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Guest Post: Air Travel, Diabetes, and Burritos.

TSA madness and a burning desire for a burrito?  Is this what diabetes travel woes are like?  Thanks to Christopher Angell's travel and diabetes guest post today, I'm feeling like a kindred spirit with this particular PWD and fellow travelin' fool.  (Not that he's a fool.  Or that I'm a fool.  You know what?  This time change thing is starting to make my brain splutter.)  Here are some travel tips from Mr. Angell.
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I find it slightly ironic that Kerri asked me to write about diabetes and air travel, since she's the one in Australia, and I'm the one sitting in my office. Still, so far this year, we've run into each other at devents in Orlando, Indianapolis, and Berlin. In fact, assuming my plans don't change (unlikely), I'll have flown 99,652 miles when the ball drops on December 31.

I have broken my air travel advice into four categories: Redundancy, Security, Nourishment, and Shameless Self Reliance.

In travel, as in diabetes, surprise is the enemy. The more that things go according to plan, the better.  But plans always do change. This is why it's critical to always have a backup plan.

It goes without saying that you should always travel with duplicates of all of your supplies (including treatments for low blood sugar), if possible.  The one thing that I don't always travel with a backup of is my Dexcom CGM, because I don't always have a backup (sometimes I do if I order another after my warranty expires but my current receiver is still working) but I always travel with a backup charger.  It also goes without saying that you should keep the backup in a different location than the original.

Probably the most controversial (and in many ways personal) aspect of air travel is the TSA security checkpoint. What to scend through the x-ray? Should you request a pat-down?  Metal detectors vs. full-body scanner?

I know Kerri disagrees [Editor's note:  I do.], but I always just go thorough whatever machine they put in front of me.  I want to get away from that area as quickly as possible.  If you take that route, and wear a Dexcom (or other CGM), I suggest wearing your sensor somewhere easily accessible in case you go through a scanner and they want "more information."  This happened to me only 3 times (out of 50+ flights and counting) in 2012.  Twice in Denver and once at Laguardia.  Since I was wearing my sensor in my thigh, it meant that I had to go to a private screening room, as pulling down your pants in the middle of the terminal is still frowned upon.  I take it in stride - I would say 99.99% of the time, if you are polite and cooperative, you'll be treated with courtesy and respect. If not, file a complaint. There was a study released recently about the effects of airport x-ray machines on pumps and CGMs that's worth reading.  I've always sent mine through the machine and never had a problem, but I'd never thought it might be an issue before, so it wouldn't hurt to check your manufacturer's guidance.

I used to keep my insulin pens in a Frio case when I traveled, but I never do anymore, unless I know I'm going somewhere really hot, and will be exposed to that heat for a long time.  The pens provide a bit of protection, and even if it gets heated up, insulin only loses a small percentage of potency.  The space savings are well worth that gamble.  That said, my most amusing security run in happened when I had a freshly-plumped Frio case in my carry on:
Agent: "Sir, is this your bag?"
Me: "Yes"
Agent: "Do you have anything sharp or dangerous in it?"
Me: "A few syringes, but they have caps on them."
Agent: "Ok.  Umm…sir…do you have…do you have a burrito in your bag?"
Three things immediately popped into my head.
1. I was in San Diego.  Shouldn't they know what a burrito looks like?
2. Are we not allowed to bring burritos on planes anymore?
3. I really wanted a burrito.

This brings me to one of the biggest challenges for me when flying: food.  If you're trying to follow a reasonably low-carb diet, you quickly become one with the grilled chicken caesar.  It's the most ubiquitous bread-less protein source out there, by a good mile, followed by the far-less-satisfying individually-wrapped slices of Tillamook cheese found in United's lounges.  My secret weapon?  Almonds.  I never fly without about a pound of raw almonds.  They're reasonably tasty, do not spoil, are very easy on the bg's, and have a lot of healthy stuff in them.  Should they be used as a meal replacement?  No.  Have I used them as a meal replacement?  More times than I can count.

Shameless Self-Reliance.
When you're on the road/on a plane/out of your normal zone, you're even more at your own mercy than normal. You can't hesitate or be squeamish/embarrassed to test, treat, or correct.    If you think you might be low, don't wait, get ahead of it. If you're high, knock it down, because you'll be sedentary. I am on MDIs and I give myself shots in my seat next to strangers in even the tiniest of aircraft. I figure the least sanitary place I could bolus would be in any travel-related restroom.

As an example of how important it is that you be prepared for whatever the road throws at you, I'll recount what happened on my flight from Indianapolis to DC after the AADE National Gathering.  About 10 minutes before we were scheduled to land in Dulles, I saw the flight attendant move nervously toward the back of the plane.  Then, the classic call over the PA "Is there a doctor on board?".  A few seconds later, someone yelled "Does anyone have any Glucagon?".  I offered glucose tablets, but I knew it must be past that point.  On this small plane of less than 100 people, there were three doctors and countless nurses/CDEs.  Seemingly the ideal flight to have a diabetic emergency.  But NO ONE had any glucagon, and the plane didn't have any either.  They ended up using the glucose drip bag from the plane's first aid kit.  There were ambulances waiting on the runway, and within a few minutes, the woman was carried off the plane, already regaining consciousness and no longer seizing. Still, this is not something you want to count on.

So there it is.  If you practice redundancy, have a plan for security, consider your sustenance, and flaunt a shameless self-reliance, you'll get to where you're going just fine.  I just can't promise the same for your luggage.

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For more from Chris, you can check out the Glucolift company blog, or just cut right to the chase and buy a jar of Cherry tabs from Glucolift's Amazon store.  Mmmm ... cherry.


I think you hit the nail on the head when you said to treat everyone with courtesy and more often than not you get it in return.

Also, I intend to eat a burrito today.

A few years ago I was at my aunt and uncles who live 30 minutes from the nearest doctor or hospital. I had a severe low blood sugar and, of course, wasn't carrying glucagon at the time. Since that terrifying experience I have always kept a glucagon pen in the zipper pocket of my purse. I never go anywhere without my purse; therefore, now I'm never without glucagon. Thanks for sharing your traveling tips!

What a scary situation on that flight with the woman having a bad low.

I have to admit that I cracked up about the whole burrito thing - especially your #3 thought!

99,652 miles? Sir, I believe you need to find a way to make that 100,000 by the end of the year!

I have a couple of dumb question. It's my shoes and luggage that gets x-rayed, right? And what does that short tunnel I stand in do?
One more: why did the TSA folk test my hands for gunpowder when I told them about my pump and cgm?

Seriously, with the burrito. Bahaha. I'm boarding a plane early tomorrow morning, we'll see what shenanigans I encounter!

One other thing I meant to include in this but didn't is that apparently Southwest will allow PWDs to get the blue "board early" card so they can get a seat in the front of the plane and be close to the flight attendants in case of a low. This was told to me anecdotally by two different PWDs, but I did not confirm with a Southwest rep.

Love, love the burrito! Good to know about SW! Denver always treated me well, Colorado Springs not so much, so I often defaulted to Denver. Funny though, Atlanta was a breeze, so was Singapore, Hong Kong and Beijing. Kuala Lumpur was totally clueless. Goes to show you, in my experience - only the US is paranoid about flying!

Travelling across timezones is surprisingly easy on a pump, but surprisingly difficult on NPH (and Lantus too, mind you, but not quite to the same extent as on NPH). When I first started travelling across 6-hour timezones, the diabetes teams never addressed it and I picked up the "next" timezone as soon as I landed. Experience (including a very scary trip with a 12-hour time flip) has taught me to scale forward or backward 1 hour per day until you've gradually "met" your new time zone. It's a royal pain in the a** if you're only going to Europe for a week, but the alternative is layering your NPH (i.e. "insulin on board" to the extreme, in pump-speak), which blew up in my face (years ago, as a 21-year old student on exchange, on my own in a residence room with neighbours who barely knew my name - FUN!) with a resounding round of extreme lows that kicked in roughly 2 weeks after arrival.

I carry glucagon in my purse always. My son is the one with T1, but now that I know what to do, I can help a stranger if needed.
I must say that I find the TSA to be extremely intrusive. Our country is feeling more communist by the hour. I hope they leave PWDs alone; that part made me sad.

I always carry Glucagon with me when I travel, and I usually travel alone. However, I have never instructed any of my friends or family in its use and administration. It never occurred to me that an announcement might be made on a plane to the effect that they needed some glucagon.

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