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Insulin Pumps and Air Travel

I recently read a blog post by Melissa Lee a diabetic and insulin pump user, the post entitled What You Should Know About Flying with an Insulin Pump made me pause for a moment.  I had never considered that insulin pumps may be affected during flight just by the pure physics of flight itself. 

Melissa relays her typical experiences of flight travel usually include an episode of hypoglycemia that in the past she attributed to other travelling factors such as stress, typical airport fast food, carbohydrate miscalculations or “sheer diabetic randomness”.  It was during a new pump training session that the manufacturers Chief Product Architect mentioned that insulin pump users should always disconnect when flying. He asked Melissa to think about how delicately ears handle takeoff and landing and to consider the force of air pressure change during ascent and descent, and what it could do to the delivery mechanism of an insulin pump device.

Indeed as Melissa points out the need to disconnect insulin pumps during flights was not information ever before provided to her. I verified this by a simple online search, there is not a whole lot of information provided that states all people who wear insulin pumps should remove the pump during flight.  I did find the study mentioned in Melissa’s blog post from the pioneer attempting to promote this information, Dr. Bruce King; Changes in Altitude Cause Unintended Insulin Delivery From Insulin Pumps.  This study provides the exact pressures, measurements and performance of 10 different pumps, tested during flight simulation.  During the ascent and descent flight pressure simulations, some pumps delivered an excess of insulin and some delivered a deficit.  This was due to several factors such as pressurization, bubble formation in the fluid and tubing, and cartridge plunger movement.  From this study the following recommendations for pump use during flights were as listed:
  1. The cartridge should only contain 1.5 mL of insulin.
  2. Disconnect the pump before takeoff.
  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.

One of the most disturbing occurrences documented in the study, was the insulin delivery issue that occurred during a catastrophic depressurization of the plane.  Cabin depressurization events may happen 40-50 times worldwide per year on commercial flights.  This type of event caused a massive insulin overdose of greater than eight units being delivered by pump plunger movement caused by extreme pressure fluctuations.

Another item to consider when travelling with an insulin pump is airport security.  Chances are an insulin pump will necessitate a “pat-down” as many pump manufacturers do not recommend that insulin pumps (or continuous glucose monitoring devices) be subjected to full body scanners, or x-ray scanners. It has been documented that there may be a risk of electromagnetic malfunction caused by these security methods.

To read the entire blog post including great documentary photos of her pump tubing during flight click the blog post title above.  Thank you for the thought provoking post Melissa! This is a subject that all nurses working with diabetics and insulin pumps should be aware of. 

PedagogyEducation.com provides online continuing education on the subjects of diabetes and continuous subcutaneous insulin infusions or insulin pumps.  This education is available to individuals or in group purchases for entire facilities and is accredited for nurses and long term care/assisted living administrators for contact hours.  Click the following course titles to learn more about each course.

Continuous Subcutaneous Insulin Infusion for the School Nurse
Continuous Subcutaneous Insulin Infusion in Long Term Care (CSII)
Diabetes: An Introduction
Continuous Subcutaneous Insulin Infusion in Long Term Care (CSII) for Administrators
Diabetes: An Introduction for Administrators

Pedagogy blog written by Capra Dalton, RN,CEO. 

Capra has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant. 

Posted: 3/20/2014 3:19:06 PM
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