Travelling with Diabetes

TRAVELLING WITH DIABETES

The summer months are a time for travel for many patients with diabetes and their families.

Leaving home for unfamiliar surroundings with time spent in transportation generates insecurity 

and many questions.

My advice is summarized in the following bullet points:

1.   Prepare for the unexpected (trip delays, lost baggage, local unavailability of basic        supplies)

2.   Have an insulated carry-on bag specifically for medication and supplies.

3.   Use clear plastic zip-lock bags to package supplies.

4.   Carry a supply of insulin pens (or vials)

5.   Carry pen needles and syringes

6.   Carry glucose monitors (2) with adequate strips (2 -3 vials) and extra battery

7.   Carry alcohol pads and gauze pads

8.   Bring cartridges for the insulin pump you may be using

9.   If you are using an insulin pump, carry a supply of long-acting insulin for use in pump emergencies

10. Carry glucose tablets

11. Carry a glucagon injection kit

12. Prepare a few easy snacks: small sandwich, peanut butter crackers, trail mix

13. Ensure access to water

14. Use your departure point time to decide on timing of meals during travel and arrival 

15. Use local time (at destination) for meals, starting  with breakfast the day after arrival.

16. Have letter from your doctor for airport personnel checking your carry-on luggage.

17. For patients over age 45, have a copy of your recent ECG

16. Keep your medication bag with you at all times during your trip

The Gut Microbiome in Diabetes 

The American Diabetes Association 78th Annual Session in Orlando, Florida this past June featured several abstracts and presentations highlighting the important role our gut flora (microbiome) plays in glucose metabolism. Diabetes mellitus reflects derangement in the glucose profile and the bacteria in our gut have a central role to play in this process. Coming to terms with our flora through our diet and with medications serves to improve blood glucose control and may even 'cure' diabetes. 

Dr. Xiaoyu Liao and his associates in Chongqing, China published an abstract featured in the Scientific Sessions, which demonstrated that a very popular class of antidiabetic drugs known as DPP-4i produces changes in gut bacteria in mice that serve to lower blood glucose. This mechanism of action was not known for this class of drugs and was not shared by another class of antidiabetic medication known as 'starch blockers' (disaccharidase inhibitors), which were tested in the same experiments for comparison. 

We  are coming to respect our fellow travellers more and more as their role in diabetes management is gradually revealed. 

 

Alteration of Gut Microbiota Induced by DPP-4i Treatment Improves Glucose Homeostasis

Poster 1119-P

July 11, 2018

Presentation at Ohio University Diabetes Institute - Diabetes Coalition

Hyperglycemia management in the hospitalized patient. 
Diabetes Coalition  from  Nicholas Mezitis

High blood glucose levels contribute to inflammation and suppress the immune system. Hospitalized patients are particularly vulnerable to the damage these processes generate, since their condition requires acute care and their recovery depends on the body mobilizing all its resources for the healing process. 

For those patients with diabetes mellitus, whether known or newly diagnosed, it is important to rapidly stabilize their glycemic profile without causing a dangerous low blood glucose experience (hypoglycemia). This is achieved through careful monitoring and judicious insulin administration. In the hospital, insulin will usually replace the oral agents patients may have been taking, permitting flexibility in dosing when meals are withheld or procedures are planned. 

 Dr. Mezitis discussed the management method developed by his group at 
St. Luke's/Roosevelt Hospital Center in New York City and published for use in the hospital setting (2006). The novel 'wheel concept' graphically describes dosing levels for insulin and the decision sequence to be used by  physicians and nursing staff in safely managing patients with high blood glucose levels. 

We live in an era when our lifestyle puts us at risk for diabetes mellitus, particularly as we age.
This screening tool helps us in estimating our risk and should prompt us to seek medical advice.
If your score is 9 or more, your risk is high for having prediabetes.
If you score 3 - 8, losing extra weight, staying active, selecting a healthy diet with meals early in the day,
and enjoying restful sleep will reduce your risk.