below is only one. We advise you to discuss the details of this with staff at your diabetes clinic, and they will give you a tailored plan..

The following methods assume you take three main meals each day.

For people who inject short-acting insulin at each meal 

(e.g. Novorapid, Humalog, Actrapid, Humulin S, Hypurin Neutral)

If flying east-to-west e.g. from London to Mexico City, the time difference of 6 hours will make the day 6 hours longer. Because of this you will need to take an extra dose of short acting insulin 4-6 hours after your third main meal of the day. You should eat after this injection. Treat it like an extra medium sized main meal.

If flying west-to-east e.g. from Saudi Arabia to Tokyo, the time difference of 5 hours 30 minutes will make the day 5 1/2 hours shorter. Because of this you will probably be having one less meal on your day of travel so you will have one less injection of short acting insulin. You should continue to take your long-acting injections at the usual times (measured at local time).

For people who take a mixed-insulin twice each day 

(e.g. Humulin M3, Mixtard 30/70, NovoMix30)

If you take a mixed insulin twice each day and are flying east-to-west, on the London to Mexico City flight, you could take your usual two injections per day plus an extra injection of short-acting insulin (supplied by your clinic) 8-10 hours after your first injection of the day. This would be just before the time of your usual third main meal. Take your next dose of mixed insulin with your fourth main meal. This way you will be taking four main meals plus snacks on that day, but the time difference will lengthen the day by 6 hours.

If you are going on the same, west-to-east Saudi Arabia to Tokyo flight as above, you could miss your second injection of mixed insulin and taking instead an injection of short-acting insulin supplied by the clinic. The dose will be about the same as the short-acting component of your usual mixture. You would then only be taking two main meals plus snacks on that day - but the day would be 5 1/2 hours shorter because of the time difference.

If you usually Free-Mix your insulins 

If you usually free-mix your insulins, that is take some short-acting and some long-acting (isophane) you can follow the suggestions for people who take fixed mixtures (above). You will already have soluble insulin available to you. Discuss this with your clinic staff before you set off.

General points 

  • Remember to eat shortly after taking quick acting insulin (or mixtures containing quick acting insulin) even if that means eating an extra meal one day.
  • Check your blood sugar often when changing time zones.
  • Discuss details of how you will take your insulin with your clinic before you go.
  • If the time difference between your departure point and your destination is less than 3 hours you should be able to stick to your usual insulin regimen.
  • Make sure your main-meals are taken 4-6 hours apart.
  • Ask the airline when the in flight meals are served and use them as between meal snacks or as main meals whichever fits your schedule better. You can use your own food to add to what is served or ask for a few extra bread rolls - there are usually some to spare.
  • Remember that in-flight alcoholic drinks will affect your blood sugar (depending on how much alcohol and how much carbohydrate they contain).
  • If flying makes you feel stressed, this will affect your blood sugar too.
  • If you are usually quite active, there is a limit to how much energy you can burn up in an airline seat, so doing nothing may give you a higher sugar if other things remain the same.
  • Take some extra food in your hand luggage in case of unexpected delays.

For more information on this topic visit http://www.voyagemd.com 

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