5 Challenges Of Traveling Across Time Zones With T1 Diabetes: Managing Jet-Lag, Sleep Deprivation, Food And Less Trivial Issues (And How I Solved Them)

I am firmly convinced that Type 1 Diabetes must not limit us.

For years I hesitated going for longer intercontinental trips because I did not know what to do with type 1 diabetes. What if I don’t find the supplies I need over there? or food? what to do during long flights where sleep is minimal? how to adjust the insulin dosage based on a different time zone? All these questions kept me stuck for a very long time, I didn’t feel prepared to go for a trip.

Then I decided it was time to face my insecurities and tackle all these challenges - so I went on a trip to South-East Asia.

I wanted to face all the challenges that can pop up traveling with type 1 diabetes, because facing problems is the only way to solve them - and perhaps realize they’re not such a big deal after all.

So I started to make my plan.

I re-read my article 42+ Variables Can Affect Your Blood Glucose - How To Use Them To Your Advantage and started preparing for it. I made a list of all the situations that were new and could cause some blood glucose confusion, and tried to come up with a solution for each. I identified an “arrow down” variable for each “arrow up” variable, and viceversa (if you have read the article above, you know).

Eventually, for my intercontinental trip I had foreseen 5 main challenges related to Type 1 Diabetes, and this is how I managed them:

Challenge #1: Airport Movement (and how I compensated for it)

This one is subtle but acknowledging it makes a universe of difference.

I knew that at the airport I would be walking from gate to gate, to the check-ins, to the gate, to the toilet (which is notably on the other side of the airport), to the area where I can charge my phone (on the opposite side, once again). That’s a lot of walking (big “arrow down” variable). And I knew I had to counterbalance it somehow in order to avoid being low all the time - especially in airports, where the food is junk and notably very expensive.

Counteracting “arrow-up”: I decreased my long-acting insulin the day before, and used a “split-bolus” approach for my bolus to gain more flexibility with my dosages.

Challenge #2: Airport Food (and how I compensated for it)

At airports, you either eat overpriced snacks, at fast foods or at some “restaurant” - processed food in all cases.

And indeed, everything I could possibly eat was either based on a combination of refined flour and sugar and refined oils (breads, toasts, pizzas, bagels, croissants). All of these foods not only cause blood sugar disruptions, but they increase insulin resistance, causing longer term issues. Airport food was a huge “double arrow up” kind of variable which I wanted to avoid at all costs.

Counteracting “arrow-down”: I brought fruits for my quick snacks, and then a 1 Kg bag of oats from home. For just 1.5 euros (and minimal estate in my bag), I had whole, nutritious food that filled me up for hours, stabilized my blood sugar and kept my insulin sensitivity intact. Oats for the win.

Challenge #3: Sleep Deprivation (and how I compensated for it)

I knew I was going to sleep 3-4 hours in 48 hours, so my sleep routine was already out of the window.

Sleep deprivation is a massive insulin resistance booster, and a big problem. I knew in advance I’d be able to put together 1-2 hours of sleep total over 36 hours due to connective flights and airport time. Sleep deprivation is yet another massive arrow up variable which I had to mitigate.

Counteracting “arrow-down” variables: I sprinkled my airplane time with short 15 minutes Yoga Nidra sessions to get some intense, deep relaxation in short bursts without actually sleeping (I downloaded them on my phone). In addition, I knew that insulin would take longer to act due to insulin resistance, so I increased the waiting time between my injections and my meals.

Challenge #4: Time Zone Change (insulin, meal and sleep timing)

The other challenge was aligning to the local time zone.

I had to figure out what to do with my long acting insulin, with the meal schedule, and how to make sure I could sleep without the jet-lag coming in the way. I had to resettle my circadian clock based on the local schedule and force some adaptations - all of which could be “arrow-up” or “arrow down”. I had to play it safe.

Here’s how I handled insulin, meal and sleep schedule:

• Insulin: I was traveling east (a few hours “in the future”), so I knew that there would be some long-acting insulin overlap at some point. To manage that, I simply retarded my long acting intake by a few hours when I arrived. Not sure if that’s the best approach but it worked.

• Meal schedule: I “forced” myself into the local meal schedule immediately: I ate even though I didn’t feel like it, just to tell my body “hey, we’re here, this is the rhythm now” and defy jet-lag as fast as possible.

• Sleep: as counter-intuitive as it might sound, I did not try to catch-up on sleep at every occasion. I could have slept during the morning connective flight (which was night in my usual time zone), but I didn’t. I forced myself to stay awake so that when I arrived at my hotel room in the evening (local time) I would be so tired that sleep would just happen. Had I slept in the morning, I would have not fall asleep so easily in the evening, prolonging my jet-lag, sleep debt and insulin resistance

Challenge #5: Keeping Insulin Sensitivity Up (with some simple strategies)

Finally, I had to keep my insulin sensitivity up somehow while flying.

Suboptimal food, absence of sleep and time zone shifts were enough already. The last thing I needed was to have low back pain by staying sit (“arrow up”variable) on an airplane for hours on end. I needed simple tactics to stay insulin sensitive.

Here’s how I added a few extra “arrow down” approach to keep my insulin sensitivity up:

• I drank a lot of water, because being hydrated helps insulin travel up and down the body more quickly. And also because staying hydrated is essential, full stop.

• I did mini “airplane workouts”. I had a big workout the morning before my trip, but I needed to keep moving during the trip too. So my plan for the airplane was to stand up every 45 minutes and take a walk. I also went to the back to do some squats, lunges, calf and tibialis raises. By the time I landed not only the entire cabin crew knew who I was, but I also got 100 squats, 100 lunges, 150 calf raises and 150 tibialis raises in.

And at the end of it, my blood sugars were pretty much stable - except for a spike and a low.

Knowing and planning for these challenges in advance helped me keep my blood sugars in range with success, despite the difficulties of traveling for 24 hours straight across multiple timezones.

It was not perfect, but had I not had a plan for each of the Variables that were coming for my blood sugar stability, it would’ve been much worse.

And most of all, I enjoyed my trip without Diabetes being in the way!