The ULTIMATE Guide to flying with diabetes
When I speak to other type 1's, one of the biggest fears I hear is about flying with diabetes. Hopefully this guide can put to rest many of your worries.
Flying with diabetes can be a scary prospect, especially if you’ve never done it before.
But as someone who has taken over 100 flights, I can safely say that flying with diabetes doesn’t need to be stressful!
Below I will take you through everything you need to know about taking that first flight.
Including all of the personal tips and tricks I’ve learnt over the years!
Some key questions you may have probably include:
- Can you take diabetes medication on a plane?
- Whether you can take all other diabetes supplies on a plane?
- How do you keep insulin safe on a plane?
- How can I pass through airport security with diabetes supplies?
Don’t worry, I’ll go through each of these in detail. First up ...
10 Tips for flying with diabetes
1. Use your insulin pens just like normal
I certainly remember the first time I took a flight with diabetes (a short one from England to Ireland). I was concerned about whether I could even inject whilst on the plane.
I always wondered if the pressure affects the insulin or the needles, but it doesn’t. You can use your insulin pens as normal when flying!
It’s also useful to note that aeroplanes all carry medical sharps boxes, so if you don’t have access to yours when you’re flying, you can ask to dispose of needles on board.
If you don’t feel comfortable injecting on an aeroplane, you can always use the onboard bathrooms too.
Tip: Carry an empty box of test strips with you to put your used needles in, then transfer them to a sharps box at a later date.
2. Keep your insulin pump running
A common question I often get asked is “can I use an insulin pump while flying?”. There is some confusion around this topic. But short answer …. Yes you can!
I’ve had an insulin pump for around 8 years, and I’ve done a lot of long haul flights, so I wouldn’t be alive if you couldn't!
There are some useful things to note ...
- Switch to aeroplane mode: like all devices you use on an aeroplane, you need to switch them to flight mode. It will knock off the Bluetooth capability which means you will have to manually enter your blood sugar when you test, rather than it sending over via Bluetooth.
- Disconnect & Reconnect: In the past, I was told that it’s a good idea to disconnect and reconnect your pump for taking off and landing. (So you keep your pump on, but just in terms of going up and coming back down). This is because sometimes insulin pumps can’t handle the pressure; and it can cause air bubbles in our tubes which in turn will lead to a blockage in insulin! (We don’t want this!)
Tip: Follow this process ... disconnect, prime, reconnect and REPEAT. That little motto makes air travelling with insulin easy peasy.
What I will say, is that I used to do this at the start of my flying adventures, but I rarely do it now. So it depends how cautious you want to be.
Or if you notice your blood sugars aren’t stable on the plane, you can always reprime whilst in the air.
3. Pre-plan carbs with aeroplane food
In a world full of information, we can now often see the carbohydrates and overall nutritional information of aeroplane foods online.
Nearly all long-haul flights offer the menu online before you fly, and even on short-haul flights, you can often check out their in-flight menus.
So have a look online beforehand and see If you find a meal that you can easily work the carbs out for. Then, when you board the plane, call over a stewardess and let them know you’ve got type 1 diabetes and could they set aide “meal x”, for you, so that they don’t run out.
I can’t eat rice, so I do this when I board a plane to make sure the rice option isn’t the only one left when they get the trolley to me; and all the air hostesses have been super accommodating.
Remember, you can always bring food onboard with you, so if you feel simply too nervous, just bring your food to eat on board.
4. Bring extra hypo supplies with you
Flying can be unpredictable and you can run into delays (I’ve been delayed 3 hours on a plane before take-off), and you must have hypo supplies with you.
Often, the aeroplane can’t provide you with food and drinks unless they’ve left the runway, so make sure you're prepared.
That being said, if it’s an emergency then ask the staff and they will assist there and then.
5. You can bring extra luggage with you!
When you’re travelling with diabetes, you often need more supplies than the average joe.
You’ve got test strips, a blood glucose monitor, insulin, infusion sets, and spares of everything.
Especially if you’re on an insulin pump.
All that extra diabetic supplies can take up valuable room in your luggage, but don’t worry, you don’t actually have to compromise on space.
If you have a medical condition, you can bring one small extra hand luggage bag with you on your flight, free of charge.
90% of airlines offer this, but some of them require you to contact them beforehand, or fill in a form, just check with your airline before you fly.
I’ve never had any issues bringing an extra bag in all my years of travelling, so that’s a good sign!
It’s also the same with your liquids bag. You can have one extra liquids bag in airport security for your insulin. Rather than trying to fit makeup, toiletries and insulin all in one bag.
I travel with a doctor's letter to confirm I am carrying insulin and diabetic supplies, but rarely need to show it.
5. Get a doctors letter
Speaking of doctors' letters, it’s a very good idea to bring a basic letter with you!
Your letter will just say your name, your condition, and what supplies you are carrying and why.
If you’re wearing an insulin pump and do not want to go through an airport 360 body scanner, it will also state on your letter why not.
On a side note, before taking a Dexcom or FreesStyle Libre through these scanners, it would be best to contact the company or your doctor to see if it is safe.
I rarely have to show my doctor's letter, but they’re useful if someone tries to argue with you.
Tip: If you’re travelling to a country that doesn’t speak a lot of English, then have your letter translated to the language of that country too.
I’ve created a sample diabetic travel letter that you can download for free when you sign up to my newsletter!
6. Don’t put insulin in your checked luggage
I have to admit, I always assumed people knew this. However, after seeing numerous threads on Facebook about flying with diabetes, I learnt of a few people who put their insulin in their checked luggage and it went missing; so they were left without.
That’s reason number 1 why you shouldn’t put your insulin in your checked baggage.
But reason number 2 is that there is a VERY high risk that your insulin will freeze on the route.
When you’re flying, the plane enters crazy cold temperatures, that insulin cannot operate under.
You might not even realise your insulin has frozen because it’s defrosted by the time you check it.
So, you should NEVER EVER EVER put your insulin in checked baggage, ever.
That’s exactly why you get an extra liquids bag when flying with diabetes, so you can avoid that problem.
Tip: If you’re worried about keeping your insulin cool or how to pack insulin for a flight, you can check out my post on insulin cooling cases.
But in the past, I’ve always used Frio bags and haven’t had an issue with them in over 5 years of use.
7. Don’t keep all your diabetic supplies in one bag
Another important tip for flying with diabetes is to NOT put all your diabetic supplies in one bag.
If you put everything in your checked baggage and that goes missing, then you’re going to struggle.
Whereas if you split your supplies between the two, at least you have enough to get by until you can source extra supplies.
8. Pack for emergencies on the flight
When I first started travelling with diabetes I often made the mistake of keeping my diabetes supplies in my hand luggage.
But then put my hand luggage in the overhead compartment so that if I needed to get something, it caused an annoying moment having to ask people to move (don’t you just love a good window seat?!).
Instead, make sure you have one of everything with you at the seat.
This means insulin pens, needles, infusion set, cartridge, wet wipes, insulin, spare battery, etc.
Have something that will cover any situation that may arise. This will honestly give you so much less stress when flying.
This won’t be a problem if you’re in business or first class and swimming in space, but I’m an economy sort of gal!
9. Stay hydrated on your flight
Did you know that high altitudes cause dehydration?
And dehydration can cause our blood sugars to rise?
Which can then lead to ketosis! Not a good time.
Therefore it’s important to stay hydrated on your flight.
This is especially important if you are taking advantage of a complimentary in-flight bar.
Alcohol dehydrates you quickly too so drinking water in between alcoholic drinks will help.
Drinking with diabetes can be a complicated subject, for more tips check out my in-depth guide on alcohol and diabetes.
10. Wear flight compression socks on long haul journeys
There seems to be some sort of miscommunication over whether diabetes can wear flight socks.
Well, if your feet have no diabetic complications, (speak with your doctor first) then yes you can and you should.
Flight socks are a great investment and you can use them over and over again.
I get mine made-to-measure so I know my feet and legs will be comfortable and avoid clotting.
Clotting is a serious risk for anyone with diabetes, so it’s better to be prepared.
Realistically, non-diabetics should be wearing flight socks too. There’s no excuse!
Switching time zones with diabetes
When you're flying long haul with diabetes, you’ll often find yourself switching some sort of time zone (even short-haul in the USA!). So it’s important to know how to manage your insulin when this happens.
Crossing time zones with insulin pens
If you are on insulin injections, it can often feel quite scary when it comes to crossing time zones. But don’t worry, it’s not as bad as you’re thinking and with a little practice it becomes quite easy to manage.
Below is a typical scenario when flying from the US (East) to Europe (West).
- The day of your travels east from the U.S. to Europe, inject your basal (long-lasting Lantus or Levemir) insulin 2-3 hours earlier than normal.
- On your first day in West Europe, take your background insulin (Lantus/Levemir) 2-3 hours earlier than normal, local time.
- The next day, give yourself a basal insulin dose at what would be the “normal” time of day for you back home, but at local time.
Europe (West) to US (East)
- On the day you are to travelling west from Europe to the U.S., take your basal insulin (Lantus/Levemir) injection 2-3 hours later than usual.
- On your first “full day” back in the US, take your long-lasting insulin 2-3 hours later than usual, on local time.
- Then on the next day, so back to your normal timing for basal injections
You need to try and switch your insulin to the routine timing of the new country you are visiting.
It’s also super important that you test frequently to judge whether you need to give yourself more insulin to lower your blood sugars or eat a little more to avoid hypos.
This will be very personal to how your body reacts.
When it comes to your fast-acting insulin, i.e. the insulin you take to cover food, you simply take it when you eat as normal.
If you are travelling on “SET” insulin doses (which is a very old school way of doing things), I don’t recommend you cross a time zone without speaking with your doctor, or learning how to carbohydrate count.
It’s important to note that if the time difference is LESS than 4 hours, then you won’t need to make MAJOR changes to your insulin. Just simply monitor closely and adjust as necessary.
This formula often helps people calculate their long-lasting dose when travelling West to East (where the day is shortened):
Reduced travel dose = Normal dose x (0.9 – [#of time zones you cross ÷ 24])
Here’s my approach …
When I travelled with insulin pens I would take my long-acting insulin (which happened to be Lantus at the time) at the same time I would back home then adjust as necessary.
So, basically, if my flight was at 8 p.m., and my background insulin was typically given around 9 pm, then I would take it on the flight.
Once I arrived at my new country with my new time zone, I would wait the 24 hours it takes for my background insulin to finish (this may vary depending on the background insulin you use) and then I would take my next dose of background insulin at 8 pm LOCAL TIME.
That means there would be a period of time in which no background insulin is entering my body, so I would closely monitor my blood sugars and use fast-acting insulin to keep them in range and adjust.
For me, this is the quickest and easiest way to adapt to a new time zone with injections.
Crossing time zones with an insulin pump
I’ve been travelling with an insulin pump for over 8 years now, so it’s my preferred method of travel and I’ve crossed through multiple time zones while flying.
This is how I manage my insulin pump ...
It’s a simple case of changing the time and date on your pump setting to your new time zones. Your basal rates will readjust to the new time zone given on the insulin pump.
Some people do this when they are on the aeroplane flying, and some people do it when they land. I do it when I land because it’s easier.
As soon as I land I switch my insulin pump to local time, and I monitor closely for any changes needed.
I typically find I will need to alter my basal rate for different parts of the day, but these changes are quick and easy and I find that within a couple of days I’ve readjusted.
Always expect some sort of adjustment period.
If you are sitting on a flight for a long time, (i.e journey above), then you may find your blood sugars run a little higher, basically because your body isn’t doing anything.
Insulin usually likes some sort of movement to get it flowing in the body, so if you’re just sitting, then it’ll take longer to work. So, you may find increasing your basal rate by 10-15% will help.
Jet Lag and type 1 diabetes
Another thing to note when flying with diabetes is that sometimes you can experience jet lag after crossing time zones, and this can impact your blood sugars.
I often avoid jet lag by living by this motto: when flying, sleep when your destination country is sleeping.
I find I can sleep anytime I need, so this usually works, but if it doesn’t and I arrive at a destination and it’s still day time, I force myself to stay awake until night time.
Sometimes it’s not pleasant, but will 1000% help reset your body clock a lot quicker.
Airport security and type 1 diabetes
If you have an insulin pump, you cannot let your insulin pump go through airport 360 body scanners.
These are becoming more common around the world, but due to the internal mechanisms of an insulin pump, it can affect how they function.
You CAN go through a metal detector (over arch walk-through), but your doctor's letter will confirm that your insulin pump cannot go through. Instead, it can be swabbed.
I simply ask for a pat-down search and swap, and never have any issues with that.
If you’re from the USA, it’s worth getting a TSA diabetes notification card to help make your transition through the airport much smoother.
Top Tip: I’ve created a diabetes travel letter template you can use to help make traveling through airport security with diabetes a breeze. If you sign up to the newsletter (using the form below), you can get the template sent free to your email address!
Have you flown with diabetes?
So there we have it, my ultimate guide to flying with diabetes!
Now over to you …
What has been your experience of flying with either type 1 or type 2?
Do you have any additional tips?
Or maybe a horror story to share? (Don’t worry we’ve all been there)
If you’ve got any other questions, simply drop me a comment below and I’ll try and help any way I can.
Other posts you may find useful: