Before she boarded her flight from Santiago, Chile, to Buenos Aires, Argentina, the unthinkable happened to Barbara Rowan: a security screener tried to confiscate her needles.
Rowan, who is a diabetic, needs to carry hypodermic needles with her for medical reasons. So she struck a deal with the Chilean airport officials: The chief purser would hold the packaged needles until the plane landed in Argentina.
For people with diabetes, such challenges are all part of air travel. And thanks to factors such as unpredictable preflight-screening rules and limited availability of food and beverages on planes, it's not getting any easier. But a few precautions and a little creativity can help you reach your destination without experiencing a health crisis.
Rowan, a retired attorney from Alexandria, Virginia, made it to Buenos Aires safely. Although her trip took place in 2009, at a time when security officials feared that syringes could be used in a terrorist attack, it serves as a reminder that screening measures can change at any time, and for any reason.
If you're not one of the 29 million Americans who are diabetics or don't know anyone who is, here's why Rowan's needles are important: Insulin injections control blood-sugar levels in diabetics. Without medication, her blood sugar could have spiked to a dangerously high level.
Perhaps the most difficult thing about traveling with diabetes is a fear of the unknown. Rowan for example, thought she understood the restrictions, but she says they had changed suddenly. "I guess it was a reasonable reaction by security, but not a happy one for us," she says.
This kind of uncertainty plagues almost everyone traveling with diabetes. Will the Transportation Security Administration (TSA) allow me through the screening area? Did I remember to pack my insulin? What if something happens to me?
Larry Hirsch is a physician who works for Becton Dickinson, a medical-technology company that manufactures the syringes and needles patients need to take insulin. He also has Type 1 diabetes. On a recent overnight flight to Europe, where he planned to attend a medical conference, he made a troubling discovery.
"I opened my carrying case for my insulin and supplies only to find, to my chagrin, that I had not brought my short-acting insulin with me," he recalls. He emailed colleagues at his destination and asked them to bring replacement medication.
Another incident stands out in Hirsch's mind. On another flight, he responded to an "Is there a doctor on board?" call. "I found a young man slumped over, barely responsive," he says. Hirsch tested the passenger with his blood-glucose meter and found he had low blood sugar. A little fruit juice revived the traveller.
The TSA allows diabetes-related supplies and medication through security checkpoints once they've been screened. Passengers should declare these items and separate them from other belongings before screening begins, according to the agency. Outside the United States, the procedures are similar, although they can vary, as Rowan, the retired lawyer, discovered. The American Diabetes Association also publishes a helpful guide to air travel.
If you're traveling with an insulin pump, check with the device manufacturer for airport screening recommendations. While the TSA may try to scan the pump, it may or may not be safe for the device, says Joshua Miller, the medical director of diabetes care at Stony Brook Medicine.
"I always ask a security agent to screen the device separately," he says. "If you are asked for a separate screening with pat-down, be sure to tell the screener where on your person your insulin pump site or sensors are located to avoid any discomfort during the screening."
Kirsten Hagemann, who has had Type 1 diabetes for four years, says that despite assurances that your equipment and medication will get through security, you'll want to take some additional precautions. "Ask your doctor for a statement saying you are diabetic and that it's medically necessary to carry syringes and other supplies in your personal carry-on," says Hagemann, who works for the federal government in Washington.
Keep your medications in original, clearly labelled containers and bring a copy of your prescriptions, advises Johnnie Yates, a travel-medicine physician at Kaiser Permanente Moanalua Medical Center in Hawaii. That should prevent them from being confiscated. "The prescription and medication labels should match the name on your photo ID. Also, check with your airline about travel restrictions regarding insulin, insulin syringes and blood-glucose testing supplies," he advises.
Travellers who have their diabetes under reasonable control can fly anywhere safely if they plan adequately in advance, which includes discussing the proposed journey with their doctors beforehand for specific management advice.
The key to preventing an in-flight episode is what Satesh Bidaisee, a professor of public health and preventive medicine at St. George's University in Grenada, calls dietary management. "In-flight meals will usually suffice," he says. "However, supplemental snacks may be necessary if meals are delayed. Some airlines do not offer a meal service and as such appropriate meals should be taken onboard to allow for blood-glucose maintenance."
Another often-recommended precaution: Wear a medical bracelet that has details of your condition - just in case you end up slumped over in your seat.
Travel insurance requirements are different for diabetic travelers. Many policies don't cover preexisting medical conditions, so if you experience a problem while flying and require hospitalisation, your policy may not cover you. "It's key to travel with a health insurance or travel health insurance plan that includes acute onset of a preexisting condition coverage," warns Zubair Jeewanjee, who runs G1G.com, a travel insurance comparison site. "Otherwise a plan could deny coverage under preexisting guidelines."
Preparedness for diabetic travelers starts with travel insurance but extends to food, medication, and, of course, monitoring your glucose. "Have your blood glucose monitoring supplies handy," advises Chrysa Nasca Kirsch, a registered nurse, and certified diabetes educator at the Cleveland Clinic. "Bring extra testing supplies to ensure that you will not be without if extra testing is needed or your stay is extended."
That's a lot to remember. But the diabetes experts I consulted told me that, with a little preparation, you can have a safe and uneventful flight. Yes, even with all the unknowns.