Hi, my daughter was diagnosed about 6 mo ago and she just started the Omnipod last week. We had a flight on Friday and had a scary hypo event on the plane where her blood glucose fell from about 200 to “low” on dexcom in 25 minutes. I had a really hard time getting her BG up and keeping it up over the 2.5 h flight. She consumed about 150 grams of carbs and was only on the low 90s when we landed. . It had been over 6 hours since she had a bolus! Plus we were doing temp basal down 90% for the flight.I can only assume the pressure change caused insulin delivery but the endocrinologist says this shouldn’t happen. I’m now pretty scared of a pump malfunction and definitely afraid for her to fly with it. I removed it for our return flight and managed with injections. Any insight or advice? Should I contact Omnipod?
@caryb I can appreciate the concern and sorry you went through this. I’m sure you’d like for one of the folks here to have “the” answer or recommendation you’re looking for (and deserve). However, I’m sorry to say that’s not likely for multiple reasons. I’ve read comments from Insulet that flying with a Omnipod is safe with most commercial aircraft; the pressures are normally reduced but controlled so as not to be overly impactful on the average person. There is significant “anecdotal” data controversy about the pressure differential impacts on pumps; you’ll find multiple people that swear it happens and an equal number that swear it doesn’t. The fluid dynamic science says there may be some marginal impact, but not much…and there the science stops and the practical mitigators begin. Multiple factors come in to play: 1) physical size of your daughter and her reactions to insulin (dosing is NOT an exact science to begin with and add in her physcal size and insulin need makes judgements dicey at best); 2) the basal, ICR and other pump settings are probably still in some state of flux given her recent diagnosis making any recommendations someone here can make suspect; 3) the measurement device used for BG determinations (CGM or fingerstick), which brand (some are more accurate and all have their quirks and peculiarities) and how “off” they are from actual (check the MARD). I’m sure there are a couple of dozen other factors I’m leaving out. Given all that, you’re action to remove the pump and use MDI is understandable. The people here can provide advice based on their individual experiences, and that may be what you need or want right now, but the fact is no one here, despite the fact we’d like to, is likely to have “the” answer. My recommendation is to contact the manufacturers of the devices you/she use to get their advice, discuss the experience with your doctor/Endo, roll in all that with the responses you get here, and judge all that based on what you think is logical and make it a learning event to guide your future monitoring and actions both for airline travel and general life. I’m sorry for not having better advice! It does get easier as you/she adapt to the reality this is very individualistic and “it depends” disease. It may or may not get better, but it does get easier to deal with time and experience.
hi @caryb I would also like to add to @Tlholz that stress and even mild exercise like walking, plays a big part of blood sugar control as well. We have a member here that regularly went low on aircraft when using pods as well, but may people fly with pods without any trouble. I am sure the manufacturer will claim the pod was not at fault but that should not deter you from complaining. The complaint is a data point for medical device manufacturers and can help with product designs and overall product safety.
My only advice is that you now have an experience, perhaps setting the pod to activity mode probably 4 hours before a flight would reduce IOB and probably prevent any kind of automatic bolus. Also, and IMO, if your blood sugar is low, then zero basal is fine. I regularly use zero basal when I know I am going to be active. I don’t have a pod I use tandem.
There’s nothing wrong with using MDI when it works better. I think your decision to go to MDI for the return flight was a great solution as well.
Hi Cary @caryb, I would suggest that something other than the Omni patch pump is at issue here, and rule out cabin air pressure if you were on a commercial flight. In addition to the suggestions @Joe presented, something to look at is the change in your daughter’s meal schedule, for example, did she get up and eat much before her regular time. I do strongly suggest that when you are back home and settled, that you validate her basal settings by totally skipping a meal [select different meals to skip on different days] and watching her BGL to see if she maintains a safe level reading.
My personal experience of going low on several [usually early morning] flights was to totally disconnect my pump and leave it off during take-off and then again beginning a half hour before landing. Removing the pump didn’t make any difference and I then explored the correction methods mentioned above; for the last 10 years I have my pump connected full-time on travel days.
Another thought when you say her basal was reduced “down by 90%”, does this mean you set her basal to flow at 10%? Something to think about when wanting a lower basal for an event - have the reduced basal begin an hour or more BEFORE the event. Although basal doesn’t show accumulated on “active insulin” or “insulin on board” display, it does still accumulate and remain in the body for 4-5 hours just as the bolus insulin.
Thanks for all of your responses. This is all good advice. I was expecting that she’d go low with the excitement if travel which is why I did not bolus for lunch. She had a normal breakfast and a snack for lunch at the airport which consisted of a boiled egg and sweetened drink. She also has celiac so food is difficult to find when we travel. The small meal probably did have a role, but the her BG was elevated from the drink at the start of the flight. It just seemed too extreme of an event to be from excitement alone… although something similar but much less extreme happened when traveling when she wasn’t on the pump. Her small size could have something to do with it. These events are just so unsettling. Of course now we are home, back on the pump, and struggling with nighttime highs again , likely due to hormones (she’s 11). She’s in manual mode on the Omnipod until they push out the G7 upgrade at the end if the month.
Hi @caryb I am not using omnipod but I have to comment that overnight control with a CGM feedback loop is , simply, wonderful. The below graph is overnight blood sugar the little blue rectangles at the bottom is the algorithm figuring out my basal all night long. I did wait for g7 but knowing what I know now I’d temporarily go back to g6 to use this feature.
