*Disclaimer: This article is not intended to provide medical advice, diagnosis, opinion, treatment or services. This blog is meant to provide general information for educational purposes only. The information provided in this blog is not a substitute for medical care and should not replace advice from your healthcare provider.*
So, you have type 1 diabetes and want to travel, huh? Well, I’m sure your mind is already racing trying to mentally prepare for your next excursion! Like any new experience with diabetes, the first time is always the most challenging. But with careful preparation and continued practice, you can become an expert and learn to experience life along with diabetes. This blog post is going to take you through exactly what to expect and what you need to know about traveling with type 1 diabetes.
TSA Security with Type 1 Diabetes
Going through TSA security at the airport can be incredibly overwhelming for anyone and even more so for those who are living with a chronic condition like type 1 diabetes. Here’s what you need to know when going through airport security with diabetes:
Do you need a doctor's note?
TSA does not require you to travel with a doctor’s note. I have traveled without a doctor's note for both international and domestic travel in the United States without any issues. However, if you feel more comfortable traveling with a doctor’s note, you are always welcome to ask your care team for one.
Can you go through airport metal detectors or scanners with insulin pumps or glucose monitors?
The metal detectors and body scanners at airports are used to scan for metal objects and potential threats. The levels of non-ionization and ionization used in these systems are very, very low as are the risk of adverse health effects. According to a Yale article, most device manufacturers specify that devices should not be exposed to radiation due to theoretical risk of device damage and should be removed whenever possible. However, the probability that x-ray or CT scan irradiation will cause device malfunction is extremely low.
With that said, you are not required to walk through the scanners if you are not comfortable and can always opt for a pat down search instead. In my travel experiences, I prefer to go through the scanners and metal detectors since the electromagnetic fields are very weak. If you choose this option, tell the TSA agent that you are wearing a medical device. The device may be subject to additional screening like conducting a self pat-down of the actual device, followed by a test of your hands for any trace of harmful substances.
I prefer this option as when I have opted to do pat downs I found them to be an incredibly violating and stressful experience. But at the end of the day, it is your choice to do what makes you feel most comfortable. If you have any questions about TSA security, you can contact passenger support 72 hours prior to your travel date to review travel policies, procedures, and accommodations.
Airport Security Screen Recommendations for Insulin Pumps and Glucose Monitors
Each insulin pump and glucose monitor device manufacturer has different recommendations for traveling. You can read more about each manufacturer's recommendations below:
Factors of Traveling that can Impact Blood Sugar
When traveling with diabetes, you may notice that your blood sugars have a bit more variability or you experience stubborn high blood sugars. There’s a few factors that you should be aware of that can be influencing your blood sugars while traveling.
Stress is a known contributor to influencing blood sugar levels. Whether you are stressed out over whether you forget to pack something or worried you will miss your flight, this stress can be contributing to raising your blood sugar levels. If you find that traveling is stressful for you, try identifying which part is the major stressor and think of ways you can counteract that stress.
Missing Your Flight: arrive 2+ hours early
Security: consider TSA precheck
Forgetting Medical Supplies: make a checklist and have someone else check for you to give you a thumbs up
When flying, the altitude changes can contribute to dehydration which can contribute to increased blood sugar levels. When you become dehydrated the amount of water in your bloodstream decreases which makes the existing glucose (sugar) in your bloodstream more concentrated. The Aerospace Medical Association recommends consuming 8 ounces of water for every hour of flight. Consider bringing a reusable water bottle with you so you can stay hydrated throughout the flight. Drink up!
It is no surprise that decreased activity can influence blood sugar levels. After making it to your gate, you will be sitting until your flight begins boarding and then sitting for the duration of your flight. The decreased activity may contribute to temporary insulin resistance. You may consider taking a lap around the corridor to get some movement in before your flight. But, you absolutely do not need to be doing sugar squats in the bathroom. If you notice your blood sugars are running a bit higher, drink some water, take some insulin, and give yourself some time.
Another factor that can impact blood sugar levels while traveling is altitude changes. Airplanes travel at high altitude which can have varying effects on blood sugar levels for people with diabetes. For some, altitude can contribute to insulin resistance making blood sugars a bit more difficult to keep in range due to the release of stress-related hormones.
The atmospheric pressure in an airplane cabin can change during flight, which may affect insulin delivery for insulin pump users. The changes in cabin pressure may cause leakage of insulin through the cannula which may cause excessive insulin delivery. A recent study recommended disconnecting insulin pumps during takeoff and landing and checking for air bubbles in tubing. If you are using a tubeless insulin pump like Omnipod, caution should be taken during flights for potential unintended low blood sugars.
Pre-boarding with Diabetes
People with diabetes fall under the American Disability Act, which means you are eligible for pre-boarding while traveling. Pre-boarding ensures that you will have immediate access your diabetes supplies during the flight by getting the first choice of overhead storage to stow equipment in close proximity to your seat. Pre-boarding can be utilized for airlines with assigned and unassigned seating. Anyone in your travel party can also pre-board with you. All you have to do is wait for the TSA agent to call for pre-boarding for eligible people with disabilities and walk up to the desk and scan your boarding pass. Under the American Disability Act, agents should not request any additional information about your disability.
What to Pack in Your Carry-On with Diabetes
You should NEVER pack your diabetes supplies inside your checked baggage in case it is ever lost en route to your destination. Packing your diabetes supplies inside your carry-on ensures that they will arrive with you. Most airlines allow medical bags in addition to your personal bag and carry-on at no additional cost. You can find out what your airline allows by visiting their website or calling them prior to travel.
Now that we got that all squared away, here’s what to pack inside your carry-on:
Double the diabetes supplies: as a general rule of thumb, always double the amount of test strips, CGM and insulin pump supplies needed for the duration of your travel. This will ensure that you have enough supplies in case you have site failures or sites that fall off early.
Backup supplies: if you are pumping, consider bringing syringes and long-lasting insulin in case your pump breaks while traveling. If you are a CGM user, consider bringing a glucometer and test strips with you as a backup to checking blood sugar levels.
Insulation for insulin: bring an insulin cooling device, like a pack it, can ensure that your insulin stays cool when traveling to a warmer destination.
Consider non-liquid low snacks: while TSA allows people with diabetes to travel with liquids greater than 3.4 ounces, it may save you a headache by opting to travel with gummies, glucose tablets, applesauce, fruit leather, or other non-liquid low snacks. You can always purchase juice boxes once you arrive at your destination.
Non-perishable snacks: you never know what type of unexpected delays can happen with traveling. Traveling with non-perishable snacks like granola bars, protein bars, meat sticks, trail mix, nut butters, popcorn, and chips.
Reusable water bottle: most airports have watering stations to fill up a reusable water bottle to keep you hydrated during your flight.
Electrolyte sticks: replenishing electrolytes are important for people with diabetes especially with elevated glucose levels or if you fall sick on your trip. Traveling with electrolyte sticks, like propel, can ensure you stay hydrated during your trip and reduce the risk of DKA.
Hopefully, this covers all of your concerns and helps get rid of (most of) the nervous jitters while traveling. Do you have any questions that weren't mentioned above? Let me know in the comments!