I am Christel from Diabetes Strong in this video I’ll be talking about
handling diabetes, jet lag and time zone changes
so specifically I’ll be going over how to
adjust basal insulin or long-acting insulin when changing time zones
I was born and raised in Denmark and I currently live in the US
I live in California and I’ll be flying back to Denmark soon to see family
and this trip it's going to be a 15.5 hour flight including layovers
it's a 9 hour time difference
so that does impact my blood sugars quite a bit
so I figured I would record my experience so you get a little bit of v-logging here
but I’ll also be going over a medical guideline I’ve found for how to adjust
your long-acting insulin for time zone changes
I will not be focusing on what I bring along
for trips like this, how to get through security and all of that
I already did a video on that so if that's what you're interested in
I’m leaving a link to that
up here so you can go check that out but let's dive in
traveling over multiple time zones usually leads to jet lag
as well as general sleep deprivation
so when that happens you often become a little bit more insulin resistant.
so that means that you need a little bit more insulin
to manage your blood sugars until your body adapts to the new time zone
to ease the headache of blood sugar-induced high blood sugars
you can nap, remember to drink plenty of water, exercise
and then of course adjust your insulin
if you travel over less than five time zones or gone no longer than three days
you might not need to make any changes to how you take your insulin
so if you use MDI, multiple daily injections. you just continue to take a long-acting
insulin at the normal time and you're rapid-acting insulin for meals and corrections
and if you're on an insulin pump
you just change the time on your pump and go on with your life
however please always consult with your medical team to see what's right for you
I use MDI, multiple data injections, to manage my diabetes
so I use an InPen, which is a smart pen I’ll link leave a link to that up here,
to help me calculate my doses for my rapid-acting insulin and then I take
a shot of Levemir in the morning and the evening as my long-acting insulin
and I’m currently taking 16 units of my Levemir in the morning
and I’m taking 7 units in the evening
when I travel back to Europe, or for any other longer trips,
I don't really make any changes to my rapid-acting insulin but I do have to be
mindful of when to take my Levemir and how much
I try to keep it as simple as possible
so when I travel east, so when I travel from California back to Denmark
or to Europe I will usually take my normal dose in the morning,
so that's 16 units, and I usually take that at 8 A.M
I stay on California time while on the plane
and my nighttime insulin is usually scheduled for 10 P.M
but what I do is, I push it out until 11 P.M
so at 11 P.M I take my nighttime Levemir,
11 P.M is 8 A.M in Denmark's, on at destination,
that pushes me right back into my normal schedule of 8 A.M and 10 P.M
once I land I’ll switch all my clocks to Danish time and I’ll go directly back to
my normal schedule so that means 10 P.M Danish time I’ll take my full nighttime
insulin dose of the 7 units so you might have picked up on me saying
hey I’m taking my nighttime insulin on the plane as well as my nighttime insulin
when I get to Denmark that technically means
that I’m getting less long-acting insulin for about 24 hours, right…
because I’m doing 7 units in the evening 16 in the morning,
I’m skipping that morning dose,
so that does mean that I have to watch my blood sugars I have to
make sure that I don't trend high, so I will check in with a blood sugar quite
often, do corrections if needed so my approach is just to be cautious
I’ll rather give myself a little bit more rapid-acting insulin for corrections than
having too much long-acting insulin on board
hey guys, so we're at the airport I
did my full dose this morning at 8 A.M, I did the 16 units,
I am still planning on doing
my full evening dose at not 10 P.M but 11 P.M, so pushing out one hour
so stay tuned I’ll let you know how it goes
it is 11:06. Blood sugar is okay,
I am ready to do my long-acting shot, gonna do 7 units
it is is now day one here in Europe, I did give
myself my full dose last night at 10 P.M I gave the 7 units and unfortunately I
did go low this morning at 4:30 A.M, you see that up here, I’m not sure however
that is due to my long-acting insulin I think that might be because I did a
correction late last night because I was running high and I wanted to correct that
It was not the right move, but this is just reality
but I’m going to keep an eye on it over the next few days I don't want to repeat
previous years when I was running low for days
so I’m going to be watching a little bit,
maybe reducing my long-acting insulin at night just a little bit
it's been a few days and my learning for this trip is that I’ve needed way less
nighttime insulin, so my Levemir at night, I’ve been cut way back to like 3
and I’m needing way more insulin during the day time
so for that one I just up my basal 1 unit
and then I’ve taken more insulin for meals and corrections
and that's the learning from this trip
it's been a little different depending on my trips, but for this trip again,
less insulin during the night time for the first few days and more during the day
so I have a slightly different strategy when I fly from east to west
so when I fly from Denmark back to California
so what I do is I still take my full dose in the morning, so the 16 units at 8 A.M
I will not change my clock to California time until I get off the plane,
so I’ll stay on Danish time, then at 10 P.M I’ll do my full nighttime
long-acting insulin and then once I get off the plane
I’ll change to California time and then when 10 P.M comes around
I’ll take my nighttime insulin again, but I’ll only take 50% of it
the reason for that is when I travel from Denmark to California I lose 9 hours,
so basically if I was to take full dose I would be stacking my Levemir
those two doses would be too close so that's why I cut it down by 50%
but that's how I do it I also found a clinical guideline
on Journal of Diabetes and Metabolic Disorders
so let's just go over that,
so that also means that if your doctor does not have a clue about
how to support you in managing your diabetes and time zone changes
you can bring that journal to your doctor maybe that can be helpful
I’ll leave a link to the journal up here so you can see the clinical guidelines for yourself
if you're interested
I will only be going over their clinical guidance for how to adjust long-acting
insulin taken twice a day, so like I do with my Levemir as well as for insulin pumps
they do also have recommendations on how to adjust
insulin, long-acting insulin, taken once a day,
so if that's what you're interested
just click on the link and go check out their guidance
let's start with the recommendation for eastbound travel for 5 hours or more
and this is a recommendation for anyone on MDI, Multiple Daily Injections,
who split their long-acting insulin in two doses
when you travel east,
they recommend that you still take your scheduled morning dose,
so the full dose and schedule time and then that you keep your watch
on your departing time zone,
once you're in the air and it's time for your evening dose they do recommend
that you reduce it and you do have to do a little bit of math
so yes, a little bit of math, but don't worry about it I’ll walk you through it
so I’m going to show you the formula and I’m going to do an example
so let's see this is a formula that they suggest that you use to
calculate your travel dose, okay so let's make an example
let's say that you usually take 10 units of long-acting insulin morning and night,
so that's 12 hours apart and that you're traveling over 6 time zones
okay, so let's just do the math together, so that's time zone 6 divided by 12 that's 0.5
0.9 minus 0.5 is 0.4, multiply that by 10 and you get to your 4 units
so there according to their recommendation
you should only take 4 units, not the full 10
on the plane for your nighttime dose
they then recommend that once you take your reduced nighttime dose,
then you then set your clock to your destination's time zone
and then once you land you're just back on regular schedule
so that means once you wake up in the morning
you're back to taking your regular morning dose
now let's fly west, so this is the recommendation for westbound travel of
5 time zones or more and this is for people using MDI, Multiple Daily Injections,
where the long-acting insulin is split in two doses, a morning and evening dose
the morning of the flight they recommend that you take your full morning dose
at the usual scheduled time and then they recommend that you stay
on your departing time zone, once you're on the plane
and when your nighttime insulin is due that you only do 50% of your usual dose
if you usually take 10 units, then you only take 5, but at the usual time
once you land in your destination
you then switch your clocks to the destination time zone
and when your nighttime dose comes up again
you only do 50% of your scheduled dose
that way you're not getting too much long-acting insulin
and in the next morning when you wake up you just resume your usual
dosing and timing schedule, the recommendation for adjusting
your pump settings if you travel over more than 5 time zones is very straightforward
they recommend that you stay on your departure time zone until you land
then once you land you just change this time on your pump
to the destination time zone
that way all of your basal settings will be, let's say, updated to match the destination
however you do have to remember that some of the insulin pumps
it's recommended that you take them off for departure as well for landing
to make sure that you don't get any
unintended insulin delivery from the pump now that we're on the ground we're at our
destination the next question is how do you then deal with being jet lag
I don't have a good answer for you, unfortunately,
just being honest here
my last trip I went low for a few days after arrival
but usually when I’m jet-lagged and totally time zone confused
I’m actually very, very, insulin resistant and need a lot more insulin
so my approach is that I stick with my usual settings, stick with my usual
carb ratios and my basal settings but I do more finger sticks
or I’ll check my CGM more often
and I’ll do corrections when needed
to help you adjust, I’ve seen some recommendations that say, hey
you should start adjusting your sleep schedule to the time zone you're going to
for a few days before you take off so depending on which way you go,
that'd be like go to bed 2 hours earlier, 2 hours later
it's not really something I’ve experimented with
but it might be helpful and that is how I handle diabetes,
jet lag, and time zone changes as you've probably picked up on
do take a little bit more insulin
than what the clinical guidelines I was describing recommend
and I always recommend that you go by clinical guidelines
and what your medical team suggests to you
I was just showing you what I do,
so again, I do encourage you to discuss any changes you want to make
with your medical team just to be safe
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thank you so much for watching