Traveling with a chronic illness

Before departure, a consultation with your referring diabetologist is advisable to check your blood glucose control and insulin administration schedule, if applicable. It is recommended to:

• Have a prescription with the pharmaceutical name (INN) of the insulin and its injection instructions, the pump flow rate schedule (to reprogram it if necessary);
• Knowing what to do in case of hypoglycemia or hyperglycemia with ketosis;
• Have the contact details of a local contact person (check with the French consulate in the country);
• Have enough supplies for the trip (needles, lancets, cotton, disinfectant, blood glucose and ketone meters with batteries, lancing device, urine test strips, insulin, glucagon, replacement pump, …).
• Plan for double the quantities needed and distribute the equipment between several pieces of luggage;
• Be aware that the concentration of insulin when purchased in some countries may not be the same as in France and Europe (100 IU/ml).

Le transport of syringes and needles In the cabin during the flight may be subject to authorization (check with the airline). medical certificate (in English or in the language of the country) may be requested (template on the website of the Aid for Young Diabetics (AJD)).

Individuals using an insulin pump and/or a continuous glucose monitoring device must inform airport security services when going through automatic security gates. must not be exposed to X-rays.

A guide Diabetes at the airport » drafted by the Directorate General of Civil Aviation summarizes the essential points.

A map in French, Spanish and English I have diabetes » can be obtained from the Federation of Diabetics.

Blood glucose monitoring during flight

You should always plan for sources of fast-acting sugars to correct hypoglycemia.

During flight, air bubbles can form in the insulin pump device (cartridge and tubing) due to cabin pressure variations. At takeoff, when the pressure drops, these bubbles can lead to excessive insulin delivery and hypoglycemia during the flight. Conversely, at landing, the pressure increase suspends the air bubbles in the solution again, potentially resulting in reduced insulin doses and hyperglycemia. Therefore, one may need to Disconnect the pump at takeoff, then reconnect it at cruising altitude after purging the air bubbles.and repeat the same procedure upon landing.

Some continuous glucose monitoring devices may also malfunction in situations of lower atmospheric pressure.

Adjusting insulin therapy during travel when crossing multiple time zones (> 3 hours) can be done according to the following principles:

• Maintain the usual injection schedule (using French time) if the length of stay is short (< 3 days);
• For injection therapy, in the case of a longer hospital stay, a basal (slow-acting) + bolus (rapid-acting) regimen is preferable to a mixed insulin regimen for better blood glucose control. Rapid-acting insulin boluses are administered at mealtimes, and the basal rate is adjusted accordingly. Several basal rate adjustment protocols are available.
• If the person uses an insulin pump, rapid-acting insulin boluses will be administered based on meals and blood glucose levels. The pump clock must be kept set to the departure zone time throughout the flight and set to the arrival zone time at the destination. During the flight, program the lowest basal insulin dose previously used.

Blood glucose monitoring during the stay

• During the first few days of travel, monitor blood glucose levels more frequently and adjust insulin doses if necessary;
• Store insulin in a cool, dry place on site. There are cooler packs or insulated bags available for transporting insulin and glucagon. Insulin pens and vials in use can usually be stored at room temperature;
• Adjust doses without stopping insulin in case of diarrhea or vomiting.

• Have an action plan drawn up in case of severe allergy by the attending physician or referring allergist before departure;
• Keep the necessary allergy medication with you. Injectable adrenaline pens do not keep well above room temperatures > 30°C;
• Check with the airline to verify that the allergen in question is not distributed in meals during the flight, and find out the conditions for possessing an injectable adrenaline pen in the cabin;

food allergy cards These forms can be downloaded and completed by the referring physician, to be presented in a restaurant. They are available in French or bilingual English – and in some other languages.

A seizure within the last 24 hours or poorly controlled epilepsy are contraindications to air travel.

• Have a convulsion action plan drawn up by the attending physician or referring neurologist before departure.
• For people with behavioral disorders, discuss with the referring therapist, prior to the trip, ways to contain and manage the anxiety generated by the trip;
• Keep epilepsy medication in the cabin;
• Plan for remote consultations via videoconference with the usual therapist for people with psychiatric disorders that may be exacerbated by changes in habits or stress related to travel;
• When transporting people by vehicle on site, provide suitable equipment for people with neuromuscular disabilities.

Individuals for whom a specialist consultation is warranted before departure include, in particular:

• living with HIV (PLHIV);
• hyposplenic or asplenic;
• solid organ transplant recipients;
• having received a hematopoietic stem cell transplant;
• undergoing chemotherapy or radiotherapy for a solid tumor or malignant hematological disease;
• treated with immunosuppressants, biotherapy or corticosteroid therapy for an autoimmune or chronic inflammatory disease;
• presenting with a congenital immune deficiency.

Increased vigilance must be exercised regarding:

• The risk associated with certain infectious diseases in people living with HIV (leishmaniasis, salmonellosis, tuberculosis, infections due to intestinal coccidia, histoplasmosis and other fungal infections contracted by inhalation, etc.);
• The need for hygiene precautions, particularly regarding food;
• Vaccinations: recommendations should be adapted according to the type of immunosuppression;
• Drug interactions between background treatment and medications prescribed for travel;
• The risk of photosensitivity caused by sulfonamides which may be prescribed as prophylaxis against opportunistic infections in HIV-positive individuals with immunodeficiency;
• Sun exposure is a risk factor, as immunocompromised individuals are at higher risk of skin cancer. Sun protection (clothing, hat, and sunscreen) is strongly recommended.

The main contraindications to prolonged travel for individuals with sickle cell disease are:

• more frequent vaso-occlusive crises,
• acute chest syndrome in the preceding months
• recent history of stroke,
• uncontrolled priapism
• the combination of several chronic complications,
• untreated pulmonary arterial hypertension,
• a recent worsening of anemia with signs of poor tolerance,
• the pregnancy
• any recent destabilization of the disease.

Travel on unpressurized aircraft is not recommended.

Heterozygous subjects (AS) or "carriers of a sickle cell trait" have no contraindication to air travel.

Before departure, the following are also recommended:

• Particular attention should be paid to PPAV measures, malaria chemoprophylaxis, and vaccination recommendations related to functional asplenia. Hydroxycarbamide (hydroxyurea) at the doses prescribed for sickle cell disease is not a contraindication to yellow fever vaccination;
• hyperhydration orally in the 24 hours preceding the flight (3 L/m²/day) and during the flight (0,15 L/m²/hour);
• possibly an injection of low molecular weight heparin before the flight (sickle cell disease being in itself a pro-thrombotic state);
• or even a transfusion in the week preceding the flight if the anemia is severe.

If the patient is involved in a transfusion exchange (TE) program, the duration of the trip should not exceed the time that usually separates two TEs.

During the flight, it is recommended to:

• Wear loose and sufficiently warm clothing, due to the air conditioning.
• Wearing compression stockings is possible from adolescence onwards.
• Avoid prolonged sitting.
• Have painkillers in the cabin in case of a vaso-occlusive crisis. The transport of opiates, sometimes necessary, is subject to authorization (check before departure);
• to be in possession of a medical certificate in order to be able to request oxygen on board in case of bone or chest pain, or in case of dyspnea (it is not justified to systematically equip the patient with oxygen for air travel).

Destination:

For people with sickle cell disease, the primary risk of traveling abroad is infection (consult a doctor if you develop a fever). Scuba diving and stays at high altitudes are contraindicated.

Cabin pressure during a flight is usually regulated to be below 8,000 feet (2,438 m). This value corresponds, according to the hemoglobin dissociation curve, to the point at which arterial oxygen saturation remains > 90% in a healthy individual. People suffering from chronic respiratory disease may experience a decompensation of their cardiorespiratory condition during a flight in relative hypoxia.

Un hypoxia test Oxygen therapy may sometimes be considered before departure for these individuals: if oxygen saturation (SpO2) drops below 85%, oxygen is necessary during the flight (the flow rate is generally 1-2 L/min). When SpO2 drops to between 85% and 90%, oxygen therapy during the flight can also be discussed.

Other indications can be discussed upon specialist advice.