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A new study has shed light on the effect of air travel on insulin pumps, revealing that pressure changes during takeoff and landing can cause insulin pumps to over-deliver or under-deliver insulin. According to research presented at the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting, insulin pumps tend to deliver slightly more insulin on ascent and less during descent.
Dr. Bruce King, a pediatric endocrinologist at John Hunter Children’s Hospital in Newcastle, Australia, explained that this phenomenon occurs due to air bubble formation and reabsorption in the insulin, triggered by ambient pressure changes inside airplane cabins. “This has nothing to do with the pump itself,” King said, emphasizing that it affects all insulin pumps, including those in hybrid closed-loop systems.
Impact on Insulin Pump Users
The extent to which this phenomenon impacts individuals with diabetes varies based on factors such as insulin dose and sensitivity. However, Dr. King stressed the importance of making people aware of these fluctuations, especially when flying. “Basically, the pumps are very safe in flight,” he said, “but they deliver a little bit of extra insulin when you go up and stop delivery when you come back down again.”
For insulin pumps with tubing, King advised users to disconnect their pump just before takeoff and reconnect once the plane reaches cruising altitude, roughly 20 minutes into the flight. On descent, users can disconnect the pump after landing and prime the tubing to eliminate any insulin deficit. For pumps like the Omnipod, which cannot be disconnected, King recommended eating small snacks during takeoff and landing to compensate for any delivery disruptions.
Balancing Convenience and Risk
Dr. Nicholas Argento, an endocrinologist in Columbia, Maryland, described the issue as a “minor effect.” While acknowledging the potential for insulin delivery discrepancies during flight, he suggested that the proposed changes may involve too much effort for a relatively small difference. For instance, on takeoff, insulin pumps typically deliver 0.6 units more insulin than usual, while landing causes a deficit of about 0.5 units. Argento proposed a simpler approach: suspending the pump for an hour on ascent, which would not entirely prevent extra insulin delivery but could reduce its impact.
Ongoing Awareness and Manufacturer Responses
This phenomenon is not new; it was previously described by King in a 2011 study published in Diabetes Care. However, the current research, funded by the European Union Aviation Safety Agency, aims to establish safety parameters for pilots with insulin-treated diabetes.
Major insulin pump manufacturers, including Medtronic, Tandem, and Insulet, have acknowledged this issue in their product user guides. For example, the Tandem Mobi user manual includes warnings related to air pressure changes and suggests disconnecting the pump during flight. Meanwhile, the Omnipod DASH and Omnipod 5 manuals advise frequent blood glucose checks during air travel.
Dr. Jordan Pinsker, Chief Medical Officer at Tandem Diabetes Care, pointed out that while pressure changes during air travel can cause minor insulin delivery fluctuations, these changes generally have a minimal effect on glycemic control.
Simulating the Effects of Flight
The study involved in vitro experiments in a hypobaric chamber that simulated atmospheric changes during a flight. Insulin infusion rates were tested in three different insulin pumps: Medtronic MiniMed 780G, Tandem t
X2, and Insulet Omnipod DASH. All pumps over-delivered 0.60 units of insulin on ascent and under-delivered 0.51 units on descent.
The study also simulated rapid decompression scenarios, which showed statistically significant differences in insulin delivery. While such events are rare—occurring around 40 to 50 times a year—the study highlighted a case in January 2024, when an Alaska Airlines flight experienced rapid decompression after a door fell off midair.
Moving Forward
Dr. King’s research group is continuing to investigate these effects in real-world settings, including among airline pilots with diabetes. As air travel becomes increasingly common, understanding how insulin pumps interact with pressure changes could be vital for ensuring the health and safety of those with diabetes who rely on these devices.
Takeaway: For insulin pump users, especially frequent travelers, understanding these effects can help minimize risks. Simple steps like disconnecting pumps during critical flight phases or adjusting eating habits may prevent fluctuations in insulin delivery, ultimately maintaining better glycemic control during flights.
