My 77 year old wife has
type 2 diabetes
and is under very good control. She injects 40 Units of
Lantus
at about 10:00 pm and 40 Units of NPH around 10:00 am. When we go
overseas, say to China, what is the best way to modify her injection
schedule?
When we get on the airplane at 1:00 am our time, airport, it is 5:00 pm the
next day there. When we arrive in China after about a 14 hour flight, it is
3:00 pm California time, but 7:00 am there. If she is to stick to
California time, she should inject her 10 am NPH Humulin on the airplane at
2:00 am Saturday China time. If she does, then, when she arrives in
China, what will she do with her next NPH and Lantus? Based on the time
difference, her next Lantus should be injected at 12:00 N China time (only
five hours after arrival and only two hours after she injects her NPH in
China). On the return to California it is totally different. We get on the
airplane at 5:00 pm there (2:00 am California time) and arrive at 1:00 pm
California time which is 5:00 am the next day in China.
Her injection schedule is more difficult to figure out because it is so
complicated. During cross-time-zone overseas travel, you cannot strictly
follow the time interval (after 24 hours) for next injection, nor can you
follow the clock time (local clock time, or clock time at the original
city) for routine injections. This makes it so difficult to decide as to
what to do. I tried to use my computer for the answer, but so far nothing
is practical. There must be some simple principle we can use since it is a
problem for all cross-time-zone travelers. Can you help?
Answer
Talk this over with your physician and/or diabetes nurse educator!
Some thoughts that might help:
- Since Lantus is long-lasting and given once daily, the easiest thing to do for the Lantus is to simply stay on
the original clock time (apparently for her, it's California time) and continue to give the injections 24 hours apart (or as close as possible if the
injection time in California is while asleep in another time zone).
- It sounds from your question like she's not on rapid-acting insulin, but if she's on one
(Humalog,
Novolog,
or
Apidra),
it should be given at mealtime, whenever she eats. If she's not routinely on one, she should definitely carry one with her "just in case", and have
instructions from her diabetes team about when and how much to use.
- The NPH is trickier. It's usually used to prevent the
dawn phenomenon, and hence
is usually
given before bedtime. But that's not the case here, and I'd wonder if she should talk to her physician about replacing the NPH with an equal dose of
Lantus (thus making her doses of Lantus 40 units twice daily). I really don't see a reason for using NPH in this situation, and it's certainly very confusing!
wwq
If you travel frequently, I would obtain a copy of
The Diabetes Travel
Guide - How to Travel With Diabetes Anywhere in the World,
authored by Davida Kruger.
slb
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