Diabetes and Travel
Travel can be & should be fun, safe & easy. Remember some basic rules for travelling with diabetes.
· Always have food at your usual time & carry an extra supply
· Keep as active as possible
· Monitor your diabetes
· Wear or carry identification at all times
· Remember your supplies & your "survival kit"
PLAN your travel......
Expect & prepare for:
· Temperature changes
· Exotic foods
· Time zone changes
· Different languages
· Misplaced luggage
· Different health systems
· Unexpected delays
If you are travelling by car:
· Ensure your meals & or snacks are at your usual time
· Take an extra supply of food, drink, medication & monitoring equipment in case of breakdown, delays or emergencies
· Take a break, stop for meals & go for a walk
· Share the driving with a friend or relative & avoid becoming overtired or over stressed
· Treat "hypos"(low blood sugar) as soon as you notice the symptoms:
- stop the car
- have quick acting carbohydrate eg soft drink (non diet) sugar or sweets
- follow with a long acting carbohydrate eg fruit&nut bar, biscuit or fruit
- wait until you feel better & check your blood glucose level.
· when your blood sugar level is back to normal, & you feel better, try to determine why the "hypo" occurred to prevent a recurrence.
· Never drink alcohol before driving. Alcohol will increase the risk of "hypos".
· Keep your insulin stored in a cool place in the car, not on the dashboard or in the glove box.
When travelling within Australia take your NDSS card to enable you to obtain more supplies.
If you are travelling by plane, bus or train:
· Follow the guidelines as above, You will need to carry an extra supply of food & drink with you. Buses do not stop often & trains may not have a dining car. Train or airline meals may be unsuitable or may not contain the carbohydrate foods you require. Extra food should always be carried in your hand luggage to allow for the unforeseen or emergency "hypo"treatment
· On longer flights alert the airline regarding your meals & snack requirements. Be sure your airline attendant is aware you have diabetes
· Carry your supply of insulin, medication, syringes & testing equipment with you in your hand luggage. Insulin carried in the luggage compartment of an airplane my be destroyed by freezing.
· Take opportunities to walk around as much as possible.
Half hour delays can sometimes stretch to half a day. Keep your handluggage & survival kit with you at all times & keep it well stocked with emergency supplies.
Sightseeing may involve walking. Wear comfortable well fitted shoes rather than any new ones recently acquired. Blisters can cause problems, particularly infection. Avoid becoming overtired. Remember to increase your food intake if you are more active than usual.
Always carry some form of quick-acting carbohydrate & always wear your medic alert bracelet or some form of identification.
Food & Drinks
Avoid drinking water or ice from unknown sources. (see The Travel Doctor-TMVC Fact Sheet on Eating & Drinking Safely). Foods such as salads washed in local water may be a problem. Bottled or canned diet drinks & mineral water are safe to drink. Choose fruit with skins which can be peeled.
"A SURVIVAL KIT"
You should organise a "survival kit" before leaving home. It will help deal with the unexpected. It should contain:
· Quick acting carbohydrate such as glucose, lollies, honey or sugar
· Longer acting carbohydrate snacks such as dried fruits or dry biscuits
· Glucagon Hypo-Kit (a travelling companion should be instructed on use)
· If you use insulin, some quick acting insulin may be necessary to manage unforeseen problems
· Extra syringes
· Blood testing equipment (preferably with strips that can be read without a metre in case it breaks down).
INTERNATIONAL AIR TRAVEL
International air travel should be planned well in advance to ensure that you have as much enjoyment as other travellers. Many of the travel guidelines already mentioned apply to international travel. In addition you will need to consider:
Have any recommended vaccinations well before you are due to leave. Some are live vaccines & may induce a mild "illness" & it is better for this to happen before leaving.
Take your medical insurance cover & make sure that pre existing medical problems is covered. BE PROTECTED. Hospitalisation can be very expensive.
You will need twice the amount of syringes & testing equipment (include ketone testing strips, if you have Type 1 diabetes). You may need to store your insulin in a special container if the temperature is ouside the range 0 -35C
In some countries you may have problems getting medication if you get ill. Many people take a medical kit with medication for vomiting, diarrhoea & minor illness. It may be wise to carry a course of antibiotics with you. You must treat illness promptly to avoid losing diabetic control.
Notify the airline that you have diabetes & request suitable meals. Find out flight times & duration. Check departures & arrival in local times.
Keep one supply of insulin, syringes, glucagon & testing equipment in your hand luggage. A second set of everything should be kept separately in other luggage in case of theft. Keep your "Survival Kit"with you in your hand luggage.
It is not necessary to refrigerate insulin whilst travelling. Insulin will be stable & safe for months at room temperature. Take sufficient for your needs as the insulins & syringes overseas may be unfamiliar. Ensure insulin is not subjected to heat or sunlight. When travelling in hot climates a polystyrene container can be used,. Special packs can be purchased from Diabetes Australia. Pack the medication in the middle of the suitcase for maximum insulation.
Ask your doctor for:
· A letter for customs stating that you have diabetes & need to carry medications, insulin & syringes. (you could also photocopy the letter as an extra copy or place it somewhere to be retrieved electronically)
· A letter of introduction from you doctor in case you need to see a doctor whilst you are travelling
· Prescriptions for the supply of insulin, medications & glucagon for your trip. You will need 2 sets of everything, one with you & one for your luggage. You may also require prescriptions for medications for travel sickness, diarrhoea or vomiting.(The Travel Doctor-TMVC Clinics cater for these in their travel kits):
International Travelling Hints
· Always carry some form of quick acting carbohydrate such as lollies
· Carry extra carbohydrates such as dried fruit or biscuits in case of delays in departure or meal times. Have a "survival kit".
· Take 2 watches. Leave one set on "home time"and adjust the other to local times. You should eat at normal "home time"hours. You can adjust your pattern of insulin & meal times when you arrive at your new destination.
· Notify airlines to prepare suitable meals. Remind them of the times you need your meals. Fruit juices & fruit should be available if extra intake is required.
· At any stop over take the opportunity to walk around as much as possible
· Always wear your identification
Insulin adjustment. This information relates mostly to people taking once or twice daily insulin
Time zones can be confusing. These guidelines may help you adjust your insulin dosage. This is a very important aspect of your diabetes travel management & must be discussed with your usual physician. PLAN TO AVOID ANY POTENTIAL PROBLEMS. Having a major HYPO in unfamiliar surroundings, such as busy international airports, is more dangerous than having slightly high sugars for a day or so.
If when travelling east your day is made shorter by :
Less than 4 hours you will not need to make changes
More than 4 hours you will need to reduce your insulin dose on the day of departure by 20-30%
If when travelling west your day is made longer by:
Less than 4 hours you will not need to make any insulin changes but you may need extra carbohydrate (for the extra time you are awake)
More than 4 hours you may need extra insulin. Have your usual insulin on the day of departure & you may need extra neutral insulin (10%) before the extra meals if necessary. 10% of your usual total daily dose is usually recommended but this is only a rough estimate. You will need to adjust your insulin based on the results of testing your blood glucose levels.
Always do extra blood glucose tests to keep track of things. Blood glucose levels will probably be higher than normal because of inactivity. You may need a small amount of quick acting insulin before meals
When you arrive at your destination you can change your meal & insulin injection times over to "local" time.
Remember all adjustments should be discussed with your physician of diabetes nurse well before departure. A written note is sensible.
Talking about diabetes
It may be wise to learn some words & phrases in the language of the country you are visiting so you'll know what to say if a problem arises eg "I have diabetes", "I need some sugar".
If problems arise with your diabetes control when overseas, remember the operator at your travel insurer's emergency assist number may be able to help contact your regular physician for advice on your behalf.
TIMES ZONES - Examples
DestinationWhen it is 12 noon in Adelaide What to do
Travelling will make the day:
Honolulu4pm 4 hours shorter Do not change anything
London2am 10 hours longer Extra (10%) before extra meals
Montreal9pm 9 hours shorter Reduce insulin by 25% on the day of departure
San Francisco 6pm 6 hours shorter Reduce insulin by 20% on the day of departure
Singapore 9.30am 2 hours longer Take an extra carbohydrate exchange
Tokyo 11am 1 hour longer Take an extra carbohydrate exchange
Wellington 2pm 2 hours shorter Do not change anything