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[IP] Disconnecting Pump for takeoff and landing



http://asweetlife.org/feature/what-you-should-know-about-flying-with-an-insul
in-pump/

What You Should Know About Flying with an Insulin Pump Melissa Lee | March 04,
2014
 Category: Insulin & Pumps, Travel  119  31.5K  340  32.3K Ive been pumping
insulin for the last 14 years, and I travel frequently.  In fact, Im on an
airplane every couple of months.  I always struggle with my blood glucose
during air travel, and attribute the in-flight fluctuations to the stress of
travel, or the crappy fast food breakfast I probably had prior to boarding
(must have miscalculated those carbs), or even to sheer diabetes randomness.
It was only recently, however, that I learned something critical about insulin
pumps and airplanes, something that I hadnt ever been told  not by device
companies, not by my medical team, not by my online friends.When flying with
an insulin pump, you should always disconnect it during takeoff and
landing.This isnt a US FAA recommendation; this isnt about turning off your
electronic devices. And this certainly isnt because your diabetes management
makes Miss Manners uncomfortable in flight.Its physics.When I was being
trained on my current pump  the Asante Snap  by Asantes Chief Product
Architect, Mr. Mark Estes, he was surprised that I had never been told to
disconnect when flying with an insulin pump. He asked to me to think about how
delicately my ears handle takeoff and landing.Now consider what that kind of
pressure change during ascent and descent do the subtle workings of an insulin
delivery device.The he asked me if I ever experienced baggage claim
lows.Absofrigginlutely.When Im shaking from a low as my husband picks up our
rental car or Im fumbling with glucose tablets in my cab, Ive always just
assumed I dont manage myself as well with the changes to my routine that day.
Ive often claimed that Im always low the whole first day Im traveling.But
there is more going on when Im jet-setting than I realized.Enter every
pumpers least welcome buddy  the air bubble. Your insulin pump (regardless
of make or model) cannot elegantly handle the pressure changes during ascent
and descent and is moving air bubbles and insulin into your body without ever
recording evidence of it.I dont know why this isnt bigger news. Even the
blurbs I could find on the Internet talk about it being an issue for some
children on some pumps and not necessarily for adults. But this happens to all
liquids in flight  from our water bottles to our bodily fluids. Estes told me
that Dr. Bruce King of John Hunter Childrens Hospital in Australia has tried
to bring this to light over the past few years, producing an impressive poster
on the study as well as an abstract.Estes explained two effects of the changes
in cabin pressure and how they relate to our pumps  outgassing (due to
Henrys Law) and expansion (due to Boyles Law):The pressure in a commercial
airline starts at the same pressure as the airport (most of them are close to
sea level, but some, like Denvers airport are at a higher elevation). When
the airplane is flying (typically above 20,000 feet), the cabin is pressurized
to a pressure of about 8,000 feet. This keeps the people on the plane from
passing out (the air is way too thin above 20,000 feet). The difference in
pressure between where they took off to the pressure in the cabin when flying
results in some of the air that is trapped in your insulin to leave the liquid
and form a bubble. This is because, as the pressure drops, the amount of air
that can be dissolved in the insulin decreases. This is called
outgassing.Another example of outgassing is what happens when you open a can
of soda. The pressure change from popping the can open causes carbon dioxide
to leave the liquid quickly and form bubbles. Your insulin is doing this as
the plane takes off, as are your bodily fluids (which accounts for why people
tend to get a bit gassy in flight). So what happens to these bubbles? Where do
they go and how do they affect your insulin delivery?Thats where the second
effect comes into play. The sudden decrease in pressure around the bubbles
causes them to expand. And they have to make room for this expansion somehow,
so they push insulin out of the way and into your body. Theres no record of
the exchange in your pump history, but there you have it  the source of the
baggage claim low. The reason why Ive hailed so many cabs while shaking
violently and chewing chalky sugar pills is an over-delivery of as much as a
unit or more. The effect was observed in both Medtronic and Animas pumps in
the original studies. This affects all of us.So what can we do? That depends
on how sensitive you are to changes in your basal delivery. The average adult,
and certainly the average child with diabetes, is likely going to react to
receiving an extra unit of insulin they werent expecting.I happen to own user
guides for two different Omnipod systems, the Tandem t:slim, the Cozmo 1800,
and the Asante Snap. Out of curiosity, I have also downloaded and read the
user guides for the Animas Ping and the Accu-Chek Spirit Combo, and reviewed
the information about air travel on Medtronics website. With the exception of
Asante (obviously), none of the pump companies recommends disconnecting during
any part of air travel. (Those pump systems with paired meters do recommend
disabling pairing or Bluetooth in flight due to electromagnetic interference,
but none of the companies go the extra step of asking you to disconnect.)I
needed to see this for myself.On several flights now, I have taken a small
bump of insulin (equal to what I anticipate missing while disconnected between
takeoff and cruising altitude) as we are taxiing to the runway. (You could do
this as a tubing prime or cannula prime on most pumps, though on tslim, I
might suggest doing it as a bolus so as not to reset your site reminder, but
keep in mind that delivering it as bolus will include it in your IOB
calculations.)Then I disconnect. I watch that tube and I wait as we climb. My
ears pop and click and adjust and I think about my little insulin pump.When we
reach that 30,000 feet or so and the captain announces weve settled at that
altitude, I check the tubing and voila.  I prime that puppy out. A unit. Maybe
TWO units. Wow.I then reconnect for the rest of the flight.About 20-30 minutes
before landing, when I feel that descent start, I do it again. Take
anticipated missed basal up front. Disconnect. Watch and wait. Estes warned
that the air bubbles may take longer to incorporate back into the solution
once youre on the ground.  SoI know what youre thinking. Nah, my pump
doesnt do this. Go ahead. Conduct your own little physics experiment. I have
tried it on three flights now. I am dumbstruck.And what about the Omnipod?
This is a great question and one I do not have the answer to. I suggest that
you take whatever other precautions you might take if you knew you had a basal
surge coming. Since you cant disconnect, youd want to discuss with your
medical team what the best option is for you in-flight. I experienced these
in-flight fluctuations flying with their device many times, too, so my gut
tells me that its a problem on every pump and not simply a tubed pump issue,
though I have a feeling Insulet would say its not an issue. If its happening
to my water bottle though, its probably happening to an Omnipod.What I can
tell you is that I am going to listen to my ears. And my ears tell me that
something significant is happening to the atmosphere around my body when I
fly.And I am priming that bubble bugger out. Melissa Lee writes the blog
Sweetly Voiced. - See more at:
http://asweetlife.org/feature/what-you-should-know-about-flying-with-an-insul
in-pump/#sthash.BwMlYSKp.dpuf



 Denise D.
.
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