What You Should Know About Flying with an Insulin Pump

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Flying with an Insulin Pump

I’ve been pumping insulin for the last 14 years, and I travel frequently.  In fact, I’m 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 hadn’t 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 isn’t a US FAA recommendation; this isn’t about turning off your electronic devices. And this certainly isn’t because your diabetes management makes Miss Manners uncomfortable in flight.

It’s physics.

When I was being trained on my current pump – the Asante Snap – by Asante’s 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 I’m shaking from a low as my husband picks up our rental car or I’m fumbling with glucose tablets in my cab, I’ve always just assumed I don’t manage myself as well with the changes to my routine that day. I’ve often claimed that “I’m always low the whole first day I’m traveling.”

But there is more going on when I’m jet-setting than I realized.

Enter every pumper’s 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 don’t know why this isn’t 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 Children’s 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 Henry’s Law) and expansion (due to Boyle’s 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 Denver’s 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?

That’s 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. There’s no record of the exchange in your pump history, but there you have it – the source of the “baggage claim low.” The reason why I’ve 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 weren’t 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 Medtronic’s 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.

Flying with an Insulin Pump - Airplane Tubing Pre Takeoff

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 we’ve settled at that altitude, I check the tubing and voila.

Flying with an Insulin Pump - Airplane Tubing Cruising Altitude

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 you’re on the ground.

Flying with an Insulin Pump - Airplane Tubing Landing

So…I know what you’re thinking. “Nah, my pump doesn’t 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 can’t disconnect, you’d 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 it’s a problem on every pump and not simply a tubed pump issue, though I have a feeling Insulet would say it’s not an issue. If it’s happening to my water bottle though, it’s 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.

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Comments (43)

  1. Kim at

    Fascinating! I always thought it was a stress thing, but now you have me wondering if my in-flight highs are because of this very reason. Thank you Melissa!

  2. I am DEFINITELY going to conduct my own experiment next time (with my Minimed 723.) It’s like, I run high the entire time I’m on the plane in the air, then come crashing down later in the day on the ground – not necessarily at baggage claim, but close enough!

  3. physicist at

    To the extent that there is an effect here, the additional insulin would be delivered between takeoff and reaching cruising altitude and a commensurate under-delivery will occur between cruising altitude and landing.  If there would be a low, it would occur during the flight (depending on the flight length).  If the flight isn’t that long then getting a little extra insulin on takeoff then removing it at landing shouldn’t have a big effect on you.  I think stress and carb estimation are much bigger sources of variation.

  4. Catherine at

    This is fascinating. I always assumed that my in-air highs and baggage-claim drops were a result of sitting still for hours while eating crap. But I’m a little confused: when I fly, I find that my plastic water bottles are all sucked in when we land (as if the air re-compressed). So while it’d seem like in one situation (take-off?), the expanding air would be released from the insulin and form a bubble, in the other situation (landing?) whatever air that’s in the tubing/insulin would be recompressed, and thus would basically suck air back *into* the tubing. By that logic, it’d seem that the lows should happen in-flight, when you get that extra insulin bump caused by the expansion of the air, and the high should be after you land, when extra air is sucked into the tubing and you miss a bit of basal. But am I getting that totally backwards?

  5. Mike F. at

    Really interested to know how this affects the TSlim.  Obviously what is in the tubing is affected by these principals, but what about the reservior?  Since it is an “air pressure” based.  

  6. Excellent article, Melissa! THANK YOU. 
    And now I know what I’ll be doing pump wise next time I’m flying the friendly skies~ 

  7. This is wonderful information, Melissa! I am going to do my own experiments. This is like a great secret. Thank you for sharing! 

  8. Colleen Nordgren at

    We do a lot of traveling by car over different altitudes. Our son ALWAYS goes high then low. I wonder if it is the same principle?? 

  9. Jen T at

    This has been happening to us for the last 3 years, every time we fly with my daughter.  I’ve mentioned it to friends and they all think I’m crazy.  It is now my advice when someone asks about flying.  Unhook at take off AND landing, only plug back in when you are at cruising altitude and safely on the ground.  I was starting to think we were in the minority so THANK YOU for not only explaining it but reassuring me that I’m not crazy! haha

  10. Ivy at

    Ah!! Makes sense! Thanks for posting this Melissa!

  11. Tom Clark at

    I’m a little confused. I understand the explanation for over delivery on take-off but while landing shouldn’t there be an under delivery? Go to this link:
     http://www.healthcommunities.com/travel-health/air-travel-insulin-pump-concerns.shtml
    I think the comment by physicist was getting to this point.

  12. Al at

    Great thinking, but unfortunately you’re missing an important point!  The difference between being connected and disconnecting your tubing is that you are opening an otherwise closed system.  Only due to the hole at the end of the cannula you allow the air to flow in and out of the catheter (also true for Dr. King’s experiment where the cannula was open to ambient air pressure).  The air pressure is the driving force behind it, that’s true, but the point is, where there is no hole there is no chance for the air to get in or out of the tubing.  Your analogy of the soda can is perfect – when you OPEN the can, the gas forms bubbles and gets out.  But as long as the can is closed, there is no bubbles…
    Now, there could still be an effect, if the pressure increase during descent would “compress” your tubing (like flight socks) and push insulin into the (softer) tissue that is in your body.  I don’t know whether that’s possible, but in a little experiment trying to press as hard as I can with my fingers on my tubing, I see absolutely no insulin coming out of the cannula.

    You can find a response from Dr. Irl Hirsch to Dr. King’s article here.

    Ohh – what about your ears?  Well, open system again, the air gets in and out of your ear cup and presses on the eardrum, is all.

  13. Kyle at

    I use an omnipod and fly multiple times a month with no issue.  I fly in planes as well as helicopters that usually fly at ~10,000 ft.  I have never noticed a change and track my blood sugar with a Dexcom CGM.

    Al, you are missing that there are always dissolved gases in fluids.  The point is that when the pressure changes gas will come out of solution and form a bubble no matter if it is open or closed.  

  14. Mark Estes at

    Al,

    You would be correct if the pressure in your body was different from that of the room you are in.  It is not.   The end of the cannula and your sub q tissue is at ambient pressure (i.e the same pressure of the room you are in).   There is no ‘opening’ that occurs when you detach as it is already effectively open. Subcutaneous t tissue offers such little resistance that it may as well not be there in terms of causing a pressure difference. Were there any back-pressure or closure as you describe, a pump system would be able to detect when sets fall out or are are left disconnected.  Sadly, this cannot be done. 

    Tom Clark and Physicist,  you are correct in that over the complete cycle, the net delivery change is 0.  The issue is that there is potential for more than a unit of unintended delivery due to takeoff.  So, depending on the insulin sensitivity of the person and the duration of their flight, this can drop the glucose in some cases.   It is all a matter of timing and sensitivity.   

    Colleen,  yes the same thing happens with any significant  elevation change  or air pressure change.   The difference is that  it happens much more slowly in a car or on foot.  So, rather than that over delivery being in the space of a minute, it is over a few hours and thus will have less of an impact relatively speaking.    Weather is generally also too slow to worry about.     

  15. margon at

    So what exactly should be done by those of us using the Omnipod?

  16. Al at

    @Kyle – this is starting to be fun!  🙂
    Of course you’re right that it is to be expected that there is some gas dissolved in the insulin.  I did spare the audience that fact, as I did the calculation (using Henry’s constant for CO2; assuming room temperature and 1atm present when you fill the cartridge) and came to a volume of gas equivalent to 0.2U of insulin which is dissolved in a full pump cartridge. So unless I made a mistake (my physics class is a long time ago), I consider the effect of outgassing is negligible in this case.
    Hence, my question – where do the 1-2 units of air come from that Melissa and others observed?  If they’re not introduced from the outside, then the only other theory that I have is that during the time that the tubing is disconnected you shake some of the insulin content out.  I have never observed that when disconnecting for a shower or changing, but it is possible (different physics, not going there).

    Anyhow… I guess what’s most important is that you consider ALL the possible sources of error when traveling on an airplane.  The mix of activity (boarding / disembarking) and inactivity (on the plane), the inflight menu (which is usually high in CHO and fat), the potential dehydration effect (blood getting “thicker” during the flight, which makes your meter readings look higher than they really are) etc. etc.  Unfortunately diabetes management is no exact math (or physics)…  🙂

    I’m sitting on 30-40 different airplanes per year, flying long- and short-haul, and my best advice is:  test often (or use a CGM) and correct quickly, but gently.  In my experience, making small adjustments even to slightly elevated glucose while in-flight and using the bolus calculator in the pump to keep track of my insulin-on-board yields the best results.

    Good luck everyone!

  17. Jack at

    I’ve been using the Omnipod for 3 years now, and fly all over the world as well as domestically…. I have to say I have never seen this effect.  I do understand that it is possible, but I have not experienced it.

  18. Les at

    Although the physics may be sound, I find this trivial. I fly several times a week sometimes as often as 3 flights a day and I have almost never, with very few exceptions, experienced this phenomenon. I regularly take flight 1.5 hours to 4 hours in length. Perhaps my insulin sensitivity is not as great as others and this may help to explain. Or perhaps, it is because I maintain rigid control and do several finger sticks a day.  If I experience a low, it is because I have likely miscalculated the carbs or over-corrected. It is more typical that I stay in range or experience the occasional high from sitting and lack of activity. I do not think I would change a thing but each of us is different and may have different experiences.
     

  19. Lynn at

    My daughter is on the Omnipod and we had the same experience as Kyle. There was not an issue. I had read about the lows after the plane and I was on top of my daughter on landing. Her bg was fine.

  20. Elizabeth at

    As a former diver this makes sense. I would also suggest though that some air may be introduced at the back end of the line via a less than perfect reservoir seal. If there is even a small area where the o-ring isn’t in contact, under the pressure change of takeoff that area will expand, releasing trapped air into the reservoir that could wind up in the line. It then would likewise expand as the pressure gradient increases during landing.

  21. Dennis at

    I am a skydiver, with well over 1700 jumps in.  I have made all the jumps with my insulin pump on and never had any trouble with it like you mentioned in your article.  I have jumped out of jets at 25,000 ft doing 250 mph and no problem, both on takeoff and during my jumps.  If its not broken don’t fix it.

  22. Omg, this makes so much sense! And I can tell you – OMNIPOD is no different. My 3 y.o. toddler is ALWAYS low on the plane, even if I halt basal altogether, its like he is still getting it and at least a double of it. We fly a lot and the only thing that keeps him form going low is taking the damn thing off him all together for the entire flight.

  23. Lynn at

    After reading varied responses on this now from the Omnipod system I wonder if some are more insulin sensitive than others. Although my daughter was four at dx (now 5) and had only been dx for 7 months now she has been on the more insulin resistant side if the insulin scale. I know, after talking to other D mom’s that some are very insulin sensitive and a small amount of insulin causes them to drop drastically. With my daughter I have always said that it takes like a bucket of insulin poured down her mouth to make her drop. So if there is some degree of bubble up (maybe not as severe as with other tubed pumps) people who are more insulin resistant, like my daughter, bg’s are not taking a big hit and are staying in range, where others who are more insulin sensitive that slight bubble up that could be occurring is causing them really drop. Idk just a thought. 

  24. I flew to England in January with a stop-over in Singapore. I did the same route on the way back. I also skipped over to Sweden while I was away for a couple of days. I noticed my sugar levels were getting very low during and after flight time. I guess this would be why, because I was pretty fanatic about managing my sugar levels while traveling (I didn’t want to go to Hospital when I was supposed to be having fun!).Next time I get on a plane I will remember to deliver a manual amount of basal, then disconnect. I hated the ‘baggage claim lows’ I was getting.
     

  25. Lori at

    I have flown a number of times with my Omnipod and never found any issues or problems with how I felt/blood glucose levels.

    I used syringes before that, so being untubed is my only insulin pump experience…

     

  26. Colleen Nordgren at

    We recently took a 3.5 car trip over multiple elevations. Our son’s blood glucose was stable and in range prior to starting up the mountain. Once we started to change elevations his blood glucose started to rise. We have a Dexcom system so I was able to watch his blood glucose trending.  To equalize the pressure in the car we opened a window.  much to our surprise his blood glucose stabilized & he didn’t go any higher. On the way home we opened the window sooner. His blood glucose was much better then usual And we didn’t have a crashing low.  Thanks for this info.!  

  27. My DH who works in avionics has always wondered about the same thing that you have written about.  The few times I did fly with my pump – I never disconnected – had no probs with BG’s (mostly long distance flights overseas).  Now with no warranty on my pump (those of you who know my woes with Animas – well – fun fun fun). Anyhow – I recently discovered what air pressure in the cabin can do to a pen needle (I use MDI when flying).  It scared the heck out of me, but luckily patient DH talked me thru’ figuring out what had happened to the piston in the pen needle (similar to a pump – but manual instead of battery operated).  You can read about it at this link – http://www.diabetes1.org/blogs/Annas_Blog/2014/2/21 – where after posting this – I’m going to link your post in my comment area – as it’s an important thing for frequent flyers of the mile high club to be aware of 😉 

  28. Ivan at

    good read.. I fly a great deal.. AirTran knows ahead of time to upgrade me to business class whenever possible.  But, I only recently moved up to pens..  The pump is in the works for this summer.  I would have never even thought about the excess delivery caused by air pressure changes.  As for baggage claim lows.. I know them fairly well already.  There seems to be a curse on me flying from the Twin Cities to Milwaukee.  I don’t think I have ever managed to get on the Milwaukee flight when my blood sugar wasn’t already dangerously low.  Too bad those flights are never AirTran, as they know to bring me apple juice by default.

  29. Emily A at

    I wear a t:slim which is pressure controlled regulated and checked every few minutes. I have never had an issue flying and I find disconnecting more dangerous. I use a temp basal while flying due to sitting for so long but that’s it. Disconnecting risks more air bubbles than cabin pressure IMO. But I see where you are coming from and I’m not saying it doesn’t happen. To each their own. No buyers remorse here tho.

  30. Loved this post. I took a trip to Montreal with my wife and thought this was the most important info I read about traveling with an insulin pump. I watched the bubbles form on both take off and landing, going to and coming from Montreal.

    I attempted to tell Medtronic about these findings. The response I received was: “Standard guidance around diabetes and travel doesn’t include disconnecting pumps for air travel. Of course people with diabetes should always follow the individual recommendations provided by their healthcare provider. Since many factors can impact glucose levels– hassle of travel, stress, changes in mealtimes, activity levels, etc.”

    I replied, “The point is that changes in air pressure cause bubbles to form in the reservoir and tubing, so testing alone isn’t sufficient when there’s air in the reservoir/tubing. Testing is important. So is a knowledge of physics.” 

    Haven’t heard back from Medtronic since. Great, great, great, great article.  

  31. Dennis at

    I have been wearing a pump since March 1983, and have been a skydiver since July 2001.  I have worn my pump on every jump, 1,702 and have NEVER had any bubbles.  We don’t have a pressurize cabin, so we go up to 14,500 feet unlike a jet which is set at 2,000 feet cabin pressure.  I have gone up to 25000 feet without any cabin pressure without any problems with bubbles in my tubing.  While skydiving we go up to 14500 feet in about 15 to 20 minutes and then jump out falling at 120 mph.  We will drop from 14500 feet to 3000 feet in 70 seconds, and I have never had any problems.  I think this istotally made up! 

  32. Mario P at

    Dennis, with all due respect… physics is not negotiable and when it comes to pressurization on Earth – it is fact. The reason why you don’t experience any problems skydiving is because you are not on a pressurized aircraft. As you climb, you ascend slowly enough that equalization can happen in your insulin bag. Don’t get me wrong… the bubbles still happen in your bag, just not as big due to the slow ascent. When you jump… the reverse happens so you will not experience that big of a problem. The difference discussed here is the experience on a commercial pressurized aircraft cabin. It is kept at around 6,000-8,000 feet cabin pressure depending on the model plane. Because these jets climb so ridiculously fast (I have ascended to 10,000 ft from sea level in 87 seconds, and to 37,000 ft in a little over 4 minutes), you will experience the effects of Henry’s Law and Boyle’s Law much more dramatically. I should mention that I am a flight attendant and have been doing it for almost 10 years now.
    One tip, and one urban myth debunked:
    Tip- Parents with babies/children, no need to worry about “unplugging” their ears with a bottle, pacifier, gum or candy during ascent (while climbing/going up). Our bodies naturally and easily equalize the pressure as we climb with no extra help. Now, on descent… that’s where the story changes. Usually about half an hour before landing, the aircraft will start it’s initial descent (lower altitude/go down) and the way you know it’s happening is because usually you will hear the engines slow down and you feel the plane shift from level to downward. This is when you give the bottle, pacifier, gum or candy to the little ones to ease the transition to a lower altitude. What’s happening? As we descend the air pressure gets higher and higher. So unless we equalize the pressure in our inner ear (low pressure) to the outside air (high pressure) as we go down, we will eventually get to the point of plugged ear. And we all know how awful it feels if we don’t control it early enough.
    Urban Myth debunked- The middle of the plane, or as some think… sitting over the wing is NOT the smoothest place to sit on the airplane for turbulence. Where you do want to sit is as far forward as you can. My favorite position to fly at work puts me in the very front of the plane looking down the entire length of the cabin, and all I can tell you is that when we fly through turbulence I can literally see the difference in the shaking of heads, row by row. And believe me, it isn’t the seats over the wing that are smoothest. Conversely, if you like a rougher ride – back row is for you. Happy and safe flying!

  33. Jack D at

    We have the Omnipod and a baby / toddler with diabetes. Happens to us every time we fly, and we fly around the world with him. He goes high the first two hours, and then we end up having to turn him off for the next 6-8 hours and struggle to get him out of the 50’s for the rest of the flight. He also wears the Dexcom so we watch the whole time. He only takes around 8 units total per day, so an extra 2-ish units is a huge deal to him.

  34. Patti at

    I also have been wearing an omnipod for many years and everytime I fly I have severe lows and also wear a dex com so I can watch and feel the rapidly dropping lows even once went into a diabetic coma on a plane I just came home from a flight yesterday and again dropped very low I’ve had type 1 for 46 years and no one seems to understand this with an omnipod I can’t disconnect for take off and landings I don’t think I would ever feel comfortable flying alone I’m at the point that maybe I should give shots when flying but don’t really want to do this  I take a total of 15-16   units total per day so just a little extra insulin with drop my BG and a little less with send me the other way any suggestions

     

  35. Holly at

    I am an Omnipod user-I have had drastic lows the last 3 times I have landed.  I travel weekly so this is major for me.  Relieved to see that it’s not just me…now just trying to figure out how to manage with an Omnipod.  Seems like suspending will still have an “air bubble” problem.  I don’t want to have to change the pod every time I fly-many times I fly 2x in one day…Only been Type 1 for 9 years now…I am 34.  I am not sure why it is more pronounced recently, although I have had tighter control of my blood sugars.  Please just tell me there’s a way around this without using a new pod each time!

  36. Mitch at

    For 15 years, I traveled all over the world for my job — 30 to 100 flights per year. I wore an insulin pump during all of those flights and I never noticed a correlation between BG levels and flights that couldn’t also be explained by the exercise of running/fast walking to catch the flight and the complete lack of exercise in sitting during the flight.

    Disconnecting an infusion set is, in my opinion, an over-reaction compared to more frequent BG testing during travel and ALWAYS carrying glucose tablets. Likewise, since the effects of ascent and descent mirror each other, having a snack or meal on the flight and then checking BG within 30 to 60 minutes after landing could be equally effective techniques.

    You can’t manage what you don’t measure and that applies to T1D and self-monitoring of your blood glucose levels — all the time.

  37. Jennifer Miller at

    Very interesting. I am a flight attendant and wear a pump. I have never heard of disconnecting my pump for take off and landing. I don’t think I have ever had a low getting off the plane that I can’t link to something I did rather than an air bubble in the cannula. And now I have a dexcom CGM, so I can keep closer track of my numbers. So I’ll keep on keeping on with what I do.

  38. Jim.can.gabriel@sbcglobal.net at

    Interesting read. I have been researching air pressure affects on diabetic pump. My daughter was participating in an athletic event this weekend that took place inside of an air pressured dome. She experienced extreme lows both days. She is in great control but usually goes high with adrinaline so to go so low was confusing. After reading the affects of air pressure (no matter how slight), I’m guessing that it was the major culprit. She will be flying too in the next few weeks, and I think we will disconnect to avoid her sensitivity. Better safe than sorry! Thanks for posting!

  39. Hilary at

    I wanted thank you! We’ve made a couple of international trips and my son has always gone low during the flight and high a few hours after we landed. We never knew why. Now we do! So we just flew to Europe (three flights!) and we disconnected on the ascent and the descent for each flight. (We blouses a tiny amount before disconnecting to cover basal.) Sure enough, on the ascent a big drop of insulin formed! On the descent, a HUGE air bubble formed! I did take pictures, but it doesn’t look as if I can post them here. The result? PERFECT BG for the first time ever thoughout our trip! Thank you so much for posting this information. I’ll be sharing our experience with others and with our Endo!!

  40. Dee at

    I’m traveling this week for the first time since getting an Omnipod 8 weeks ago. Thank you for posting this! I had no idea! I’ll turn off my basal shortly before descent and keep some snacks handy.

  41. Matt at

    I am 6 months into late onset type 1 and fly a lot with an insulin pump …. I have very tight control, however I struggle with flying. I quickly worked out the disconnect required on ascent and descent, but recently had a crushing low when forgot to disconnect on ascent and then bolused for an inflight meal. Had to eat 75g of EXTRA Carb/sugar to stay in range….so obviously the flight has had a marked affect and caused effectively an overdose of insulin …..will disconnect and prime out in future!!

  42. Liz at

    I must be a weirdo. I travel work work and vacation a couple of times a year and sometimes the vacation involves several flights (one three week trip had a total of 18 takeoffs and landings). I’ve been using a pump for five years, I don’t ever remember having a low after landing and my most recent vacation was two weeks ago. I’m still going to do the experiment though.

  43. Lynn at

    I fly quite a bit and I frequently experience ‘baggage claim lows.’ I’m going to start watching more closely on my CGM. It is great to see others in the DOC that experience the same issues. Not great that we’re low, just makes me feel like I’m not imagining things.

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