Insulin adjustment and time zones

Hi,

Firstly i'm very jealous your jetting off to Oz, have a great time!

It's lucky really your going from the pump to injections! as you wont have any insulin to interfere going back to MDI.

Your plan sounds pretty good, that's definately how I would do it. Makes sense to start the dosage to match a suitable time in Oz.

Remember as were shivering over here the ozzies are sunning it up, i assume you will be calculating your required lantus dose from your total daily dose of insulin on the pump, so if i were you i'd probably underestimate to compensate for the weather, then increase if required. Also running around the beach like a looney (thats what i'd be doing) is likely to reduce your insulin needs too.

Have an awesome time!

Hi Kazzabon!

I've been to Japan twice (and hope to go live there in the next year or so) and while I've been finding out more about healthcare there, I have had a few people ask me exactly this sort of question. Here is one of my replies (I've made the particular bit of interest bold):

Hello! I'm more than happy to give advice if it can help..! I know how daunting it can be but it is do-able! ^_^

I am on Levemir and Humalog. Levemir lasts about 10-12 hours for me so I have to split dose across the day. With this knowledge, I have a rough idea on how long I can leave before taking another Levemir injection.

On that note, in a way I'm thankful that Japan is about 9 hours in front of the UK because it means that when I get the flight over (which I think was about 15 hours or something the last time I went), I sort of just turn my day upside down - my morning levemir injection time (7am in UK) becomes my evening (9am in Japan) and vice versa (9am UK, 7am Japan).

I didn't manage to establish what was best when it came to deciding what was the better one to take on the flight though - so I played it safe and took my smaller dose which is my morning one (I usually take 10 in the morning and 17 in the evening).

Obviously, humalog is my fast acting for food and is designed to work for 5 hours max (so I check myself again after 5 hours to see what my insulin did). If your friend finds that her sugar levels rise during the flight (after all, your body is being confused anyway), it can work out okay to take some fast acting insulin in help cope with the situation.

In the UK, we have a course called DAFNE and I'm not sure what system your friend uses in comparison so there's some detail I won't go into (like, how much to correct by) because I know everybody is different when it comes to their body's response to their insulins.

Hope I've helped.

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To me, you sound like you know what you're doing so I'm sure you'll be okay! My initial advice about this was from one of my diabetes team back in 2007 and with the added understanding I've got from the DAFNE course I've done, I've managed to keep even better tabs on what's happening. Kept the sugar levels somewhat reasonable anyway!

Have a lovely time!

Kazzabon said:

Thanks for that Ebony. I kept looking at my working out wondering whether it made sense.

I usually have to up my basal from the pump from around 17 to 22units of lantus. But, I'll test test test......well, that's what I'm telling myself! Oh and should I mention I'm going for 3 months or is that just cruel :wink:

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Always a good plan, lots of testing so you get to grips with it all quick then you've got nothing to worry about! Going abroad is always a little worrying with diabetes but if you keep a close eye on your BG's you should be sorted!

Oh, that is very very cruel! (even more jealous!) Going to Oz is definately on my to-do list!!!

Have a great time, hope you still find time to visit us!

When I've gone to NZ before I would just treat the duration of the flight as being a very long night, I was on slightly different lantus doses for am and pm. Then bolus approximately as per normal for the duration. On arrival though I'd still not switch to NZ time until I'd had a good nights kip first, like don't be landing at 9am and think that it is a normal day, it's not.

Depends on flight times and what you normally do of course. I was just aiming for keeping a limited basal level and then correcting with boluses as needed for the flight and first day or so. Then you are into their time zone so just switch.

Not done a long flight since being on the pump yet, but would expect I'd reduce the bolus for the duration of the flight, and then change the date/ time on it once landed. Again with a few tests to see what is actually happening.

Hi all,

I too am flying out to Australia for Christmas (yes, I know I am very lucky!). I'm on MDI, levemir basal but I take a 17:83 ratio am to pm, i.e. I take 4u in the morning and 20u in the evening. I fly out at 2010, when I'd usually take 20u. However I land early morning GMT in Dubai, have a three hour or so wait and then fly on to Oz, taking off at nearly the normal GMT when I'd take my 4u in the morning. This seems okay up to now.

However, after a 14hr flight, I then land early morning in Australia, but because of the time difference that's about the same time that I would be taking my evening 20u dose if I had kept to GMT.

I'm slightly concerned about taking too much in the 'morning', as I have found that if I take 5u in the morning, I hypo at lunchtime and in the early evening. My initial thought was to reduce to about 2/3 total dose and top up with bolus as needed, but I’m in a bit of a quandary about how to migrate my doses to the right balance at the right time. My HbA1c is 5.9%, brought up from 5.2% in May but my consultant wants me to raise it a bit higher as I'm having too many hypos.

Where I will be is ten hours ahead of GMT. Plus I'll have a nearly three year old and two in-laws in their early 80s taking their longest ever trip to deal with!

The only other option I reasonably think of is to take the first 20u dose and the second 4u dose as normal then leave the 2nd 20u dose for an additional 10 hours and take it in the evening, local time of the first day and accept I'll run high for the longer leg.

Any thoughts?

Bumping this in an attempt to guilt someone into offering some advice!

Am thinking I will have to miss my evening dose during the second leg and wait until evening time local time when I land and top up with bolus.

Wow, I have no idea what I'd do to change my son to another time zone. I kind of think I'd start moving my long acting an hour or so each day prior to leaving. I can't say it has been warm here the last couple of days. I'm in Queensland and it has been raining and only 15 deg C yesterday but back up in the low 20's today. Hard to say if we are going to have a hot Summer or not. Last year we had floods so hoping that doesn't repeat.