Diabetes and flying: A turbulence-free guide

As the daughter of an airline mechanic, I've been a frequent flier since I was six weeks old. When I was diagnosed with type 1 diabetes at age 11, I had new things to pack in my suitcase but my sense of adventure simply adapted.

For people with T1D, the air travel considerations and solution sets that need to be taken into account are more complicated than deciding which swimsuit to pack. On normal, ground-based days, we make hundreds of decisions about carbohydrates, insulin dosing and technology troubleshooting. Those decisions are amplified when balancing diabetes and flying. With all the gear and backup plans needed, diabetes can sometimes feel like an additional passenger.

So, how do you prepare (and transport) an entire suite of diabetes technology through airport security? And how do you manage the disease once buckled into that "roomy" seat? Here are helpful tips and insights you need to know, from flight planning to touchdown.

Plan the flight, fly the plan

Pilots are trained to "plan the flight, fly the plan" — diabetes and flying is no different! You can avoid surprises, ease anxiety and mitigate technology disruptions by putting in the time upfront to properly plan. Since I order all of my diabetes supplies through mail-order pharmacies and suppliers such as Edgepark, I like to take stock of what I have a couple of months before the trip. Then I calculate my anticipated supplies and determine if I need to call in early refill requests.

The CDC recommends bringing twice the amount of medication and supplies required for the time period you will be away, so I try to follow this guideline. I also take some time to gather paperwork like a TSA Notification Card, letters from doctors, prescription information and technology descriptions/notifications (which are available on manufacturers' websites).

Packing for your pancreas

Let's talk packing. It's easy to remember the essentials like insulin, site changes and CGM sensors, but there are many other things to keep in mind. I like to use a checklist of less-common items:

• Backup insulin pens and needles
• Blood glucose meter and strips
• Snacks
• Batteries
• Charging cables
• Medical ID bracelet

Per FDA guidelines, it's also a good idea to bring an ice pack if your trip is longer than 28 days or you plan to be in a warm, sunny place. This can help keep insulin cool. And the good news with diabetes and flying is that liquids related to managing the disease are not restricted (yes, you can bring those juice boxes through security because they qualify as medicine). Remember to keep all of these diabetes items in your carry-on bag, in a separate compartment if possible, for easy declaration upon arrival at security screening.

T1D and the TSA

The first and most important tip for airport security is planning out your insulin pump and CGM sites to make unhooking and inspection during the TSA screening process easier. Most insulin pump and CGM manufacturers recommend against wearing the devices in the full-body scanners or sending them through the X-ray machine — to be on the safe side, I always opt for a full-body pat-down instead. I want to avoid any negative interactions between scanning equipment and diabetes technology, so to me, it's worth the extra time a pat-down requires.

It's important to remain calm and courteous when interacting with screening personnel. Sometimes it may be necessary to stand firm if you experience pushback when requesting a pat-down or declining X-ray scans. The use of precise language can help, for instance, "I have type 1 diabetes. My insulin pump cannot go through the full-body scanner or X-ray because it has sensitive electronics." You can also point to site locations, "This is where my insulin pump connects to my body and this is the transmitter for my Continuous Glucose Monitor." It's fine to send insulin through X-ray, just be sure to have the appropriate prescription label handy.

Getting cleared for takeoff

Most diabetes technology interacts via Bluetooth signals — this is true for CGM transmitters, receivers and cellphones. The FAA allows Bluetooth during every phase of flight. So, if you use a standalone CGM receiver or insulin pump to receive readings, these Bluetooth signals can be active whether you're taxiing to the runway or flying at cruising altitude. If your CGM sends readings to an app on your phone, simply turn on "airplane" mode and enable Bluetooth.

During the flight, I try to stay hydrated by drinking water. If I order a soda, I ask to have the entire can, as this allows me to verify my order and dose accordingly. Luckily, with the standard cabin pressure being equivalent to 6,000–8,000 feet (ca. 2,438 m), I don't see much change in my insulin sensitivity, although I do take into account that I am generally less active onboard compared to a normal day.

Good planning and a courteous attitude go a long way when considering type 1 diabetes and flying. There's no reason to let this chronic illness keep us grounded!

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