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VOLUME 10 NUMBER 2 • JUNE 2013
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes Educator’s Focus
Minimising travel-associated risks
in cardiac and diabetic patients
S Afr J Diabetes Vasc Dis
2013;
10
: 70–71.
T
ravel, especially when it involves long-haul
flights, can be hazardous to some patients
with cardiac conditions and diabetes. It is im-
portant therefore for their doctors and nurses/educa-
tors to be aware of this and advise them accordingly.
Dr Jonathan Klotnick, an executive member of the
South African Society of Travel Medicine who runs a
travel clinic in Rosebank, Johannesburg, elaborates
further. “Stable cardiac patients, who are control-
led on their medication, have no real issues when it
comes to flying/altitude and are unlikely to decom-
pensate, provided there is no depressurisation of the
aircraft cabin. It’s unstable patients that healthcare
professionals need to be concerned about.”
The Aerospace Medical Association lists the following
contraindications/precautions with regard to flying:
A myocardial infarction (MI) within the previous
•
2-3 weeks
In the event of a major MI, patients should wait
•
six weeks before travelling
Unstable angina
•
Severe congestive heart failure
•
Uncontrolled hypertension
•
Patients who have undergone coronary artery
•
bypass grafting should wait two weeks before
flying
Any uncontrolled arrhythmias or tachycardias
•
make it unsafe to fly
Severe disease of the heart valve may pose a
•
risk in the event of a dip in oxygen saturation
Dr Klotnick underscores, however, that this is a guideline
only, not a set of black and white rules. Oxygen desatu-
ration and the reduction of aircraft cabin pressures are
the major concern when it comes to unstable patients
who fulfil any of the abovementioned criteria.
Deep vein thrombosis (DVT) is a risk associated
with flying generally, and Dr Klotnick notes that
Dr Jonathan Klotnick
Executive Member: South African Society of
Travel Medicine
those on an anticoagulant such as warfarin reduce
their risk. He points out, however, that aspirin is
not a preventative for DVT, contrary to widely held
beliefs. “The idea that taking one or two aspirins a
day before undertaking a flight will lower DVT risk is
misinformed and wrong. Doctors need to make their
patients aware of this.”
Moving away from flying, he says that cardiac pa-
tients should factor in altitude differences. “If their
destination is at a much higher altitude than their
point of origin, they might take time to adjust, experi-
encing symptoms like shortness of breath. This is not
necessarily indicative of a worsening of their con-
dition.” Temperature can also be a factor. “Patients
with low blood pressure, who are normally asympto-
matic, may develop symptoms like light-headedness
and fatigue in very hot climates. Increasing their fluid
and salt intake can help alleviate these symptoms.”
It’s vital too to take an adequate supply of medica-
tion. Dr Klotnick advises that patients take a two-week
supply over and above what they expect to use and
to factor in delays in their return and possible non-
availability of medication at their destination.
Patients with pacemakers are often concerned about
interference from airport metal detectors. Dr Klotnick
reassures them that this is very unlikely. “There is a
theoretical risk but there have been very few issues in
reality. On the whole, they’re pretty safe.”
Turning to patients with diabetes, he notes that
travel and flying are in fact more complicated in
these individuals than those with cardiac conditions.
Patients need to advise airlines in advance of their
dietary requirements and must ensure they have ad-
equate travel insurance, something that also holds
true for cardiac patients.
Non-insulin-dependent diabetics, with stable
blood glucose levels and who are not prone to hy-
