When Frank*, a 56-year-old professional living in Boston, boarded a flight to Las Vegas for a speaking engagement in the summer of 2006, he was certain he had prepared adequately for his voyage.
Having lived with diabetes for 32 years, he made especially sure to have his insulin handy on the flight. And as so happens with many who live with diabetes, the inactivity of the flight caused Frank's blood sugar to rise.
He took his insulin. But he forgot to have a snack before leaving the plane. The sudden activity when the plane landed caused his blood sugar to drop dangerously low -- and that's when his trip took a drastic turn for the worse.
"I don't remember getting off the plane," he says. "The next thing I remember, I was being transported very, very fast, with my hands handcuffed behind me, in a wheelchair."
Only after he was taken to the police station in the airport, where he received glucose pills for his hypoglycemia, would he fully realize what had transpired.
"I finally learned what happened," he says. "I had gotten off the plane and wandered into the security screening lines. The security officers saw me wandering around, and they perhaps tried to talk to me, but I was not responding.
"They called the cops, who tried to subdue me," he continues. "But I'm a big guy -- 6-foot-3. It didn't work, so they Tasered me. Well, I didn't respond to the Taser either, so they Tasered me again."
All told, Frank counts himself lucky. Aside from some small burn marks on his back from the Tasers and lingering numbness from the handcuffs, he suffered no lasting ill effects from his experience. And though he believes he was treated roughly, he did not file suit against the airport or the police.
Frank's experience, fortunately, represents an extreme case of what can go wrong when traveling with diabetes.
"It is fairly easy to travel safely with diabetes," says Dr. Larry Deeb, clinical professor of pediatrics at the University of Florida and immediate past president of the American Diabetes Association, who says cases like Frank's are exceedingly rare.
"People with diabetes shouldn't be afraid to fly," he notes, adding that proper preparation is key. "People with diabetes can travel safely and can go anywhere they want to go safely if they prepare for it."
"First and foremost, people with diabetes need to prepare ahead and anticipate what they might need," he says.
Planning for the Inevitable
For those who rely upon a strict schedule to control their diabetes, the realities of travel could pose challenges.
Deeb says that those with diabetes must also bear in mind that air travel -- especially during the holiday season -- is often fraught with unexpected mishaps.
"Things may be stressful, you may miss a plane, or you may be stuck on a plane," he says.
"One of the issues is all of the extra supplies people need to take with them to manage their diabetes," Wolpert says.
According to ADA guidelines, this should include two blood glucose monitoring devices -- packed in separate bags -- with extra batteries; insulin lancets, test strips and syringes; and, for insulin pump users, pump supplies, extra batteries, and insulin and syringes in case of pump failure.
Emergency snacks are also a must, and everything should be kept close at hand.
"Everything goes in carry-on; don't check anything," Deeb says.
Longer trips involving travel between five or more time zones pose additional considerations when it comes to scheduling meals and insulin injections.
"I think it's more complicated when changing time zones," Wolpert notes. "Insulin requirements will vary according to the time of day, and they will need to adjust."
In light of this, people with diabetes should take time out in the days before their trip to scan their itineraries and realize what changes they may have to make to their schedule.
Security No Longer an Issue
Along with the concern over what to pack, some with diabetes may be concerned that the needles and vials they have in their carry-on will present a problem in the security line.
In years past, such problems have been reported. Take, for example, the case of one 54-year-old engineer with diabetes returning to Australia after a four-month placement in Norway.
At a Norwegian airport, security staff told him that he was not permitted to carry his insulin or equipment in the cabin without a letter from his doctor and a current valid prescription. Despite the man's protests, he was forced to board without his insulin.
In the course of his trip to Sydney, he began to vomit, sweat profusely and display other symptoms consistent with dangerously high blood sugar. Fortunately, quick treatment upon his arrival in Australia saved his life.
But while such accounts may sound frightening, the chances of such an occurrence in the United States today are nearly zero.
"In the past, there was a major crisis of what you could and couldn't bring on an airplane," Deeb says. "The truth is that today, the TSA people are very understanding. I've found them to be much more understanding now of people with diabetes."
Wolpert agrees. "In terms of security, it is generally not as much of an issue as it was before."
Nonetheless, the Federal Aviation Administration has issued a list of guidelines for those with diabetes to follow to minimize the possibility of problems clearing security. These include only carrying insulin in vials, pens or cartridges that carry a professional, preprinted pharmaceutical company label clearly identifying the medication. They also recommend that patients bring the original box in which their insulin was packaged. Lancets should be capped, and glucose meters should bear the manufacturer's name.
But Wolpert says that even if some of these guidelines fall by the wayside, travelers should still be fine from a security standpoint.
"It has been recommended post-9/11 that people need to take their insulin with them in a vial with a label," he says. "In practice, this is no longer necessary, because the TSA has become more familiar with this."
The Importance of Identification
Far and away, one of the simplest things that those with diabetes can do to ensure their safety on long trips is to have a bracelet, necklace or other item that identifies them as having diabetes.
"I was not wearing anything that identified me as diabetic," Frank says. "Since then I have learned my lesson. .... The truth is I should have been wearing a bracelet."
The other thing they can do, Wolpert says, is keep a close eye on their blood sugar levels, taking action when necessary.
"They need to monitor, monitor, monitor," he says. "Diabetes is much more difficult to manage when traveling."
According to the ADA, even those who do not test frequently at home should test themselves at least every four to six hours while traveling. They should also keep themselves well hydrated with nonalcoholic, caffeine-free beverages throughout their flight.
And Frank has one more point of advice that he says he'd share with anyone with diabetes who intends to board a flight.
"It doesn't hurt to make the person next to you aware of your condition," he says.
*Name changed to protect privacy.
For tips from the ADA for people with diabetes who are planning travel, visit http://diabetes.org/pre-diabetes/travel/when-you-travel.jsp.
For details on security guidelines with regard to the needs of people with diabetes, visit http://www.tsa.gov/travelers/airtravel/specialneeds/editorial_1374.shtm#3.