#507 Diabetes Variables: Travel

July 14, 2021Scott Benner

Diabetes Variables: Travel

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends and welcome to Episode 507 of the Juicebox Podcast.

Back again with another diabetes variables episode means Jenny's here, and today we're going to talk about traveling. That is a variable. You know, I asked the Facebook community Juicebox Podcast type one diabetes, for a list of things that impacted their blood sugar, they came up with over 150 of them. Today, Jenny and I are discussing number three, travel and travel time, the world's open back up, it's warm outside. Many of you may be heading off in your car or an airplane or other ways that you travel. We thought this would be helpful for you. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, always consult a physician before making any changes to your healthcare plan. or becoming bold with insulin. For those of you who are right now thinking can long car rides my kids blood sugar goes up. Wait a minute. Yeah, that's traveling. Now you're interested. It comes Jenny.

This episode of The Juicebox Podcast is brought to you by me kind of and I want to tell you about my thing. That back in Episode 210 of the Juicebox Podcast. I started making episodes called diabetes pro tip with Jenny Smith. These are ideas from the podcast that you hear, you know sprinkled about in different episodes condensed down in one place. These are management conversations. So I'm going to tell you about them very quickly. Episode 210 diabetes pro tip newly diagnosed are starting over. You may have just heard Dr. maltz talk about it in Episode 506. I think after that to 11. All About MDI to 12 all about insulin to 17 Pre-Bolus ng to 18 Temp Basal to 19 insulin pumping to 24 mastering a CGM to 25 bump and nudge to 26. The perfect Bolus to 31 variables to 37. Setting basil insulin to 56 exercise to 63 fat protein to 87 illness injury and surgery 301 glucagon and low beegees 307 emergency room protocols 311 long term health 350 bumping nudge Part Two 364 pregnancy 371 explaning type one two others 391 the glycemic index and load 449 postpartum for 70 weight loss. I am incredibly proud of this series, it is completely free. You can go back and listen to it in your podcast player right now. Or you can find it at diabetes pro tip.com. You can also get to it through Juicebox Podcast calm. And now I'm going to read your review. I saw a mention of the podcast and one of my Facebook groups. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years, I wish I had been more proactive in finding this information sooner. I'm going to recommend this to my endo. That's a podcast review from Apple podcasts, diabetes pro tip calm. My son was diagnosed with type one about five months ago, I've learned so much from just the pro tips. And I will be listening to all of the other episodes. This podcast is amazing both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel as Scott correctly describes the feeling of type one diabetes and more like you can find ways of keeping your loved ones happy and healthy. Also from Apple podcasts. They're real reviews. You can read them at diabetes pro tip.com. I am not a doctor. This is not advice. But I think if you listen to those episodes, your life will get better. It'll get healthier, it'll get happier, it'll get easier. At least you've got a great shot of that happening. If you don't believe that. Go back and listen to Episode 506 with Dr. Meltzer because she believes it and I do to travel elevation or exercise you pick.

Jennifer Smith, CDE 4:48
Oh, what about travel? That's big right now.

Scott Benner 4:50
Okay. Well, I I just flew on a plane. You did. It felt a little weird. I'm finally breaking a rule. But it wasn't a it was it was fine. I mean, I'm vaccinated. I didn't think I have to admit I didn't think much about it. But my son had to go cross country to work out for baseball. And he was staying for five weeks. He's still actually there right now. And I just was like, Look, I'll come with you. It was all very nebulous. The place is great, where he's working out, but all the pieces around it, like, Where do you stay? How do you run a car when you're 21? Like, I just felt like, if I sent him out there by himself, he would have called four days later crying from the airport and being like, I don't know what happened. Yeah, so I'm like, I'll go out with you. I'll get you set up, and then I'll come back. So the first thing that I think about, I mean, we're gonna do air and like ground travel, right, like, we'll talk about cars and flying. So start with flying. The first thing, the only thing I think about about flying is that people talk about the air pressure, pushing insulin through their tubing and giving them insulin that they don't mean to get. That's the thing I feel like I used to hear about all the time, but we've flown with Arden a million times. And I've never once thought of flying as any different than any other sedentary situation. So I might be the wrong person to ask, but what do you say?

Jennifer Smith, CDE 6:21
So it's a it's a known while, it's a known issue. While there's no real at least, I haven't found any as of yet, there might be something out there that I haven't seen. But from a tube pump standpoint. We advise people based on people's anecdotal information about what they've tried. I mean, they're even photos online, if you look at people have used tube pumps have flown and done their own experiment in flight or before, during or after kind of thing, what they've done is they've taken pictures of their tubing. From a pressurization standpoint, on ascent and descent, there's a pressure shift. And that can either push insulin out, meaning the reservoir actually pressurizes enough to push insulin through the tubing and give an infusion of an extra almost like a Bolus. Or the pressure can pull insulin, sort of the reservoir in making the insulin from the tube sort of retract into the reservoir inside creating a bubble in the tubing, which means then you would miss insulin, as it's being pumped out if you didn't realize what could be going on. So we typically advise on ascent and descent essentially just disconnect from your tube site. Once you get to cruising altitude, or once you land essentially reconnect to or take a peek at your tubing to begin with. If there's any bubbles there, purge them out. People with two pumps know how to do that, purge it out, pop it back in and go ahead about your business. In both regards, then you're not only going to not miss a dose of insulin from a bubble, but you're also not going to get a push of extra insulin, that the pump doesn't register as a Bolus. You don't visually see that in your pump, insulin dosing history, right. So those are tube pumps. Omnipod is it seems different. There's no tubing obviously. That's the reason a lot of people use it, which is great. And I, I have had only I'd say less than a handful. From what I can remember in counting to people that I've worked with, who've noticed because they fly often enough that they've noticed a definitive difference in their blood sugar during flight as well as after flight. Where and these are more lows. They're not highs, but they are lows. One woman who religiously flies first thing in the morning, she doesn't eat any food. She's got her settings, well in place. And mid flight depending on the length of the of the flight, it seems like mid flight she ends up having a low blood sugar. Now is it because she walked a lot at the airport while she was there and didn't realize it. I mean, we've looked at all of those pieces in terms of travel for this individual. But what she actually chooses to just do Is she has a snack as soon as she gets on the plane and she doesn't cover it.

Scott Benner 9:37
So for whatever reason, she just thinks there's something happening a variable that is basically Pre-Bolus thing me, I'll just I'll

Jennifer Smith, CDE 9:46
just take care of it. Exactly. Now after flights, people of all pump you know types can sometimes have like baggage claim lows. That's kind of what I refer to them. You know, if you haven't disconnected your tube pump, you could have gotten a kind of a pulse out of insulin. And now you're traveling through the airport who knows how long depending on the size of the airport, you're kind of walking around a little bit more after flying and moving your legs. You could technically have a low walk into a taxi, you know, stand to pick something up. All of those could be variables in the mix of travel. They may have nothing or something to do with potential extra insulin. Yeah,

Scott Benner 10:27
you're lifting things and you're right tussling around, there's a lot of pressure. By the way, did you get a parakeet or is that a bird outside of your window here?

Jennifer Smith, CDE 10:35
Oh, those are birds outside? Yeah. Oh my god, I would never I don't I don't do birds.

Scott Benner 10:40
No birds in Jenny's house. over to my house. No, I've got cats fish dogs. As crazy as it sounds. Maybe I see diabetes everywhere. But I when I flew with my son out west, we were waiting. It was an It was a nighttime flight was my first experience of flying with the sun. Which was very strange, because we took off here around 630. And it never got dark outside of the plane. And so you know, you're tired. But your brains like No, dude, it's seven o'clock still. And you're like, ah, and so we get there, we're standing at baggage claim. And there's a girl there. She's a mom of a little kid less, maybe two years old or so. But the the woman's I call her a woman. But she felt she felt young to me. She was like in her 20s. And she had a pump on with tubing. And the entire time we stood there waiting for the bags. I felt so parental towards her. Like I never talked to her spoke to her. But I just thought of the whole time because the kid was fussing, we'd all been on a long flight. She's kind of wrestling holding on to the kid. I just kept thinking like,

Jennifer Smith, CDE 11:44
Is there something I could do to help you I could help you. If you

Scott Benner 11:47
want to check your blood sugar just like I just, it's all I could think I started talking to my son. So I stopped paying attention to her. But she was fine. So okay, so the air pressure thing aside from flying is the next idea of travel is being sedentary, right? Correct. not moving around, can make your blood sugar go up.

Jennifer Smith, CDE 12:08
It can and are typical is a recommendation for if you're using a pump to increase using a temporary basil, somewhere between 10 and maybe 30% extra for the duration of time of sedentary travel. So in this kind of goes for both air travel, train travel, you know if you're taking a boss, if you're taking a car, whatever it might be, but sedentary more than about two hours, typically needs more basil at least insulin,

Scott Benner 12:41
right? Yeah, well, so So now so you have steps here. Then if you're using a two pump and you're going to fly, you disconnect, you take off you get up to cruising altitude, you purge the the line of air hooked back up again and then start with some sort of an extended basil and increased Temp Basal, to address the sedentary nature of you just sitting about. That's it. Alright, typically,

Jennifer Smith, CDE 13:03
that's about right. I mean, usually for me, I've found that where I need extra, because we know how long it takes that temporary rate to kind of get circulating. I tended to find a need to increase it while I was sitting and waiting for the flight to kind of come in so that we could get on

Scott Benner 13:23
a flyer. You're not a nervous flier or you know, I like flying. Yeah, it's so relaxing. I love the idea of like not there's nothing I can do about my situation. There's something very freeing about it.

Jennifer Smith, CDE 13:35
Yeah, but I like sitting in the airport watching people that's the like, I do I was I always bring a book along. I never get to reading my book until I actually get on the plane. Because I'm I like watching people and people are interesting.

Scott Benner 13:49
I have I'm going to tell a story at the end of this but so So interestingly enough, now you disconnected to pump get up to fly altitude, purge, reconnect, do your Temp Basal increase so that you don't get high during the flight. But then do you do a Temp Basal decrease like right before the flight stops? So you don't have the baggage check thing? Or do you just throw some food in your mouth as the plane hits the ground? Do you think?

Jennifer Smith, CDE 14:10
No, usually I recommend setting that Temp Basal increase for like three quarters of that travel duration kind of so that by the time you get to the descent, which can take some time, once the you know the pilots like we are going to start descending into wherever it may be, right? I mean, it could be a little bit of time. So I usually say that's a good cue if you didn't set your Temp Basal to run a certain period to just stop that Temp Basal increase, right.

Scott Benner 14:38
So I do and I disconnect my two pump for the descent as well. Okay, yes. All right. So

Jennifer Smith, CDE 14:46
I'm shaking my head and then realizing that nobody can see me. Yeah, do

Scott Benner 14:49
Jenny please, please respond with words. Okay, so here's my quick airport story. I went to Dallas to speak at a thing. It was a Very quick in and out, I don't want anybody to feel bad for me but I'm basically I'm cargo get any mean like they shipped me down I get stuffed in a car I show up, I clean myself off put on clothes that I look better and stand on a stage talk like a lunatic for four hours. And then somebody goes your cars here and they take you back to the airport and jam. And so I'm sitting at the Dallas airport, I'm wrecked, right? It's only been 36 hours since I left my house and I'm already going home. And talking takes I know it's maybe it's think it comes naturally but talking and thinking like it takes a lot out of you. So I'm sitting at the airport still on the clothes that I presented in thinking, just rest up enough to go into the bathroom, and change it to something comfortable for the for the flight home. That's I've got my headphones in, I'm trying to relax. And this woman if she's listening, she was lovely. I can see her from across the terminal. She is coming at me. Like and she's walking with a lot of purpose. And the closer she got, the more I thought wow, I think she's really coming over to me there are a lot of people there. So I started taking out like my my earbuds. And I was I've made eye contact with them like Hi, how are you? Can I help you? Like, but what I'm really thinking is don't murder me in the airport. Like cuz I don't know, like, I don't know what's happening right now. And she goes and

Jennifer Smith, CDE 16:18
you're tired. Your brain isn't working.

Scott Benner 16:21
I'm like, What is she goes, are you Scott? And I was like I am. And she goes, I love your podcast. And so and so my brain just goes through? Well, she was just that the thing. I said, Did you just hear me speak? And she goes speak Where? And I'm like, Wait, you're not here for the thing. And she goes, No, I'm here. I think she said her daughter was an attract meet in college, they flew into sere. And I was like, so it's coincidental that we're sitting in the airport together. And you know who I am? And she was like, Yeah, and I was like, Oh, I was so freaked out, you know, like really, really, really freaked out. And she said a lot of nice things. And it was lovely. And she walked away and I and etc. But I never like you don't start a podcast thinking one day across the country, somebody will recognize you and identify you. But there I was back in New Jersey, in the little bus going back to where my car was parked and talking. And this woman turns to me and she goes, are you Scott? And I was like, wait, what's happening? Why is this happening again? She was I recognize your voice. I love your podcasts. I was like, Ah, so it's very, very, very strange. But generally speaking, I'm a heads down flier usually,

Jennifer Smith, CDE 17:33
are you you

Scott Benner 17:34
don't really I just put my earphones on. And I kind of keep my I do look at people, because it's fun. But you know, then I'm sure they're also looking at me going like picking this guy's stupid headphones on not paying

Jennifer Smith, CDE 17:45
I found I've found that, especially with the amount of people that I work with and talk to and like the different personalities in travel. I've, I've got kind of a good personality filter. I've found, like interaction wise, you kind of you learn how to talk to certain people and interact and whatnot. And that's kind of the traveler that I am you. You get this like almost Sixth Sense feeling about people that really could be a good interactive like discussion. And other people who are like, nope, they sit down, they get their book out, they put their headphones on, you're like, yeah, I'm just gonna leave you alone.

Scott Benner 18:25
I was sitting next to a woman in the terminal. And then we took a five hour flight. And then an hour and a half later, I'm standing at a train station. And she and I are the only ones there. And I just looked up at her I went it's weird that seven hours ago, we were sitting next to each other across the country. And now we're standing here and she goes, I was just thinking the same thing. And we had a nice little conversation. Listen, the truth is if I'm not tired, I will talk that I love talking. I will talk to anybody my son's like, Why do you talk to people you don't know? And I was like, I don't know, man. Like we're not alive that long. Like, let's write what's the point? And he does it. But he doesn't think he does it. Oh, never pointed out to him. But that's funny. Yes. I don't say anything. Okay, so what do you hear all the time from people? I put my kid in the car and their blood sugar shoots up. It's not the car though, right? It's that you have this little thing that moves around like a ball of kinetic energy. You've got it and now you're making it sit in one spot and it stopped and now suddenly the basil that works while the kids super active is not enough for while the basil for while the child is is steady. But does that happen to adult? I guess that would happen? It does. Yeah.

Jennifer Smith, CDE 19:33
Yeah, absolutely. I mean, we used to live down the east coast, we would drive up from DC up to New York or whatever, which is a long enough drive, especially depending on traffic that I always found I needed a Temp Basal increase to accommodate for that. I also found as I do with a lot of the people that I work with that food, if I mean if you're used to a Pre-Bolus that's 15 minutes. I found I needed longer. Yeah, it was just that sedentary nature that really like, was horrible. So yeah, and with the shoot up for kids, I think sometimes it might be anticipation of what they're going to do, right? I mean, if you're living someplace that you're going to take this awesome vacation, once you kind of get there, and the child knows about it, they get in the car that's like, that's like adrenaline. They're like, excited, or they're going to go and spend a week with their favorite grandfather or grandmother or whoever it might be. They know what they're gonna do. It's like, all of this energy that's now like, sitting. Yeah, and they can just run it out. So it goes up.

Scott Benner 20:45
Now it's the same thing. You know, Arden's insulin needs can go up or down, depending on if she's like in school, or virtual, just like she's even just the walking around the hallways. My mom's in her mid 70s. And she told me the other day, that she hasn't been able to sleep during the pandemic. And then she got vaccinated. So she's out again, moving around. She's like, I sleep so much better now. And I'm like, Yeah, well, you're exercising more. And she's just like, I had to talk her into believing that that was true. Like you're moving around more you've expelling your energy at the right times a day, when it's time to sleep. You don't have extra energy. And she's like, no, we're just sitting right here. We're just sitting there. It's, I mean, listen, movement of some kind, everyday is super important. And children do it so naturally, that you don't notice it as being part of there. Unless you have a boy who's just like constantly throwing trucks against the walls, then maybe you're aware of it. But But um, he kids are like little mini tornadoes. And then yes, I'm still listening is a car ride across town, like 15 minutes. That's not if you're talking about a long travel situation. Yeah, seated in a car,

Jennifer Smith, CDE 21:52
which is why we usually say, like, defining time, which is what most people want, how long should I expect? You know, a need to change something for is it 15 minutes? Is it an hour, we usually say two hours or more, you're gonna need extra insulin.

Scott Benner 22:10
So all of this really, you know, my mind, in my mind, it's just being flexible. It's noticing something happen. noticing it before it's a problem. And just, I don't even care why it's happening. Like that's almost why some of these conversations are so interesting to me, because I was like, I didn't realize that, if because if I put Arden in a car for a long time, their blood sugar started going up. I wouldn't even care what the variable was. I just be like, she needs more insulin. I don't and I don't argue about it. I just give it to her.

Jennifer Smith, CDE 22:35
Right. But the prep for them for the next time gives you some hindsight to say, this is what happened last time. Yeah, I can do it. Let's do better job this time by attacking it before it happens. Yep.

Scott Benner 22:47
Okay, so I'm excellent. I want to thank Jenny Smith, so much for lending her Sage like wisdom to the Juicebox Podcast. Don't forget Jenny does this for a living and you can find her at integrated diabetes calm. You know, I also want to thank today's sponsor me. Actually, I just want to remind you that the diabetes pro tip series is available right now in your podcast player, just hit subscribe and go to Episode 210. I listed them all for you at the front of the episode. But they're also available at diabetes pro tip calm, which is also accessible through Juicebox Podcast calm. Please try the diabetes pro tip series. As always, is completely 100% free. It's not like I give you some of the information and the good stuff is locked up somewhere behind a paywall. That does not happen on this podcast. Everything is free for you. The show is always free, it is ad supported. And so it is free. Understand I don't have to charge you for content. The content is yours. Share it, use it. It's for you.