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Insulin Pumps & Flying: Why you are at risk of a hypo in the bagage reclaim hall

You have already prepared yourself for your trip, took the plane, managed your insulin, checked your blood glucose. You have done everything and yet when you arrive to the baggage claim area your blood sugar drops.

Let me tell you, you are not alone and this has probably nothing to do  with how you manage your diabetes. This phenomenon is called the bagage claim low. It is when your blood sugar drops after the flight has landed due to an excess of insulin delivered by your insulin pump. This is caused by the pressure change that happen during landing.

DO NOT PANIC IT’S NOT YOUR DIABETES, IT’S PHYSICS!

 

The American Diabetes Association tell us that “Atmospheric pressure reduction causes predictable, unintended insulin
delivery in pumps by bubble formation and expansion of existing bubbles”

WHY?

Insulin is a fluid and like every fluid it is affected by pressure
changes as explained by Henry’s law, “the amount of a given gas that dissolves in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid.”

Therefore, if the pressure of a gas over liquid increases, the
amount of gas dissolved in the liquid will increase proportionally. If you want to learn more the technical details of Henry’s law click here.

SO WHAT ACTUALLY HAPPEN WHEN FLYING ?

Dr. King and Bruce R. et al study demonstrated that decreases
in ambient pressure cause predictable unintended insulin delivery from insulin pumps. You can find the full
study here.

During take off, the air pressure and altitude change create
bubbles in the pump reservoir which block insulin and reduce the amount that is being delivered.

During landing, it is the contrary, the air pressure and altitude
change dissolve the air bubbles during and lead to excess delivery of insulin. It takes an average of 15 minutes for insulin to act which is approximately the time it takes to go to the baggage claim area.

Hello baggage claim low !

TO PREVENT TO EXPERIENCE BAGAGE CLAIM LOW AND HYPERGLYCEMEA DURING FLIGHT :

  1. The cartridge of the pump should only contain 1.5 mL of insulin.
  2. Disconnect the pump before takeoff and landing.
  3. At cruising altitude, take the cartridge out of the pump and remove any air bubbles before reconnecting.
  4. After the airplane lands, disconnect the pump and prime the line with 2 units. Then reconnect the pump.
  5. During flight emergencies involving cabin decompression, disconnect the insulin pump.
  6. Control your blood sugar regularly and bring snacks and sweet in case of hypoglycemea.

 

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