Traveling with diabetes somehow always seems to raise the hairs on the back of my neck -- despite the fact that I've rarely had any serious mishaps. Still, the idea always makes me nervously expect that something will go wrong (Murphy's Law, right?)
Summer is of course our busiest travel season, with multiple diabetes conferences and family travel all jammed into a 10-week period.
As such, it's a great time to visit that universal topic of "traveling with diabetes" and some ideas and resources to help with our packing lists, emergency preparations and airport security issues.
Airport Security with Diabetes
A lot of people who wear insulin pumps or CGMs use the "don't ask, don't tell" method here, meaning they say as little as possible going through the security line in the hopes they'll be directed to the older, non-3D scanners that don't pick up on medical devices. If you are directed through the 3D scanner however, you will be subject to a body pat-down and that litmus test the TSA agents do where they rub your hands with a special sensitized slip of paper to make sure your devices are not dangerous.
Personally, when I travel I typically get there extra early and voluntarily opt out of the full-body scanner to get the pat down instead. I may be paranoid but I don't trust those scanners and I also worry about lost luggage so tend to go for the "cautious approach." I carry all of my diabetes supplies with me, along with a note from my endo in my meter case, clearly stating that I should be allowed to carry all of this stuff on my person. Fortunately, I've only once ever had to take that out and flash it at a grumpy airport security guy who balked at seeing syringes in my case.
After the pat down (which I'm not bothered by), the TSA screener of course goes over my CGM sensor and pump infusion set spot and swabs my medical equipment and my hands for any dangerous residue. Only once have I been told that there were traces of explosives (!) detected on my pump... but the TSA screener stayed cool and relaxed about it, and they correctly figured out that it wasn't a danger.
One resource that PWDs can utilize is the TSA Cares program, allowing you to have a Passenger Support specialist meet you at the security checkpoint. That's supposed to make the process go smoothly for people with disabilities and medical conditions.
To use this program, you're instructed to call TSA roughly 72 hours in advance of your flight to let airport security officials know about your medical condition or disability. You can either ask some FAQs about going through the screening process and what might apply to your specific needs, and/or you can request a passenger assistant to personally accompany you through the TSA security checkpoints to make sure all your needs are addressed.
That may be a great comfort for some folks who worry about TSA holdups due to medical devices, or are carrying open insulin vials and syringes on board.
I'm lucky in that TSA has always treated me with respect and consideration... except maybe that one time when I was trying to opt for a pat down and the TSA screener tried to argue with me about it. But that was one isolated, grumpy set of people who probably hadn't had enough coffee so early in the morning, IMHO.
Diabetes on the Airplane
First off, you should definitely check out the handy "Flying with Diabetes" Cheat Sheet compiled by our D-peep friend Brandon Arbitor, who works at open-data nonprofit Tidepool. This community resource Google Doc has some excellent tips and tricks on getting through airports when you have diabetes as a permanent carry-on. For example, did you know that all of us with T1D qualify for pre-boarding? All you have to do is let the agents know when you check in. That's extremely helpful for airlines like Southwest, that don't have reserved seating. (Thanks for putting that together, Brandon!)
I personally like to get an inside seat on the plane so that my CGM sensor isn't exposed to an aisle where people or beverage carts could knock it off. And I follow the sage advice from DOC friend Melissa Lee about disconnecting my insulin pump during takeoff and landing to avoid bubbles in the tubing. Of course I have my meter case and glucose tabs handy at the top of my bag, for quick access if needed.
Now that I've been on Afrezza inhaled insulin and my insulin pens for while, I tend to not use the pens while flying and afterward I push a few extra units out before dosing myself -- to get out any air bubbles that may have formed in flight.
Aside from the supplies in my carry-on backpack, I always have more backups and extra insulin in my leather-strapped Chaps case. I try to take this as a carry-on when possible, but you can't count on it, because flights are so often full an I'm asked to check it anyhow.
Here are few general things I have learned about making air travel with diabetes go smoothly:
- While TSA does not require you to have prescriptions with you, having them may speed up the security screening process if agents question your medications or supplies.
- Having a letter from your doctor or clinic may also help TSA feel more at ease that what you have is legit.
- With diabetes you are officially allowed to take more than one container of liquid or gel to treat low blood sugars, but practically it might help to switch to other fast-acting carbs for travel time: glucose tabs, hard candy, raisins, or something else solid that won't flag TSA.
- Plan to have more snacks than you think you may need on your carry-on, just in case any flight delays or detours happen and food is not readily available. This happens more often than you may think!
- Travelers are told to turn off all phones and electronic devices, but naturally we can keep our insulin pumps/ meters /CGMs/ medical smartphone apps running. Still, you may want to turn off alarms or set to vibrate mode so as not to concern the airline crew, or annoy fellow passengers.
My International Highs and Lows
My first-ever international trip outside of adjacent countries like Mexico and Canada was a journey to Dominican Republic in 2015. It brought a whole new adventure in D-travel that I'd never faced before.
I had to get my head around differences like the fact that, even in mid-February, it hit almost 90 degrees with 90% humidity in the Dominican Republic. So a big concern going in was making sure my insulin wouldn't overheat.
Yes, I do own a Frio cool case. But for some reason I decided ahead of our trip that I just didn't want to fuss with having to soak the Frio, so instead I only took one bottle of insulin with me, and kept it in the hotel room mini-fridge. I filled my pump reservoir up each time only about a third of the way, so just in case it spoiled, I'd still have the rest of my vial. Also, while out by the pool and ocean, I often left my pump in the room, chilling in the cool air-conditioning until I came back to make corrections. In hindsight, I probably should have brought at least one backup vial of insulin, in case the first one broke or got lost (!)
But things went quite well initially. Since I was wearing my Dexcom CGM, I didn't feel the need to do mass amounts of fingerstick tests. I was happy with my tropical blood sugars:
See that palm tree there, reflected on the Dexcom receiver -- Yay, tropical blood sugars!!
Unfortunately, I got hit with a stomach bug the last day of our trip and that messed everything up. I had trouble eating or drinking anything, and my BGs hovered in the 200s for most of that last day and our travel day home. I decided not to wear my pump traveling home, in part because I didn't want to take the risk of it slowing us down through international airport security, so instead I decided to rely on multiple injections of Humalog every few hours.
And then things got messy: I just knew I'd grabbed my insulin and packed it in my meter case before heading to the airport. But somehow, it disappeared and I only discovered this on the plane, about 30 minutes before departing (after a two-hour delay). Long story short: I panicked as I didn't have enough insulin for close to a full day, but managed to not go into DKA and got some emergency insulin immediately once we were back in the States.
The silly end to this story is that I ended up finding the "missing" meter case once I got home. The damn case was buried in the bottom of my backpack, hiding underneath books. I was so mad and frustrated at myself and the situation. Yeah, I guess packing only one vial of insulin was not the best idea...
It was a rough experience, but I survived. And I came out a lot wiser about the need for taking backup supplies, and taking that Frio case even if I didn't want to.
Now, as I'm knee-deep into travel season once again, I'm happy to at least be staying in States where I have easy access to replacement supplies if needed. But I'm still following the Scout motto to always be prepared!