Travel in India with type 1 diabetes – flying, medical letters & adjusting basal

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 7 in the series about that trip and its planning and how type 1 diabetes played a part.
This post is predominantly geared towards people with type 1 diabetes, rather than general travel advice. For info, at the time Amy was taking 7 units of slow-acting Levemir each night at 8:30pm and the follow doses of fast-acting Novorapid for each meal: 10, 7, 6 which were adjusted depending whether she was high, or low.

Getting anxious about flying

Whilst Jane was generally nervous about the travelling/diabetes combination I had done so much planning I was getting blazé about the difficulties we might face on the trip. One thing we did worry about together was the whole airport/flying/injecting thing.

A letter of consent

With all the recent changes in airport/airplane security we were nervous about how to transport Amy’s insulin and needles: putting it in the rucksack in the hold could result in lost luggage and insulin; carrying it on board gave us worries about needles and liquid and security regulations.
When she was diagnosed we were given some travel literature and it advised that we should request a letter from the hospital which stated Amy’s condition and her medication requirements, this in turn would be shown to the security desk at the airport and we would be allowed to carry the insulin/needles on-board.
Way before we were due to fly Jane got the letter and we were all set, albeit still slightly nervous.

A word about flight times

In 2009 we took an overnight flight to India leaving at 10pm and arriving at midday (Indian time), a flight that didn’t go well as we got hardly any sleep on the plane. We thought an overnight flight would be better as we wouldn’t waste a whole day flying but instead we wasted a whole day – after arrival – sleeping. However after the first night our body clocks were adjusted to the local time. Amy didn’t have diabetes back in 2009.
This time we decided to try a day time flight, leaving at 10am and arriving before midnight (Indian time, about 7pm our time). This seemed to work out much better as we didn’t need to worry about sleeping and just had fun on the plane watching films and eating. However it tooks days for our body clocks to sort themselves out.

Calculating the correct basal (slow acting insulin) dose

Amy normally takes her basal insulin – Levemir – at 8:30pm, so the night before we flew we had to adjust her dose.
During August India is 4.5 hours ahead of England which meant that Amy’s first injection in India would be at 4pm as far as her body clock was concerned.
Therefore we adjusted the Levemir dose using the following calculation, bearing in mind that Amy was on 7 units Levemir and the difference between 8:30pm and 4pm is 19.5 hours.
Normal basal units divided by 24 hours, multiplied by number of hours between doses.
= 7 divided by 24 multiplied by 19.5 hours
= 0.29 multiplied by 19.5 hours
= 5.6875 units.
We decided to give 6 units and delay her first injection in India by 30 minutes, giving it 9pm, which would fit in better with holiday time.

At the airport

We always make sure we arrive at the airport in plenty of time and arrived four hours before our flight on purpose, giving Amy time to eat a decent breakfast before we even checked in. It was funny seeing her sat on our baggage eating Weetabix out of a plastic container we’d taken.
At the check-in we made sure they knew she was diabetic, even though it was noted when the flights were booked. The check-in person made us feel quite at ease and told us just to show the letter to security and we’d be let through without issue.
Jane went first holding the letter in one hand and the packaged diabetic kit in the other, showed the letter to the security person who guided us through to the family aisle and within seconds we were through.
No fuss. No checking. We felt silly for being so worried beforehand.

Breakfast number two

Whilst in the departure lounge it was time for the rest of us to have breakfast and in true form Amy decided she wasn’t just going to sit there and watch us eat. So it was time for another bolus for her. At the time she was on a fixed bolus (fast-acting) insulin dose per meal, which was adjusted if she was really high or really low. We weren’t carbohydrate-counting at the time and looking back I can’t imagine how we coped with semi-fixed doses.

Meals and injecting whilst flying

Before we were served our first meal Jane spoke to the cabin crew and asked it was possible for them to let us know 20 minutes beforehand so we could sort out Amy’s injection. This was no problem for them, they’re obviously quite used to it.
Although we were sitting together in a row of four Amy didn’t want to do her injection in the cabin so Jane and her went to one of the tiny loos, getting a few strange looks when going in together. It was a little cramped. Amy was worried about movements due to turbulence but it worked out fine.
We hadn’t specified a special meal for Amy but the dessert was a full-on sugar one. Without us saying anything the cabin crew apologised and went and got Amy a piece of fruit.
Amy did go slightly low (3.6mmol) on the plane but generally her numbers on travelling day weren’t too bad: 7.0, 5.3, 9.8, 3.6, 9.7. We’d expected it to be a lot worse.
There were no other problems on the flight and the cabin crew were wonderful.

Next up – buying diabetes supplies in India

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2 Responses to Travel in India with type 1 diabetes – flying, medical letters & adjusting basal

  1. Rob Woolfson says:

    I fly a reasonable amount, anywhere between 2 and 10 flights a year. I carry my diabetes bag (insulin, needles, snacks, sugar, glucometer, glucaon, spare test strips, pain killers, sunglasses, prescriptions) everywhere. When I fly I usually stuff that in a backpack. At my seat I put the backpack in the overhead, and the diabetes kit by my feet. Few things to note. I did have a letter explaining that I was diabetic and that I needed this stuff with me at all times. I am pretty sure I have never shown it to anyone. It got a bit tatty so I threw it out. When asked if I have anything sharp in my bag I used to say that I had needles. Now I do not say anything at all. In the unlikely event that they see it in the scanners (usually no one picks it up) I will tell them that there is something sharp so they don’t just shove their hand in there and prick themselves.
    The reason I do this is because there have been times where I have been asked if I am carrying anything sharp and I get one of two responses when I say yes. “Oh Ok, thats fine” or “Do you really need all of it” / “can it go in the hold”, or something silly or impractical like that.
    I live in Israel so I have to go through some pretty tough security coming in and out. I am not suggesting that anyone take as blase approach as I, just that handing them the opportunity to make issues might not be always be the path of least resistance.
    On a more positive note, I had a hypo on a return flight home on BA from London. I had some stuff on me, but thought a can of coke would do the trick. I stumbled to the back of the plane and explained the situation. I was amazed. The two stewardesses knew exactly what to do. They gave me coke, and some cake and a roll. They made sure I was ok before sending me back to my seat. And they gave me extra just incase! Turned out one used to be a nurse. And they both had received training on how to deal with such a thing as part of their regular instruction. I love BA, and this just strengthens that feeling

  2. steph says:

    I have travelled at least once or twice a year or 6 times in 2012 and never asked for a letter or to see my diabetic kit, no need to worry 🙂

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