Traveling and Humalog

Continue to take your 2 shots of long-acting insulin 12 hours apart whether or not this falls at typical lunchtime or bedtime (this won't be the case when you cross major time zones). Give yourself Humalog whenever you eat (this is usually frequent on long flights). If you find you are running high between meals give yourself small extra doses of Humalog (say 1-2 units). When you get to your destination gradually adjust your 2 shots of long-acting to conform to the local lunchtime and bedtime. Within a day or two you will be stable.

Insulin Adjustment Software

In collaboration with a young computer programmer who has diabetes and who is also my patient I have developed an insulin adjustment software that runs on IBM compatible computers. It is a DOS based program but does run very well on Windows or Windows 95/98. I would be happy to give you a copy of this software which will make specific suggestions about insulin adjustment. This software will automatically make the most appropriate suggestion.

Driving/Operating Machinery and Diabetes

If you have a severe low while you are driving or operating machinery there is a risk of injury or death to you or others. It is therefore your responsibility that this never happens. You should never drive a car without knowing what your blood sugar is within the last hour or so. If you have had a recent severe hypoglycemic reaction you should test immediately before driving. You should not drive with a blood sugar under 4.5 (under 6 if you have hypoglycemia unawareness, or recent severe low) and you should always carry snacks with you to treat yourself. If you are driving long distances you should stop every hour or two to test your blood sugar. If you have motor vehicle accident with a low blood sugar it is likely that the SuperIntendent of Motor Vehicles will temporarily rescind your driver's licence. This will necessitate re-certifying through the Diabetes Centre and may cause you to lose your job if it requires driving.

International Travel and Insulin

There is no single or correct way to adjust insulin during long distance air travel, particularly when major time zones are being crossed. In general, the best approach is to continue taking your 1 or 2 shots of long-acting insulin so that you at no time produce ketones. It is best during this sort of travel to take a shot of short-acting insulin before each meal basing the dose on the same criteria mentioned above - size and nature of meal etc. In doubt it is safer to take frequent very small doses of short-acting insulin (taking extra insulin according to a sliding scale every few hours) rather than guessing and giving yourself too much insulin and running low.

Intercurrent Illness and Insulin

During intercurrent illness (colds, flu etc) your body will be less sensitive to insulin and you will therefore require more. The simplest approach is to take the usual amount of long-acting insulin, to test more frequently and to use the sliding scale mentioned above but to give 1 or 2 units more than you would usually give at any one time. Providing you test frequently and do not develop ketones (see below) and give yourself insulin the chances of a significant problem are very small.