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Non-insulin Medication Considerations

Oral Medications

  • Metformin
    • Try to keep changes minimal while traveling and switch to the destination time when going to bed. After switching to the destination time, take your medications at the hour that you normally would. If you miss a dose, take the dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take the next scheduled dose. Do not take extra if you miss a dose.
  • Semaglutide Tablets (Rybelsus®)
    • Continue to take semaglutide each day at least 30 minutes before eating breakfast. If you miss a dose, take your next dose the following day. Do not take an extra dose the next day.
  • Repaglinide (Gluconorm®)
    • Continue taking Repaglinide with meals while you are travelling. If you forget to take a dose before a meal, skip that dose and simply take the next dose with your next meal. Do not take extra if you miss a dose. If you are taking the Gluconorm SR®, take it with breakfast.
  • Dapagliflozin (Forxiga®)
    • Keep taking your dose once a day while traveling. Dapagliflozin can be used in the morning or night, so you can continue taking it every 24 hours based on the time at home or you can begin taking it at a new time at your destination. If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take an extra dose the next day.
  • Sitagliptin (Januvia®)
    • Keep taking your dose once a day while traveling. Sitagliptin can be used in the morning or night, so you can continue taking it every 24 hours based on the time at home or you can begin taking it at a new time at your destination. If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not an extra dose the next day.
  • Empagliflozin (Jardiance®)
    • Keep taking empagliflozin once a day in the morning once at your destination. Empagliflozin can cause increased urination, so consider how this may impact your travel
  • Glyburide (Diabeta®)
    • Continue taking glyburide with usual meals at your destination. There is a risk of low blood sugars while taking glyburide, especially with delayed meals. Be prepared with quick sugar treatment and snacks.
  • Gliclazide (Diamicron®)
    • Keep taking your dose on your usual schedule while traveling. If you miss a dose, take the dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take the next scheduled dose. Do not take extra if you miss a dose. There is a risk of low blood sugars while taking gliclazide, especially with delayed meals. Be prepared with quick sugar treatment and snacks.

Non-insulin Injectables

  • Semaglutide injections (Ozempic®)
    • Semaglutide injections are taken once a week, so there is no need to make dose adjustments. Take the dose as normally during the week of the trip. During the trip, take the dose every week at the same hour, based on the new time zone and each week afterwards. If a dose is missed, take it as soon as remembered as long as it is within five days (120 hours) of the missed dose. Do not double the dose if a dose is missed.
    • New, unused, semaglutide pens should be stored in the refrigerator. Semaglutide pens can be stored in the refrigerator between 2ºC and 8ºC (36ºF to 46ºF). Pens that are in use can be stored at room temperature between 15ºC and 30ºC (59ºF to 86ºF) for up to 56 days. Do not freeze pens. 
  • Dulaglutide (Trulicity®)
    • Dulaglutide is only used once a week, so there is no need to make major adjustments. Take the dose as normally during the week of the trip and each week afterwards. If a dose is missed, take it as soon as remembered as long as there are at least three days (72 hours) before the next dose. Do not double the dose if a dose is missed.
    • New, unused, dulaglutide pens should be stored in the refrigerator. Pens that are in use can be stored in the refrigerator between 2ºC and 8ºC (36ºF to 46ºF). Pens can also be stored at room temperature between 15ºC and 30ºC (59ºF to 86ºF) for up to 14 days. Do not freeze pens. 
  • Liraglutide (Victoza®, Saxenda®)
    • Try to take liraglutide injections at the usual time based on the destination time zone. Keep doses roughly 24 hours apart. If a dose is missed while travelling, simply skip that dose and take the normal amount at the next dose. Do not double the dose if a dose is missed.
    • New, unused, liraglutide pens should be stored in the refrigerator. Pens that are in use can be stored in the refrigerator between 2ºC and 8ºC (36ºF to 46ºF). Unused pens can also be stored at room temperature between 15ºC and 30ºC (59ºF to 86ºF) for up to 30 days. Do not freeze pens.

Insulin Adjustment Considerations

There are multiple options for how to adjust  insulin while traveling. For some insulins listed, two options are provided. Choose the one that will be the easiest for your patient to stick to. The following destinations have time zones five or more hours ahead of Alberta: All of Australia, All of Africa, All of Asia, and All of Europe (this is not a complete list of all destinations). 

Degludec (Tresiba®)

  • The night before the trip, take the usual dose of degludec (Tresiba®).
  • While traveling, continue to take bolus doses with meals. If having additional meals during the extended day, take bolus insulin with these meals.
  • Take the next dose of degludec, at the usual dose and time according to the destination time zone. Ensure there are at least 8 hours between doses.
  • Continue taking degludec once a day.

Detemir (Levemir®)

For travel under 4 h, take detemir at the usual dose and time according to the destination time zone. For time differences of 4 h or more, adjust as shown below (patient handount available here).

Detemir traveling East (4+ hours)

  • Take the detemir dose at the normal time(s) on the day before the trip.
  • While travelling, continue to take bolus doses with meals as usual.
  • Take the next detemir dose at the usual time interval during the trip (about every 12 or every 24 hours). This will be a different hour at the destination but will be the same time at home. If on 2 doses per day, and taking a different dose in the morning compared to night, consider averaging out the two doses.
  • Keep taking detemir insulin at the same time during the trip.
  • Once back, take insulin at the normal time.

Detemir traveling West (4+ hours)

  • Take detemir dose at the usual time(s) on the day before the trip.
  • While traveling, continue to take bolus doses with meals as usual.
  • Take the next detemir dose at the usual time interval during the trip (about every 12 or every 24 hours). If on 2 doses per day, and taking a different dose in the morning compared to night, consider averaging out the two doses.
  • Switch to destination time and schedule when first going to sleep at the destination.
  • Once back, take insulins at the usual times.

Glargine U300 (Toujeo®)

For travel under 5 h, take glargine U300 at the usual dose and time according to the destination time zone. For time differences of 5 h or more, choose one of the options below. (patient handout available here.)

Glargine U300 traveling East (5+ hours)

  • The night before the trip, take normal dose of glargine U300 (Toujeo®) insulin.
  • While traveling, continue to take bolus doses with your meals. If you are having additional meals during the extended day, take bolus insulin with these meals.
  • For the next dose of glargine U300, keep it within about 3 hours (3 hours before or 3 hours after) of the usual time based on your home time zone. This means that the next dose should be somewhere between 21 and 27 hours after the last dose.
  • Change the time on watch/phone to the new time zone.
  • Continue taking glargine U300 once a day, based on the new timezone.

Glargine U300 traveling West (5+ hours)

  • The night before the trip, take normal dose of glargine U300 (Toujeo®) insulin.
  • While traveling, continue to take bolus doses with your meals. If you are having additional meals during the extended day, take bolus insulin with these meals.
  • For the next dose of glargine U300, keep it within about 3 hours (3 hours before or 3 hours after) of the usual time based on your home time zone. This means that the next dose should be somewhere between 21 and 27 hours after the last dose.
  • Change the time on watch/phone to the new time zone.
  • Continue taking glargine U300 once a day, based on the new timezone.

Glargine U100 (Lantus®, Basaglar®)

For travel under 4 h, take glargine at the usual dose and time according to the destination time zone. For time differences of 4 h or more, adjust as shown below (patient handout available here.)

Glargine traveling East (4+ hours)

  • Take glargine dose at the normal time the night before your trip.
  • While traveling, continue to take bolus doses with your meals as usual.
  • Take the next glargine dose 24 hours after the dose from the previous night. This will be a different hour at the destination but will be the same time at home.
  • Keep taking glargine insulin at this time during the trip.
  • Once back, take insulin at the usual time.

Glargine traveling West (4+ hours)

  • Take glargine dose at the usual time the night before the trip.
  • While traveling, continue to take bolus doses with meals as usual.
  • Take the next glargine dose about 24 hours after the previous dose. This will be a different hour at your destination but will be about the same time at home.
  • Keep taking glargine insulin at this time during your trip.
  • Once back, take insulin at the usual time.

Insulin Pump

  • Remember to pack a safety kit, including insulin and pens/syringes in case you are unable to use your pump for any reason.
  • Do not make any changes to pump before or during the flight.
  • Switch the time on the pump to the time zone at the destination upon arrival.

NPH

NPH traveling East

  • Option 1: 
    • Upon arrival at destination, change the time on watch/phone to the new time zone. Take next dose of NPH insulin at the usual hour, but based on the new time zone.
    • Take NPH dose(s) at the normal time(s) on the day before the trip.
    • While traveling, continue to take bolus doses with your meals as usual.
    • Based on the original time zone, decrease regularly scheduled NPH dose by 4% per hour of flight time. This means that a five-hour flight will require a 20% reduction in NPH insulin during for scheduled injections during the flight to account for the shorter day.
  • Option 2: 
    • Take your NPH dose(s) at the normal time(s) on the day before the trip.
    • While traveling, continue to take bolus doses with your meals as usual.
    • Based on the original time zone, decrease regularly scheduled NPH doses by the hours of time difference divided by 24. For example, an 8-hour time difference will result in a 1/3 reduction in the dosage (8 / 24 = 1/3). Therefore, one would take two-thirds of a usual dose.
    • Once at the destination, change the time on watch/phone to the new time zone.

NPH traveling West

  • Option 1:
    • Take NPH dose(s) at the normal time(s) on the day before the trip.
    • While traveling, continue to take bolus doses with your meals as usual.
    • Based on the original time zone, increase your regularly scheduled NPH doses by 2% per hour of flight time. For example, a five-hour flight will require 10% more insulin during scheduled injections to cover the extended length of the day.
    • Once at the destination, switch to the destination time zone. Take next dose of NPH insulin at the usual hour, but based on the new time zone.
  • Option 2: 
    • Take NPH dose(s) at the normal time(s) on the day before the trip.
    • While travelling, continue to take bolus doses with your meals as usual. If you have an additional meal due to the longer day, take an extra dose of bolus insulin. Do not make changes to your basal insulin schedule.
    • Switch to destination time and schedule when first going to bed at your destination.