All you need to know about air travel with syringes, pens or pumps to make everything from packing to arrival stress and hassle free.
If you are planning to take a flight and take your insulin, Humira, hormones or EpiPen along, you might be wondering what you need to prepare and pay attention to, especially when you are new to this.
What can I bring on the plane? What do I say at security? Will I have any problems with my diabetes on the flight?
Most probably, you will find that flying with medications is nothing to be worried about. Many people carry medications that come in syringes, pens or vials. And airport security staff see insulin pumps, CGMs (Continuous Glucose Monitors), cool bags and other medical equipment every day.
However, travelling is already stressful. So here is a quick list of things to consider:
- medications always go into carry-on luggage (carry-on limits for liquids don’t apply)
- you can carry an extra bag for medical supplies (check with airline beforehand!)
- a travel letter/doctor’s note might come in handy
- check if your medical device can go through x-ray? (some insulin pumps should not!)
- you are allowed to take frozen ice packs for a coolbag on board
- MedAngel is safe to use during Airport Security and flights to check that medications are stored right
- air pressure changes can cause air bubbles in prefilled pens and an extra 1-2 unit insulin delivery from pumps
- plan your dosing schedule if you are crossing timezones
Planning & Packing
Medications belong in carry-on luggage
Always pack your medications and medical supplies in your carry-on luggage. Suitcases get lost or arrive late all the time.
If you are travelling with a friend or family member, you might want to distribute medications and supplies between several bags, just in case something gets stolen or lost.
Will my medications freeze in hold luggage?
Another reason to keep medications in your carry-on is that you have no control over the temperature when your suitcase is in the aircraft hold. Airlines advise against packing anything temperature-sensitive in hold luggage. It could be exposed to freezing temperatures during the flight or when transported at the airport. Or it could be sitting in the sun or a hot storage room. To be on the safe side it is better to have your medications with you, where you can control what is going on.
Carry an extra medical supply bag for free
If you are carrying a lot: airlines usually allow an extra bag for medical supplies. For longer trips, or if your condition requires supplies that take up lots of space, this can come in handy.
Sara from inflamed&untamed relies on TPN (total parenteral nutrition) daily, which comes in 2-3 liter bags. On her blog, she shows on how she packs her supplies for 10 days in 2 carry-on suitcases, icepacks and all.
Just always check the airline’s regulations and confirm with them beforehand!
Do I need a travel letter/doctors note?
The official answer is yes. However, not everyone travels with a letter from their doctor and maybe it will just sit in your bag and no one will ever request to see it.
If you ever run into problems, having one could make your day much easier. You might travel to places where your medication is not as common, or just be unlucky and meet an unknowing person at security. A travel letter can make any searches at airport security go faster and smoother.
If you are also carrying medications that fall in the category of ‘controlled drugs’, such as diazepam or morphine on an international flight, you might need a special letter. You can check this with your national authorities.
At most airports, there are five different ways to go through a security check: the x-ray machine which scans your carry-on luggage, the metal detector walk-through, the body scanner, a pat-down by staff and swabbing hands or luggage to test for explosives.
If you use an insulin pump, a CGM or other medical devices, do confirm with the manufacturer about what to do at security checks. Some insulin pumps, for example, should not go through the x-ray machine or the body scanner, but are safe to keep on while walking through a metal detector.
Read how Dana from DIYaps has mastered the procedure flying from the US, carrying not only her pump but also everything for a DIY hybrid closed loop artificial pancreas.
If insulin gets too hot or if it freezes it becomes less effective. It will not harm you if you inject this insulin but it may not work as effectively.
The same goes for many other medications, for example biologics for autoimmune conditions such as Rheumatoid Arthritis, IBD (inflammatory bowel disease) or multiple sclerosis.
How to keep medications cold on a flight?
If your medications need to be kept refrigerated (2-8°C/36-46°F) at all times, you will need a cool bag with ice packs. These can be taken on the plane in your carry-on when they are frozen and used to protect your medications.
Often, medications in coolers can actually get too cold and even freeze. When choosing a cool bag, one thing to look out for is that there is an insulating layer in between the cooling elements and the medications.
Also, note that Frio Bags are great to protect from heat (below 30°C/86°F), but will not cool down to refrigerator temperatures.
MedAngel on Flights
Use a thermometer to keep an eye on your medications during flight and your travels. MedAngel connected thermometer works via Bluetooth to let you know on your phone if your medications are getting too warm or cold. To use MedAngel on a flight, just put your phone in flight safe mode and then reactivate Bluetooth.
During the Flight
Air Pressure and Injections
You feel the sudden changes in air pressure during take off and landing in your ears (ever taken a plane while having a cold?). It has been shown that it also affects some medical equipment, for example insulin pumps or stoma bags.
Prefilled pens can accumulate some air bubbles in the pen cartridge after a flight, so if you usually keep the needle on the pen, just give it a quick check before injecting again.
What happens with insulin pumps on a plane?
Research has shown that the change in pressure as the plane ascends, causes the pump to deliver an extra 1-2 units of insulin. For many people, this is a small amount of insulin and you might not even notice it. But for a child or a person who is quite insulin sensitive, it is something to be aware of. Melissa Lee has kept a close eye and her camera on her pump during a flight and wrote about her experience here.
To avoid the involuntary extra dose: Disconnect the pump during take-off, check and prime, and repeat when landing.
As if jetlag wasn’t enough, people with diabetes dose their medications around their day. If you are using an insulin pump, change to the local time when you reach your destination.
If you are using insulin pens or other daily injections, you might want to think about timezones even ahead of the flight and change timing of injections, like you would try with your sleeping schedule to avoid jetlag. In general, if the time zone change is less than four hours, you will not need to make major changes to your injections.
Read how Cazzy manages her insulin injections on her many travels around the globe on her travel blog, or check this scientific publication for an exhaustive guide and more background info.
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