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Fainting during a long haul flight

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SueDLM

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Parent of person with diabetes
My teenage type 1 daughter fainted last week half way through a transatlantic flight from London to New York. It is the second time this has happened when flying on exactly the same route and she hasn't fainted at any other time apart from on these 2 flights.

We monitored her blood sugar levels carefully before and during her flight and made sure she had eaten sufficient carbs. She did have a hypo but not a severe one (she can go down to as low as 0.7 without passing out). She was found by a cabin assistant on the floor outside the toilet. Her Freestyle Libre sensor, when she came round, showed she had had a hypo but by the time she had come round her sugars had gone up to 6.3. She felt really nauseous and needed oxygen but was fine within 45 minutes. BA crew were incredible but it was just a really scary experience and I wondered whether this happens often? Has anyone heard of this or has any ideas how to prevent happening again. Should we see a doctor/specialist?
 
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Hi and welcome.
I am so sorry to hear that you and your daughter have had such a scary experience. I am guessing that there is an error in your text somewhere as London to Gatwick is definitely not long haul??
I am not sure I have any significant input, but things to consider would be when she took her basal insulin if she was travelling across time zones and did she possibly miscalculate her bolus injection as in flight meals are usually much smaller than normal meals.
I would be inclined to ensure she runs her BG levels higher than normal before and during a flight in the future and/or scale back her bolus ratios.
I would be extremely concerned that she has had a hypo as low as 0.7.... was that confirmed by a finger prick test rather than just a Libre reading? I would be encouraging her to run her BG levels higher in general for a few weeks to improve her hypo awareness, as that situation is beyond dangerous in my opinion.
Has she been diagnosed long and had she had a DAFNE course or similar?
 
Thanks Barbara and oops, I've amended my post to show it was a flight from the UK to New York. She was diagnosed 8 years ago and has good control and a HBA1C around 7 every 3 months. Always had really low (occasional) hypos and luckily has brilliant awareness as anything below 3.9 wakes her up at night. Basal insulin probably not a factor here as it was a daytime flight and she had reduced her dose slightly the night before. Since coming out of puberty, her insulin needs are really low (basically 18 units of Levemir single dose and 1 unit of Levemir to 30g of carbs but can't have more than 2.5 units with meal regardless of carb content without hypoing). She purposely tried to run slightly higher than normal throughout flight and had a good meal before boarding with lots of slow release carbs. We wondered whether it was a mixture of blood sugars and air pressure and also she does tend to swing towards slightly low blood pressure too which may not have helped.
 
I did wonder if low BP might be an issue, particularly with the cabin pressure.
I also wonder whether a low carb diet might benefit her if she is so sensitive to insulin, particularly if she is beyond puberty. Also wonder whether splitting her Levemir dose might be beneficial... it is usually recommended with Levemir to give better coverage and if she is now more sensitive to insulin, it might make it more relevant having a half dose morning and evening.
I am no expert so please be guided by more experienced people but those are things which occur to me from reading you post and my own limited experience.... I find a low carb diet (and minimal quick acting insulin) is a safer option for me.
 
I would also recommend a DAFNE (Dose Adjustment For Normal Eating) or equivalent course if she has not had one. Just had mine a couple of weeks ago and really found it beneficial even if "low carb" eating is not really "normal"
 
Thank you Barbara for taking the time to respond and for your suggestions. Will definitely try splitting her Levemir dose but unfortunately we live in the Channel Islands and so no access to the DAFNE course. She has been independently carb counting for some years now though and is always spot on whenever I do ad hoc checks. She just seems so sensitive to insulin now and already eats a low (ish) carb diet anyway. You are very kind.
 
I would discuss splitting the Levemir dose with her Health Care Professionals and also see what input they have on her situation/problem regarding passing out when flying.
It is a shame that DAFNE is not an option due to your geographical situation. I found it hugely beneficial. It is not just about carb counting, but keeping you safe in amy number of situations. It is also really helpful to make contact with other Type 1s with various backgrounds and share and learn from your combined experiences.
 
I think air pressure and generally stuffy cabins can make flying challenging especially if she has low blood pressure and is prone to hypos. I would guess her fainting is a bit of a combination of the two. It’s a bit like doing sport in terms of pressure on the body. I don’t know if compression socks and the like would help on long haul flights. I’d be tempted to have some faster release carbs during long flights to give her more of a chance of staying high enough. Can you have a chat with her diabetes nurse or team as they may have ideas about it.
 
Some people are more sensitive to changes in air pressure and the oxygen content and it could be that your daughter is one of them.
Perhaps the airline should be alerted to the problem before future flights so that precautions can be taken rather than needing assistance, plus careful adjustment of carbs and insulin before and during the flight.
I used to go caving and know that some people can react strangely to caves where there is a stream running though them, as the oxygen content is higher down there - the different gasses in air dissolve differently and the oxygen is up at about one third instead of one fifth.
It is amusing to watch those who disregard the ban on smoking and light up in a 'wet' cave - the cigarette burns with a fair sized flame and lasts only seconds.
 
Good morning @SueDLM
Sorry to hear about the problems your daughter had on her flights.

As her readings for hypos are as low as 0.7 it would be worth talking to her team.
I know that if I am low my Libre sometimes gets in a strop and tells lies, but if that was confirmed with BG it may be worth talking to them about lifting her levels for a while, although I think I picked up that she normally picks up hypos at around 3.9 and is usually well aware. So it does sound like there may be other issues, as suggested by others. So worth taking precautions for future flights.
 
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