Collapse on flight prompts needle warning to diabetics

[rotornut]

Collapse on flight prompts needle warning to diabetics
August 20, 2007

INSULIN-DEPENDENT diabetics have been warned to seek approval to carry life-saving needles and medication onto flights after a man collapsed en route to Sydney.

Under tough new airline security measures, patients must carry documentation to be allowed to take vital supplies onto flights.

A Sydney intensive care physician, Dr George Skowronski, warned diabetics to seek approval from their doctors so they would not risk their lives.

He said a 54-year-old Sydney man was recently forced to fly from Norway to Australia without medication because he did not have a letter from a GP.

"The man's protests were to no avail and he boarded without his insulin," Dr Skowronski wrote in the latest Medical Journal of Australia. During the 25-hour journey to Sydney, the man, an engineer, developed sweating, breathing and urinary problems. He also vomited.

"Despite making cabin staff aware of the underlying problem, he was offered no assistance apart from a steady supply of airsickness bags," wrote Dr Skowronski, a St George Hospital doctor.

The passenger was "very ill" on arrival, and was taken by ambulance to hospital where he slowly recovered.

"Australian doctors and their diabetic patients should be reminded that airline security requirements are now very strict in most countries, and that life-threatening [diabetic reactions] can readily develop during the course of a flight between Australia and the northern hemisphere," Dr Skowronski warned.

"Insulin-dependent patients must continue to take their insulin during these flights and should not board an aircraft without their supplies."

In Australia, the Department of Transport and Regional Services stipulates that people with medical requirements may carry prohibited items such as hypodermic needles, but must also carry a doctor's letter, a medical certificate, or a current National Diabetes Services Scheme card.

Supplies should be clearly labelled, carried in a clear plastic bag and declared to security staff before being screened.

http://www.smh.com.au/news/national/collapse-on-flight-prompts-needle-warning-to-diabetics/2007/08/19/1187462087961.html

[west lakes]

I really can't help but wonder:confused:

These rules have been in force since 9/11, all carriers and all airports (in the UK) have clearly given this advice since then.
How do i know? I am insulin dependant also and have carried a doctors letter since. Though TSA were confused by it last year as the operative wanted a copy of the prescription, only issued in the UK by doctors immediately before going to pharmacy. In the UK most security just wave me through - shock horror.

What confuses me though is that insulin is required to lower blood sugar levels, the onset and effects of low blood sugar can be very quick and sudden (a hypo) and is related to insulin dosage, exercise, stress and lack of food intake. The opposite (a hyper) is slower to manifest itself and in the short term (certainly in my case) not a serious concern - in the longer term it is.

The symptoms are what I would expect to suffer in a hypo, the quick solution being sugar & carbohydrate. Insulin would only make it worse!

A big problem is in flight meals, I was advised strongly not to order a "diabetic meal" being on insulin as they are low in carbohydrates and are more suitable for sufferers on diet & tablet treatment.
Airlines - note this!

As treatment of a Hypo is common infirst aid training it is even stranger, though it is likely that the situation would have been confused with the probably insistance of the situation re lack of insulin.

Wife is a RN and was a ward diabetic nurse for a time. She agrees with my take of this. It is also worth noting that some sufferers/travelling companions still haven't got the ins ad outs right in their heads.

As with most media reports there is probably more to this than printed

[indaba]

As a medic who has to deal with the potentially life-threatening consequences of this sort of thing, can I ask one simple question:

Just how big a security threat does an 8mm long 31 guage insulin needle pose? :ugh:

[Westofhere]

West Lakes is right. Spot on. As an insulin dependant diabetic in the industry for 20 years plus or I have also had to contend with all the changes in the rules for going airside or travelling as pax. If you halfway understand the condition and the rules there is no problem at all. Most security..and certainly all UK are well aware and a quick word or check with them and all is well as long as you are not claiming the usual victim status.. In my view, the pax mentioned here would not have benefited from insulin from what I can see..if it was lack of insulin that caused this, he was in a bad way well before boarding! Its not rocket science. Think about it and stick to the rules and diabetes and insulin is NO problem at all...

[west lakes]

indaba
Think it through, certainly in the days of syringes you could get someone fairly worried with the possible contents or health risks.
As I use pens, less of a threat but a massive dose of insulin would leave even a healthy person on their back.

Went through BLK once (2005) & forgot to declare needles to security, when I realised I apologised & said I had a letter if they wanted - the answer - "no problem we know what they are have a nice hol"

[Tolsti]

Whilst Airlines and Airport Authorities owe a duty of care to all passengers it should be borne in mind that passengers also have the same duty both to themselves and to the authorities to ensure that they prepare themselves properly prior to turning up for a flight. This includes making yourself aware of, and complying with, the measures in force.... just try ignoring these procedures at TLV...

[llondel]

Just how big a security threat does an 8mm long 31 gauge insulin needle pose?

Obviously much more than a glass bottle of duty-free.

While I agree that he should have had his paperwork, it's just another example of security being worried about the wrong things.

The question has to be asked how he got to Norway? There's nothing to say he was returning after a trip but it implies he might have been - did Australian security just wave him through with his medical kit outbound so he didn't realise that elsewhere in the world they'd be more picky? I can see that if he'd only travelled within an area where they didn't care, he'd never have learned that he needed the paperwork.

[west lakes]

Tolsi

Tee-Hee
You mean the bit where we're supposed to read the T&C of carriage, the prohibited items for hand & hold luggage, the what's banned & allowed thro security And of course listen to safety demo & read safety cards?
I think there is (see CC threds) a large proportion get the ticket & hope for the best:ugh:

Had one last year, working to repair an electricity fault on a street
Customer's wife "My husband is a diabetic & we need electricity for the fridge to keep insulin cool"
Me " Oh yes read the instructionns with the insulin it is OK at 20 or 25 deg C, dependant upon type, for up to 4 weeks"
Cons wife "How do you know"
Me "I'm diabetic and I read the instructions"

At times I really feel sorry for airline industry staff

I'd be interested to hear a CC/check in view of this thread:confused:

[sinala1]

It sounds to me like there is a lot more to this story...

As CC, one thing I always warn my crew about (particularly in long delay situations) is insulin dependant diabetics who may have injected in the terminal expecting to then eat on the flight within half an hour to 45 mins etc. All of a sudden, 1/2/3/4 etc hours later they are still in the terminal waiting for the flight but havent eaten (thinking its going to depart at any minute etc) - this can lead to them effectively having a hypo, even though insulin dependant's (from my understanding) are more at risk of hyper's - as no sugar/carbohydrate has entered the body that the insulin was injected for.

The question that as Senior CC I am asking is: WHY on earth he was allowed on the flight if the crew knew prior to departure he was insulin dependant diabetic without his insulin? (There is of course the possibility the crew were not aware). I have had to offload pax who were medication dependant (eg insulin, adrenaline etc) who werent carrying their medication - this is purely for their safety - the airline is generally very accomodating in changing flights for them.

There has to be more to this I am thinking... and 25 hours from Norway to Australia - chances are this passenger was quite sick wherever he transited enroute - Surely he could have requested assistance there if (according to the media report, which I am taking with a pinch of salt) he was not recieving medical attention onboard?

[Nov71]

This raises some interesting questions
The most likely consequence for an insulin-dep diabetic who injects and/or does not eat is a HYPO (low blood glucose), symptoms - aggressive foul-mouthed behaviour akin to drunkeness before coma Solution-sugar intake
Eating high carb diet without insulin injection leads to a HYPER, dehydration & potentail coma. Solution-insulin Flying also increases dehydration.

Syringes & needles can pose an airborne security threat Insulin can be fatal in a healthy individual, even pens.
Diabetes is a recognised medical disability (UK Disability Discrimination Act) Fredom to travel & access to medication could be regarded as a Human Right

Insulin dependant diabetes Type 1 manifests when a child, later onset Type 2 is normally a slow progression in middle age so rather than a Dr letter how about a passport entry or an identifiable medic-alert bracelet

Before medication is confiscated by Security the advice of an on-duty medic should be sought as per Police Dr

From NHS Direct

Hyperglycaemia High blood glucose levels
The person may be dehydrated, in a stupor or coma. They need urgent treatment for the dehydration and to correct their blood levels of certain chemicals such as glucose, potassium and sodium chloride (salt).
Prevention
In order to prevent hyperglycaemia from occurring, people with type 1 diabetes need to control their blood glucose levels by maintaining the right combination of diet and insulin injections (or tablets).
It is important not to miss or alter your dose of insulin and to maintain your fluid and food intake. It is also important that you test your blood glucose levels regularly.

Hypoglycaemia Low blood glucose levels
Symptoms
The symptoms of hypoglycaemia can include:
• headache,
• mental confusion (which may include aggressive behaviour),
• slurred speech,
• abnormal behaviour,
• loss of memory,
• numbness,
• double vision, and
• temporary paralysis and seizures (fits).
If you are hypoglycaemic, you may also experience trembling, faintness and palpitations, and excessive sweating. Sometimes, behaviour can be irrational, and disorderly, and may be mistaken for drunkenness.
The immediate treatment for a hypo is to have some food or drink containing sugar straightaway to end the attack. Examples of ideal types of food or drink include a glass of fruit juice that contains sugar, sugar lumps, chocolate, biscuits, a handful of sweets, glucose tablets or dextrose gel (such as GlucoGel).

After having something sugary, you should have a longer-acting carbohydrate food such as a few biscuits, or a sandwich.
If you have type 1 diabetes should carry glucose gel or some sugary food with them at all times. They are more likely to have a hypo than people with type 2.

[mustafagander]

I hate to be harsh, but this guy had an own goal here. He's reported to be 54 years old - surely old enough to take care of his diabetes yet unlikely to be senile. I would expect a reasonable person who needs regular medication of any sort to clarify the process for carrying it onboard the aircraft well prior to travel.

All diabetics, well type 1 anyway, are well schooled about how to manage their disease as soon as they are stabilised during their stay in hospital upon diagnosis. No diabetic (type 1) in his/her right mind would attempt to go without insulin for 24 hours, not one - even 4 year olds. The only rational explanation for this, to say the least, near incomprehensible behaviour is that he is a pumper and had a total malfunction during the flight or was already in hypo at boarding and hence becoming irrational - similar to hypoxia. There is nothing known about the MTBF of insulin pumps according to the endocrine team at Sydney Childrens' Hospital - there has yet to be one in over five years of use. Were he actually in hypo, he's dropped the ball once more - blood glucose checks are well known to be required more often when the normal daily routine is disrupted - I mean every 2 hours or less here.

[west lakes]

Sinala1

Correct, most airline sites advise diabetics to advise at check in if carrying insulin needles, I assume so info can be passed onto CC. From experiance it varies. Done so in the UK with little effect, in 2005 informed check in at GRO who made a photocopy of doctor's letter.

Last year travelling to USA asked CC if I could do inhjections in front galley area, (cleaner than toilets, easier than in seat)? no problem.
I did note at one time that some airlines will ask you to surrender items to CC for safe keeping especially on USA flights, this has never happened

Nov 71
Onsets are average, obviously I'm not as was diagnosed type 1 in mid-late 30's

For facts and figures, the target blood sugar level is in the region of 4 - 8 (not going into the unit of measurement). anything below 4 is classed as Hypo and most diabetics should be able to recognise they are going "down". Anything above is Hyper, harder to spot and as I said aqbove not as immediate (when diagnosed I was in the region of 35 -40 and still functioning - just!)

[dustybin]

Just a thought but I'm CC and have saw pax inject insulin in their seat and was angry as i was not informed of them being on board. I would want the pax to inform the airline and crew so that we are prepared in case they take ill not just turn up with a letter for security. Another thing that corcerns me is how do security or crew know its insulin (terrorists can be diabetic as well or pretend to be)
I can see both side of the argument and a common sense approach need to be taken, and please don't leave needles in seat pockets:yuk:

[mustafagander]

dustybin,
Insulin is very easy to identify - just smell it, it has a characteristic odour. Once smelt, never forgotten is pretty close to the mark.
Most diabetics I know are pretty good with their needle discipline and anyhow their syringes are small and it's usually a smart move to put them back in the bag with your diabetes kit. Snapping off the sharp is another common way to make them safe - the sharp is 30 gauge and about 8mm long, not to hard to store for safe disposal. Leaving syringes lying about these days is almost guaranteed to get adverse reaction from all quarters and rightly so.
west lakes,
Your onset was atypically late, wasn't it. Are you pumping yet? If not, look into it if you can, it will give you most of your life back, trust me!! If still injecting, have you tried pens yet? Nice and discreet - my teenage diabetic friends love the ease with which they can inject discreetly.

[west lakes]

Mustafagander

Yes it was, pumping still (as a far as I know) not yet fully available in the UK.

Set off with 1 pen & syringes (used to mix for evening injection), now use pens. Even got the kids style wallet for them so its more noticable.

As for lifestyle - it never really changed
(apart from one manager who held long meetings so usually coming up to lunch when I pointed out I needed an injection 20mins before {don't use that insulin now} always hastely finished the meeting said it made him ill to see injections- collegues loved me:ok:)

Dustybin
That was my point. Yes some will notify check in as requested by airline (as required by T&C's of booking) whether they care/tell you is another thing. Most will also carry a bracelet or card in their wallet, and all insulin is marked on the package as such (my vials are 3ml) that is also part of the security that the labelling is visible if required for inspection.

[PaperTiger]

There has to be more to this I am thinking... and 25 hours from Norway to Australia - chances are this passenger was quite sick wherever he transited enroute - Surely he could have requested assistance there if (according to the media report, which I am taking with a pinch of salt) he was not recieving medical attention onboard?I agree, this is a media item and probably wriiten by someone with neither aviation nor medical expertise.

A 25-hour hypoglycemic episode would likely have been fatal, but his symptoms (as reported) just don't gel - a mixture of hypo- and hyper- indications :confused: . My guess is he was having panic attack(s) at the thought of not having his insulin and the possibility of a hyper- episode, which if he's type-2 isn't that much of a deal providing you don't make a habit of it.

Since there are no Norway-Australia direct flights, I wonder where his insulin was denied ? Any bets for LHR :*