Travelling with diabetes

Preparing your trip

Are you fit to travel?

There is no reason that you should not travel if you have diabetes, but as it is a condition that is potentially deadly, you should plan your trip carefully and remember to bring a number of things along to prevent problems. Remember to keep your usual routine unless indicated otherwise by your physician. It is also a good idea to test your blood sugar levels more often than usual.

Choosing your destination

As different environments and physical activities will affect your body in different ways, it is important to carefully plan ahead what you will be doing during your journey. It is also essential to learn about health care provided at your destination, as you may have to rely on it in case of an emergency. For example, you should find out what types and strengths of insulin are available in the region you will be travelling to. Find out about the quality of local health care facilities and where they are located. Learning how to say “I have diabetes" and "sugar or orange juice, please" in the language spoken at your destination beforehand can prove very valuable in case of an emergency.

Medical preparations

See your physician

Get a medical checkup to be sure that your diabetes is well controlled before departing and discuss your travel plans with your physician to be sure that there are no limits on your activities. Keep in mind that it is best to get immunization shots three to four weeks before you leave, as some of these may affect your blood sugar levels.

Medication

Regarding your prescribed medication, it is best to take with you twice the amount that would be sufficient for the duration of your journey. Keep medication in its original packaging to avoid any problems with customs as well as to aid doctors in case of an emergency. If possible, store your medication in two separate bags, but keep in mind that one of them should always be close at hand (e.g. in carry-on luggage if you fly) so that you can easily access it if necessary. Moreover, it is recommended to take the following with you insulin and syringes, blood and urine testing supplies, oral medications and some form of sugar to treat low blood glucose levels. Make sure to stick with the exact brand and formulation of insulin that your physician has prescribed.

Nevertheless, should you run out of insulin and your regular brand is unavailable, bear in mind that insulin can come in different strengths in different countries. In that particular case, you will have to buy new, matching syringes to avoid any dosage mistakes. While insulin does not need to be refrigerated, storage in excessively hot or very cold temperatures can weaken it.

What to take with you

Ask your doctor to write you a letter that explains how your diabetes needs to be treated and what medications or devices you use. It should also include a list of any allergies you have. Also ask for extra prescriptions, that indicate the generic name of the medication in English. Remember to write down your doctor's name and contact details so that he can be contacted in case of an emergency. Do not forget to take a list of all the medication you are taking, including the dosage. When travelling, remember to wear a medical ID bracelet or necklace that identifies you as diabetic.

Travel insurance

We strongly recommend that you purchase travel insurance before leaving, as you suffer from a pre-existing medical condition. Medical bills can be very expensive abroad, and if any health problem related to your diabetes should arise, insurance coverage will be necessary.

Transportation

By plane

If you are using an electronic device to monitor blood glucose levels or to inject insulin, ask your airline beforehand if these devices can be used while in-flight. When boarding the plane, make sure that you are carrying medical supplies with you. As long as your supplies have a prescription label on them, they can be taken through security checkpoints. Syringes are allowed, provided that you have insulin with you as well. Do not forget to inform security personnel beforehand, especially if you are wearing an insulin pump.

Crossing time zones during your flight may force you adjust your schedule. Generally, adjustments to insulin doses are unnecessary if you are crossing fewer than three to five time zones, but in any case you should ask your physician for advice. Keep your watch on your home time to keep track of shots and meals and frequently check your blood glucose levels. If you want to adjust to your destination's time, remember that travelling eastward means the days are shorter, thus a reduction in insulin may be necessary. In contrast, travelling westward means the days are longer and thus the insulin doses may need to be increased. Be careful, as these recommendations can change if your departure is deferred or the flight time prolonged. Check your blood glucose level as soon as possible after landing, as jet-lag can make it hard to estimate it just by the way you feel.

When injecting insulin while in flight, remember not to allow too much air to get into the insulin bottle, as the cabin pressure is different than pressure on the ground.

You can request special meals that are low in sugar, fat, or cholesterol, but this has to be done several days before the flight. Should you take insulin, wait until you have your meal in front of you before injecting to avoid low blood glucose levels. An even better solution to special meals is to bring your own carbohydrates in the form of fruit, sandwiches or cereal bars. You may be asked upon arrival in a foreign country to surrender this food.

By car

Driving with diabetes is not a problem, but you should remain cautious. Be sure to always have food with carbohydrates in your car and not to drive for more than two hours without eating. Do not delay or miss a meal or a snack and regularly check blood sugar levels before and during the trip. It is also a good idea to carry identification on you and in your car that identifies you as having diabetes.

Should you feel hypoglycemic, stop as soon as it is safe and eat food containing carbohydrates or drink sugary drinks immediately. Follow by eating a longer-lasting carbohydrate-rich food and check your blood sugar level. Wait for 40 minutes after your blood sugar is above 4mmols before driving again.

At your destination

Precautions

After arriving, take it easy and relax for a couple of days if you have had a long flight. Remember to regularly check your blood glucose levels, especially if you are more active than usual. Make sure that you stick as closely as possible to your day-to-day schedule.

Whenever you go hiking or sightseeing, do not forget to take snacks along with you as you cannot be sure to find food along the way. Wear comfortable shoes and do not walk barefoot. Regularly check your feet for blisters, cuts, scratches or redness and seek medical attention if there are signs of infection or inflammation.

In case of emergency

An insulin shock can occur after taking too much insulin, or because of a lack of food or too much exercise. If this is the case, you will likely experience the following symptoms: a rapid pulse and quick, shallow breathing, sweaty, pale and cold skin, and a feeling of disorientation, irritability or aggressiveness.

If you experience these symptoms, start by eating some sort of sugar, be it in the form of a candy bar, fruit juice or soda. Once you feel better, eat a full meal with carbohydrates to stabilize your blood sugar level. Regularly check your blood sugar level, as it can fall again without warning after an insulin shock episode, even after having consumed sugar.