aeromedical concerns with the diabetic patient presentation

7/31/2019 Aeromedical Concerns With the Diabetic Patient Presentation

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AeromedicalConcerns for the

diabetic patientTC4 AVMX 721

Sundaresan Maiyalagan

15thMay 2012


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Content Overview

Introduction

Current definition and classification of Diabetes

Complications and its implications foraeromedical transfer

Aeromedical concerns with management ofblood glucose levels

General advice for passengers flying with

diabetes


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Introduction

171 million people in the world with diabetes mellitus(DM) in the year 2000 and this is projected to increase to366 million by 2030

8.3 percent of the U.S. Population

In Mauritius the prevalence is as high as 15% (2004survey)

Multiple associated complications and co-morbidities

Heterogeneous population with a varied range ofdisease spectrum


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Current definition and classification


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Current definition and classification


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Complications and its Implications forAeromedical Transfer

Acute consequences of impaired glycemic control Hypoglycemia, Ketoacidosis and hyperosmloar non-ketotichyperglycaemic coma

Stiff Joint Syndrome and associate difficult laryngoscopy

Cardiovascular complications - Silent MI, Cardiomyopathy

Diabetic Sensory and Autonomic Neuropathy

Diabetic Retinopathy and Cerebral Complications

Diabetic Nephropathy

Impaired wound healing and immunity


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Diabetic Autonomic Neuropathy effect on various organsCardiovascularResting tachycardiaExercise intoleranceOrthostatic hypotension

Silent myocardial ischemia

GIEsophageal dysmotility

Gastroparesis diabeticorumConstipationDiarrheaFecal incontinence


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Diabetic Autonomic Neuropathy effect on various organs

GenitourinaryNeurogenic bladder (diabetic cystopathy)

MetabolicHypoglycemia unawarenessHypoglycemia-associated autonomic failure

SudomotorAnhidrosisHeat intoleranceGustatory sweatingDry skin


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Diabetic Autonomic Neuropathy effect on various organs

PupillaryPupillomotor function impairment (e.g., decreased diameter ofdark adapted pupil)

Argyll-Robertson pupil like phenomenon

RespiratoryImpaired response to hypoxia and hypercapnia


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Aeromedical Concerns With ManagementOf Blood Glucose Levels

Oral Hypoglycaemic Drugs and Insulinadministration

Blood Glucose monitoring


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Oral Hypoglycaemic Drugs and InsulinadministrationTiming

Maintaining bioactivity of insulinInsulin pumps and aeromedical transfer

Picture of the Minimed Paradigm 722 (Insulin pump device,

Medtronic)(A), with the continuous blood glucose monitor(C) and transmitter (D), and the infusion set (B).


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Oral Hypoglycaemic Drugs and InsulinadministrationTiming

Maintaining bioactivity of insulinInsulin pumps and aeromedical transfer

(Bruce R King et al . Diabetes Care 34: 1932-33, 2011

The cartridge should only contain 1.5 ml of insulin

Disconnect the pump before takeoff At cruising altitude, take the cartridge out of the pump and remove air

bubbles before connecting After the plane lands, disconnect the pump and prime the line with 2

units. Then reconnect the pump.

During flight emergencies involving cabin decompression, disconnectinsulin pump.


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Blood Glucose monitoring

Availability

Variability

Effect of altitude on glucometer performancePatricia L Brubaker. Adventure Travel and Type 1 Diabetes. Diabetes CARE 2005; 28 (10): 2563-72

Aircraft regulations regarding use of ContinuousGlucose Monitoring devices


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General advice for passengers flying withdiabetes

Two blood glucose monitoring devices, with extrabatteries, packed in separate bags

Enough insulin, syringes, lancets, and test strips to lastthe entire trip

For pump users, enough pump supplies for the entiretrip, extra batteries, and supplies of long-acting insulin(ultralente or glargine) and regular or rapid-acting insulinanalog (lispro or aspart) and syringes for use in case of

pump malfunction or battery failure

Prescription medicines (including a glucagon emergencykit), for diabetes and other medical conditions


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Simple carbohydrate sources, such as glucose tablets,gels, candy, and nondietetic soft drinks to relievesymptoms of hypoglycemia

Complex carbohydrate sources, such as breakfast bars,cheese crackers, granola bars, and trail mix to serve assnacks when meals are missed or delayed

Regular insulin or short-acting insulin analogs fortreating high blood glucose and for sick-day

management even if these are not part of the patientsregular regimen

Identification (diabetes identification card, Medic Alertnecklace or bracelet)


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Insurance papers (Confirm before travel what medicalcoverage is available from the insurer in the event of amedical problem abroad.)

Medications for vomiting and diarrhea

A first aid kit, including analgesics, antibiotic andantifungal creams, bandages, sterile gauze, andadhesive tape


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Conclusion

In conclusion, patients with DM are a heterogeneous

population, but there are key areas where the aeromedical

team must focus and be prepared with regards to type of

diabetes, the associated complications, management of

blood sugar levels and the effects of aeromedical transfer

on these areas in order to ensure a safe and effectiveaeromedical transfer of patients with diabetes.


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Thank YouTC4 AVMX 721

Sundaresan Maiyalagan

15thMay 2012

aeromedical concerns with the diabetic patient presentation

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