Diabetes shouldn’t stop you from doing the things you want to do. If you want to travel, and you have diabetes, you must plan ahead carefully.
Although you can’t avoid the odd surprise, preparing before you leave can help avoid undue stress.
Travel can make it hard to keep your blood sugar within your target range because of changes in time zones, meal schedules, and types of foods available.
With the right preparation a short holiday or a long journey is just as feasible for people living with diabetes as it is for non-diabetics. But good planning is important in order to enable you to enjoy as many carefree days as possible.
Ideally you should start planning your trip well in advance of your departure date.
Before embarking on travel, you should ensure that your health is optimized and can be maintained throughout your trip.
Not all people with diabetes require medication, or are on insulin, therefore some advice stated here will not apply to everyone.
Pretravel Medical Check-up
A routine checkup with your Diabetic Consultant, Diabetic Nurse Specialist or General Practitioner pre-travel will include assessment of:
1.Visit your doctor/Diabetic nurse for a check-up several weeks before you leave for a holiday.
2.Discuss your itinerary with your healthcare team and work out plans for your meals and medication, especially if you are travelling through different time zones.
3.Be sure to get any required vaccinations at least four weeks before you travel, so you have time to deal with any possible side effects.
4.Ask for a list of your medications (including the generic names and their dosages) from your pharmacist.
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.
5.If you take insulin, record the types of insulin and whether the insulin is rapid-acting, short-acting, intermediate or long-acting. Be sure to carry a copy with you at all times.
6.Have a letter from your doctor stating that you are allowed to carry medicines or supplies because some airlines and some countries require you to. Syringes and needles in particular can present a problem when flying and when entering some countries.
Travel can have all sorts of effects on diabetes management. For example, when en route to your destination, you may be sitting for prolonged periods of time.
Keep in mind that the lack of activity may prompt your blood glucose levels to become elevated; conversely, sightseeing and other physical activity may lower glucose.
Because of the changes in your schedule, it is very important to test glucose before and after meals. If you’re unsure how to correct for highs, ask your healthcare team for more information.
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If you are crossing time zones, alteration of the timing of medication can be discussed.
Blood glucose levels can be disrupted during travel – altering the doses of medication in response to this can be discussed
You must continue to take your medication regularly while you are travelling.
Remember that blood glucose is measured in mmol/L in some countries but in mg/dl in many other countries.
So if you need to contact a healthcare professional abroad, the conversion rate is 1mmol/L= 18mg/dl. e.g. 6 mmol/L= 108mg/dl.
8.Sick day rules – ensure you are aware of how to maintain glucose levels when ill, how to check urine for ketones and when they need to seek medical attention.
9.Management of hypoglycaemia/low blood glucose levels.
When you travel, you may disrupt your normal routine for both eating and dosing insulin; you may also be sightseeing or increasing your physical activity in general.
Because of these changes, you need to be prepared for low glucose whenever it strikes, so pack plenty of glucose tablets—these are usually the best because they won’t melt, explode in heat, or leak and become sticky.
10.Diabetic complications-Need to be recognized and managed before travel.
11..Contact details of your diabetic clinic can be obtained in case information/advice is needed during long trips.
Safe Trip Tips For Diabetics
Diabetes Precautions For Temperature Changes
Both hot and cold weather extremes can harm your testing equipment and your medications and have a negative impact on your body’s ability to produce and use insulin.
If you are travelling to an area that is likely to experience very extreme temperatures, check with your meters manufacturers about limits on the reliability of their machine.
Tips For Travelling By Plane
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 urine 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.
4.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.
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.
5.Avoid risks 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.
6.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.
7.Once you’ve arrived
Once you arrive at your destination, store your insulin in the minibar in your hotel room or in one of the hotel’s refrigerators.
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 Ship
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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 .
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
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.
A small cooler is useful in the car. Be sure to leave enough space between the cooling element and the insulin and test strips when using a cooler. Your supplies should never be exposed directly to extreme cold.
Tips for travelling by foot (or other physically active means e.g. cycling or hiking)
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:
1.Avoid going camping or hiking alone.
2.Tell someone where you will be and when you expect to return, so you can be found if there is an emergency.
3.Carry all your insulin supplies . 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.
4.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.
Travelling with a Insulin Pump Or Continuous Glucose Monitor
Some airlines will require you to notify them of your medical equipment in advance and fill in additional paperwork before you fly.
Failure to do this can, in some cases, result in passengers not being allowed to board the aircraft with their pump or CGM.
Although insulin pump manufacturers indicate that pumps can safely go through airport security systems, pump wearers may request a visual inspection rather than walking through the metal detector or being hand-wanded.
Advise the screener that the insulin pump cannot be removed because it is connected to a catheter inserted under your skin.
Let screeners know if you are experiencing low blood sugar and are in need of medical assistance.
Insulin pumps and supplies must be accompanied by insulin with a label clearly identifying the medication.
You should also speak to your diabetes team – should you need to remove your pump for any reason, they can provide you with any extra equipment such as insulin pens and help plan your doses throughout your journey.
Caution around insulin pumps and CGM onboard aircraft is due to wireless functionality, which may interfere with aircraft communication and navigation systems.
If your pump or CGM cannot function without a wireless signal, then you may need to be prepared to remove your CGM and pump and administer insulin with an insulin pen for the journey.
You would also need to test your blood glucose levels manually with a standard blood glucose meter.
Also dont forget to pack extra insulin pump supplies (cleaning agents batteries, plastic tubing, infusion kit, catheter, and needles).
General Travel Tips
1.If you are travelling with a group, at least one of your travelling companions should be aware of your diabetes and understand what must be done if you experience a hypoglycaemic emergency.
Your travelling companion should be instructed on how to use glucagon in case of an emergency.
2.It is recommended that you carry an emergency ID card (diabetic ID card) in English and/or the language of the country where you are travelling.
3.Locate the nearest physician and/or hospital at each destination on your trip.
4.Before your trip ask your insulin manufacturer whether your insulin is available in the country or countries you will be visiting – possibly sold under a different name.
5.Ask your insurance provider whether your policy will cover the costs of any treatments you might need while abroad.
6.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.
Dont forget to bring spare batteries for your glucometer, spare lancing device, lancets, spare test strips,
Spare insulin pens, disposable syringes.
7.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).
8.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.
9.If you do visit a hospital take along as much supporting documentation as you can (your medications, test results, travel/medical insurance forms etc.).
10.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.
11.Avoid using local needles if not sterile.
12.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.
A Carbohydrate exchange book could be very helpful.
Some foods may upset your stomach and this may make your blood glucose management more difficult.
For more great Health and Nutrition Tips refer to the website Positivehealthwellness.com
13.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.
You may not be able to leave your diabetes behind, but you can manage it and have a relaxing, safe holiday.Your self care is your travelling friend.
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