Diabetes And Time Change

[elye]

A couple of weeks ago I posted with my questions about jetlag. We are travelling to Europe in a month, and I've never done a six-hour time change before. I got some great advice on how to best get onto the new time, i.e., plenty of water, sleeping on the flight, staying out in daylight etc. Now I have a question for any other type one diabetics out there who have made this kind of time change. I am taking two shots a day and have very precise times for meals and daily workouts (my sleep time stays fairly rigid, as well). This has allowed me to maintain tight blood sugar control for many years. Now, I am flummoxed as to how I can make this two-week change work. Should I keep the times of my shots the same? This would mean injecting at 1 pm instead of 7 am, as I do here, and then at 10 pm instead of 4 pm. But then I will be sleeping right after I inject, and my meals will be at totally different times relative to my shots. Help!

[Guest Doll]

A couple of weeks ago I posted with my questions about jetlag. We are travelling to Europe in a month, and I've never done a six-hour time change before. I got some great advice on how to best get onto the new time, i.e., plenty of water, sleeping on the flight, staying out in daylight etc. Now I have a question for any other type one diabetics out there who have made this kind of time change. I am taking two shots a day and have very precise times for meals and daily workouts (my sleep time stays fairly rigid, as well). This has allowed me to maintain tight blood sugar control for many years. Now, I am flummoxed as to how I can make this two-week change work. Should I keep the times of my shots the same? This would mean injecting at 1 pm instead of 7 am, as I do here, and then at 10 pm instead of 4 pm. But then I will be sleeping right after I inject, and my meals will be at totally different times relative to my shots. Help!

Oooh boy...that IS a big time change. 2 questions: Have you looked into a an insulin pump? Many companies will offer you a "trial" pump for a short period of time. You would need to get set up with that ASAP in you are leaving in a month, since it takes some time to set your basal rates. I have a pump and love it. You can eat whenever you want, and sleep in as well. You make your own schedule. The pump works well for this kind of setting. Prior to the pump, I was on multiple daily injections 5x per day.

Another question I have is: are you still on the old insulin and not Lantus? It sounds like you are are on Regular and NPH. The new analogues allow for much more flexibility in your lifestyle, as well as a reduced risk of low blood sugar. Lantus does not have a peak, so you don't need to eat until you are ready or need snacks. Then, you simply take a meal time injection of fast-acting insulin when you want to eat.

Of course if you are using the old insulin, and they work for you and you want to stick with it, of course you should. I personally had terrible control with the old insulin as I am so insulin sensitive. I had numerous seizures due to the unpredictability of NPH and Regular.

If you are not on Lantus and Humalong/Novolog, I suggest switching over just for the trip. NPH is just horrible to work with in this case! I do *NOT* suggest taking a peaking insulin like NPH before bed, and that will not work well anyway if you are not using analogues for your meals. Regular has just about as much flexibility as NPH...which is none! ;p You also obviously cannot eat dinner at 10 pm...just not practical if you want to enjoy your trip.

That said, there is a way to "switch" over your insulin dosing, I believe by either gradually increasing or decreasing the hour at which you take your initial shot until you eventually are near the "new" time. However, that requires way to much disruption, and you will need to be on your "new" schedule for a bit while still still at home.

If you don't like the idea of the pump or Lantus, here is the "easy" option. On the day that you leave, take your insulin as normal in the am. At supper, DO NOT take your 2nd long-acting insulin, just your fast-acting. Continue to use your fast-acting insulin *only* to correct any high blood sugars and to cover any meals (I assume you know how to carb count and match your insulin dose to your food). Once the long-acting (NPH) is out of your system (I think after 18 hours? You will need to check), you can start the next am with your regular routine again. In the meantime, you will need to test lots and adjust with your short-acting insulin only. You might need to give a few units to sustain you overnight until you make the switch that next day.

Enjoy your trip!

P.S. Have you talked to your endo yet?

[elye]

What great advice! Thanks so much, Doll. I have my appt. with my endo in two weeks. Yep, I've been on NPH and Toronto for almost all of my life. I am one of those anomolies who can, for whatever the reason, keep my HbA1Cs at or below 6 with these insulins, only twice a day. Many diabetics look at me like I'm from another planet when I tell them this. I have considered the pump only a couple of times in my life, and never seriously because I've never had control issues. But it sure would be nice for this trip, I tell you. I like your idea of multiple regular insulin dosages and blood testing for the first night or so until I am in sync. And no, I wouldn't inject either of these insulins at bedtime. My bs is always quite low first thing in the morning as it is. I will ask my endo about Lantis. Again, there's the old "if it ain't broke, why go fixin' it?", which is what he will say to me. But it may be a good temporary measure.

[Guest Doll]

What great advice! Thanks so much, Doll. I have my appt. with my endo in two weeks. Yep, I've been on NPH and Toronto for almost all of my life. I am one of those anomolies who can, for whatever the reason, keep my HbA1Cs at or below 6 with these insulins, only twice a day. Many diabetics look at me like I'm from another planet when I tell them this. I have considered the pump only a couple of times in my life, and never seriously because I've never had control issues. But it sure would be nice for this trip, I tell you. I like your idea of multiple regular insulin dosages and blood testing for the first night or so until I am in sync. And no, I wouldn't inject either of these insulins at bedtime. My bs is always quite low first thing in the morning as it is. I will ask my endo about Lantis. Again, there's the old "if it ain't broke, why go fixin' it?", which is what he will say to me. But it may be a good temporary measure.

Yay! Glad I could help! Just make sure you give yourself time to switch over, that is not always as easy as it sounds. The good thing is, you can always decide to *not* use either of these methods the entire trip if they aren't working for you. All you really need to worry about is that first day or 2 there, and your first day or 2 home.

I'm going to Scotland for my honeymoon in Dec., I all I can say is thank God for my pump! Now *all* I have to worry about is gluten-free food....

Always something to think about!

Cheers!

[RiceAddict]

Sorry I'm a little late here, but there is no additional advice that I can think of that Doll has not covered. I think one month is a bit of a crunch to try and get a pump and learn to use it, plus you are getting ready for a big trip and we all know what a nightmare that can be. I too wear a pump and it is the most amazing medical advancement that I have ever experienced! The freedom is absolutely unbelievable, I eat ANYTHING ANYTIME I want (gluten-free) and my BS stays in range.

I used to live in New Zealand and I had to fly 12 hrs over the date line (arriving 1/2 day before I left) I was on Lantus and Humalog at the time and it was a total disaster. Going west was harder than coming back to the US.

I think it is good that you are maintaining control with NPH/Regular. Lantus/Humalog and pumps are not JUST for people who have poor control. It is a lifestyle decision. Gluten-free is bad enough, you don't want to be stranded somewhere when your insulin peaks and be forced to eat a doughnut or something bad for you. I would DEFINITELY talk to you endo about either option, you can always go back to NPH if you are unhappy. I do know one guy in California that was on a pump for 3 years and decided to go back to MDI, his choice.

Good luck and take lots of pictures!