DIABETES & TRAVELLING
Carry essential supplies and insulin on you at all times
Have several copies of a medical letter stating you have diabetes and are carrying syringes or pen needles on you to give to customs agents. Don’t give away the original of this letter
Don’t store insulin in the baggage compartment of planes because it will freeze
Get specialist help before you leave on adjusting insulin doses and food through time zones
If you use an insulin pump, follow the manufacturer’s guidelines for flying
Don’t expose your insulin to extremes of temperature. If necessary carry it in an insulated bag or small wide mouthed thermos flask
Always obtain medical insurance when travelling
Check the strength of any insulin you get overseas (some countries market different strength insulin)
Check your blood glucose frequently while travelling
DIABETES AND RELATED DOCUMENTS:
Before any trip, get two papers from your doctor:
A letter for customs
A letter for a doctor (should you need to see one when you are away)
The letter for customs:
Should state that you have diabetes and are carrying syringes or insulin pens and needles for your diabetes
Store the original of this letter safely with your travel documents. Have enough photocopies of the letter to give to the customs agents at each border you are crossing. Don’t give away your original!
The letter for a doctor should:
Explain you have Type 1 diabetes and what insulin type and doses you are on. Also the times you usually take your insulin
List the pen device or syringes you use, plus the blood glucose meter and testing strips you use
Note any other medical conditions you have
List any allergies you have or any foods or medications to which you are sensitive
SUPPLIES OF DIABETES MEDICATIONS
Make sure you have a full supply of all your diabetes medications before you leave.
The prescription to get filled before you leave should give you:
Ample supplies of insulin and test strips. Enough to get you through to the next time that you will be settled in a country where you are certain you can get supplies (never run low on insulin or test strips while you are travelling)
A supply of individually foil-wrapped blood ketone testing strips
Two glucagon hypokits if you are travelling with a companion
OTHER MEDICINAL SUPPLIES
It is often sensible to get a prescription from your doctor for anti nausea and vomiting medication, anti diarrhoea medication, and some basic anti fungal and antibiotic medication. Doing this means you’ll have the medications you need should you become sick overseas and are unable to get medical help quickly. Discuss your needs with your doctor and remember to get he/she to give you instructions on when and how to use the medication. Get the prescription filled before you leave and carry these medications on you.
No matter where you go, wear a medical ID bracelet or necklace that states you have diabetes and take insulin. It is also wise to carry a card in your wallet or amongst your travelling papers that states you have Type 1 diabetes and are on insulin. If you’re leaving the country learn how to say, “I have diabetes” and “sugar or orange juice, please” in the language or languages of the countries you’ll visit.
Visit the MedicAlert Foundation of New Zealand website for more information about obtaining a medical ID bracelet.
MANAGING LOW BLOOD GLUCOSE LEVELS
Always carry a source of simple carbohydrate on you, like orange juice, glucose tablets, or jelly beans. It also pays to carry a small complex carbohydrate snack on you, like a muesli bar. People on holiday often drink more alcohol than usual. Try to drink only moderately, and be aware of the safety guidelines for drinking alcohol when on insulin.
MANAGING SICKNESS AND HIGH BLOOD GLUCOSE LEVELS
If you get sick overseas, you may not have access to the same level of health care that you have in most parts of New Zealand. You may get sick on a camel trip across the Sahara!
It is important for you to be really clear about how you go about managing sickness and high blood glucose levels. You also need to have the tools for avoiding ketoacidosis on you at all times. These tools are:
In-date, individual foil-wrapped blood ketone testing strips and meter
A good supply of unsweetened fluids. The best is a supply of bottled water
A good supply of short-acting insulin that has been stored properly
Anti nausea and vomiting medicine
Anti diarrhoea medicine
If you are away from medical help a supply of a basic broad-spectrum antibiotic tablets
Anti fungal cream
Your own knowledge about managing your diabetes during illness
Basic guidelines written down (for yourself and others) on managing Type 1 diabetes in illness
Pack more medication and blood-testing supplies than you think you will need. Pack all of these in your personal carry bag so that your medication and testing supplies are always with you. This way you are less likely to get separated from your essential supplies if your luggage goes astray. Also the temperature in the baggage compartments of some planes can be very low. This can damage your insulin, testing strips or meter.
Your carry bag should contain:
Your insulin and your delivery device (syringes or pen)
Blood testing supplies (include extra batteries for your glucose meter)
Ketone testing sticks
Any tablets you take
Your other medications such as glucagon, anti-diarrhoea medication, antibiotics, and anti-nausea drugs
A diabetes identity card stating your name and the fact you are on insulin
A supply of simple carbohydrate e.g. glucose tablets, small juice pack, jelly beans
A well-wrapped snack pack of something containing complex carbohydrate e.g. muesli bar, crackers and cheese
A clear, written guide sheet for managing Type 1 diabetes through illness
TRAVELLING WITH INSULIN
Keep these things in mind when you travel with insulin:
Insulin doesn’t need to be refrigerated, but if insulin is stored in very hot or very cold temperatures it may lose its strength
The glove compartment or boot of your car are not good places to store your insulin as they can get very hot. Nor are backpacks or cycle bags exposed to direct sunlight
If you plan to travel by car or bike or be out in the elements, take steps to protect your insulin
There are travel packs available to keep your insulin cool. They are insulated bags. Another option some people use to keep their insulin cool is a small wide-mouthed thermos. This can be bulky however and if you are hiking or travelling light you may prefer an insulated bag
At room temperature the insulin you have opened (and are using) retains its potency for 30 days
INSULIN DOSES WHEN TRAVELLING
Managing your insulin doses while travelling is complex, especially if you are crossing time zones rapidly (by air). Crossing time zones, effectively, makes your day either longer or shorter, so you’ll need to adjust your insulin doses (and food) to compensate for this.
The safest way to plan your insulin management when travelling is to work it through with your specialist diabetes team before you leave. Give yourself plenty of time to plan by making this appointment well in advance of your departure date.
Take your full travel itinerary when you see the team. Make sure you come away with a plan you are happy with and that you understand. This plan should be written down. See more on managing your insulin across time zones in the “Tips for Travel by Air” section below.
TIPS FOR TRAVELLING BY AIR
Some people have found that if they request special diabetes meals on airlines, they get served meals that are very low in carbohydrate. It is often best to order standard meals and to make healthy choices within that. Always have some appropriate snacks with you also in case your flight or in-flight meal is delayed or the meal doesn’t have enough carbohydrate.
The cabin staff need to know that you have diabetes and are on insulin (in case you get unwell during the trip).
Make sure you carry a supply of simple carbohydrate on you, such as glucose tablets, fruit juice or jelly beans. Also carry blood ketone testing strips.
The security scanners used at check-in will not damage your insulin or blood glucose meter.
Insulin is affected by extreme temperatures and should never be stored in the unpressurised baggage area of the aircraft.
Carry your insulin with you at all times. Wait until you see your food coming down the aisle before you take your injection. Otherwise, a delay in the meal could lead to you having a low blood glucose level.
Be aware of time zone changes and schedule your meals and medication accordingly. If you choose to sleep while on board, use a travel alarm clock or ask the flight attendant to wake you at meal or medication time.
Having two watches often helps you keep track of time zone changes. Keep one watch on the time of the country you have just left. This will enable you to remain very clear on when your next dose of insulin would have been due. You can also accurately judge how much time has passed since you had your last insulin if you record your insulin doses against this time.
INSULIN MANAGEMENT AND TIME ZONES
Making dose changes to your insulin as you cross time zones is complex. Work out a plan in conjunction with your specialist diabetes team, in advance, as to how you will manage your insulin doses.
A simple way that some people choose to manage their insulin crossing time zones, is to use short acting insulin only for the flight. Once they get into the time zone of the country they are travelling to, they reintroduce the intermediate-acting insulin.
In this system, you dose with short acting insulin (actrapid or humulin R) every 4 – 6 hours (before snacks or meals which are taken at these times also) until you are established back onto your usual insulins in the new time zone. BUT get advice, before you leave, on the dosages you need if you are using this system.
Other people adjust the dose of their intermediate insulin up or down according to whether the time zone change means that their day will be getting longer or shorter by more than 2 hours. Get advice before you travel on a plan that will suit you.
If you are on an insulin pump make doubly sure that the safety plug (for waterproofing the pump when swimming) is NOT in your pump. If you leave this plug in your pump when flying your pump can deliver wrong doses due to pressure changes in the atmosphere. Otherwise, a pump is an ideal way to deliver your insulin across time zones as you can pump and dose for meals in the normal way with no real change to your dosages.
AVOID RICKS OF BLOOD CLOTS IN YOUR LEGS
Keep up a good level of activity during your journey. Walk around in the terminal before boarding. When you are booking your seat try to get an aisle seat. Because you have diabetes you are more likely to develop blood clots in your legs. To prevent this happening, it is essential that you get up and walk around in flight for a few minutes every hour while you are awake. Doing simple stretching exercises when seated also helps. Move your ankles in circles and point and release your toes often. This encourages good blood flow in your legs.
BLOOD GLUCOSE TESTING
Test your blood glucose levels frequently when travelling through time zones. The timing of your eating and insulin administration will be changed. It is also easy to mix up the effects of jet lag with either high or low blood glucose levels, so it pays to know what your glucose levels are doing. Remember when you are tired it is easy to neglect your diabetes. But it is at these times that you need to know more about what is happening.
ONCE YOU'VE ARRIVED
After a long flight, take it easy for a few days. Test your blood glucose often. If you take insulin, plan your activities so you can work in your insulin and meals. If you are more active than usual, your blood glucose could go too low. Take along snacks when hiking or sightseeing. Don’t assume you will be able to find food wherever you are.
TIPS FOR TRAVELLING BY SEA
With the wide array of mouth-watering foods available on cruise holidays, it’s easy for your diabetes management to get out of kilter. Talk to your diabetes educator or dietitian before you leave about how you plan to deal with the food aspect of the trip. It’s often helpful to get a sample menu from the cruise line so you can get an idea of the types of foods that will be served.
Cruise ships offer some great activities to help you stay active. These range from aerobics classes, swimming, gym workouts, dancing, or strolling the deck at sunset.
It’s a good idea to make the cruise staff aware of your diabetes in case any problems arise. Keep a card or ID on you that states you have diabetes and that you are on insulin.
Because you are crossing time zones slowly, the changes in your insulin dosing times will happen gradually and usually without the need for planned changes.
TIPS FOR TRAVELLING BY CAR
Our “Diabetes & Driving” section contains practical information about what you need to look out for when you are driving, as well as some of the legal aspects of driving in NZ with diabetes. Your travel agent can often find out in advance the rules covering driving in the countries you will be visiting. Test your glucose before and during driving and treat any low blood glucose levels promptly.
TIPS FOR TRAVELLING BY FOOT
(or other physically active means e.g. cycling or kayaking)
A holiday in the great outdoors can be a wonderful retreat from the pressures of everyday life. But there are a few things to consider before you go. Here are some tips:
Avoid going camping or hiking alone
Tell someone where you will be and when you expect to return, so you can be found if there is an emergency
Carry all your insulin supplies (as outlined above). Make sure you carry an in-date glucagon kit and teach your travel companion when and how to use glucagon
The key to enjoying a trip of this kind is to try to avoid things that may severely alter your blood glucose levels. Be aware of safety and try to avoid sunburn, injuries, blisters, insect bites and contaminated food or water. Make sure your footwear is sturdy and fits you well. Don’t use brand new shoes to hike in, try them out before the trip.
Eat and drink enough to meet your needs
Take extra food, water, medication and supplies of simple carbohydrate (e.g. glucose, sugar).
Hiking, cycling or kayaking nearly always means you are a lot more physically active than usual, so you may need to significantly reduce all your insulin doses. You will also need to increase your carbohydrate food intake. Have a good understanding of how to reduce your insulin to compensate for increased activity. Your specialist diabetes team can help you with this before you go.
GENERAL TRAVEL TIPS
Test your blood glucose frequently. Your whole routine of activity and food is likely to be very different. The type of food you eat may also change.
Keep a daily record of insulin doses and test results (to help you identify any trends, and to help any medical advisors that you may need to see).
If you are having problems with your blood glucose levels, follow the guidelines you worked out with your team before you went away and/or contact a hospital or diabetes doctor in the area for advice.
If you do visit a hospital take along as much supporting documentation as you can (your medications, test results, travel/medical insurance forms etc.).
Some insulins have different names and are supplied in different strengths in other countries. If you have to use insulin from another country, make sure it is either the same strength as you are used to or a diabetes specialist has helped you make the necessary dose adjustments to take a different strength insulin.
Avoid using local needles if not sterile.
It’s smart to watch what you eat and drink when travelling. Avoid tap water overseas (including ice cubes made from tap water). Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and this may make your blood glucose management more difficult.
Wear comfortable shoes and never go barefoot. Check your feet every day. Look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation on your feet.
Go wherever your heart leads you. But remember that you take your diabetes with you. Your self care is your travelling friend.