When You Travel
Planning a trip? Whether you're camping or cruising, you can go anywhere and do almost anything. It just takes a little planning ahead to handle your diabetes.
How you prepare depends on where you're going and for how long. Two weeks backpacking through Europe takes different planning than a week at the beach. Will you be crossing time zones? What kind of food will you eat and when? Will you be more active or less active than usual?
See Your Doctor Before You Go
Before a long trip, have a medical exam to make sure your diabetes is in good control. Schedule the exam with enough time to work on your control before you depart. Get immunization shots — if you need them — at least one month before you leave. If the shots make you sick, you'll have time to recover before your trip.
Before any trip, get two papers from your doctor: a letter and a prescription. The letter should explain what you need to do for your diabetes, such as take diabetes pills or insulin shots. It should list insulin, syringes, and any other medications or devices you use. The letter should also list any allergies you have or any foods or medications to which you are sensitive.
The prescription should be for insulin or diabetes pills. You should have more than enough insulin and syringes or pills to last through the trip. But the prescription may help in case of emergency. In the United States, prescription rules may vary from state to state.
The prescription laws may be very different in other countries. If you're going out of the country, do some research about the laws where you'll be going.
Prepare for an Emergency Abroad
You may want to get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers (IAMAT), 1623 Military Road, #279, Niagara Falls, NY 14304 (www.iamat.org). IAMAT can be reached at 716-754 4883. If an emergency occurs while you're traveling and you don't have such a list, contact the American Consulate, American Express, or local medical schools for a list of doctors.
No matter where you go, wear a medical ID bracelet or necklace that shows you have diabetes. If you're leaving the country, also learn how to say "I have diabetes" and "sugar or orange juice, please" in the language or languages of the countries you'll visit.
Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.
Medical IDs are usually worn as a bracelet or a necklace. Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person’s full medical record for use in an emergency.
The second rule of travel for a person with diabetes: pack at least twice as much medication and blood-testing supplies as you think you need. Pack all of them in your carry-on bag so that your medication is always with you (checked luggage can get lost).
Whether you travel by car, plane, boat, bike, or foot, you'll want to keep this "carry-on" bag with you at all times. Pack this bag with:
- all the insulin and syringes you will need for the trip
- blood and urine testing supplies (include extra batteries for your glucose meter)
- all oral medications (an extra supply is a good idea)
- other medications or medical supplies, such as glucagon, antidiarrhea medication, antibiotic ointment, antinausea drugs
- your ID and diabetes identity card
- a well-wrapped, air-tight snack pack of crackers or cheese, peanut butter, fruit, a juice box, and some form of sugar (hard candy or glucose tablets) to treat low blood glucose
Eating in the Air
When you fly, you can request a special meal low in sugar, fat, or cholesterol. Make your request at least two days before the flight.
If you take insulin, wait until you see your food coming down the aisle before you take your shot. Otherwise, a delay in the meal could lead to low blood glucose. To be safe, always carry some food with you. If your meal is delayed or an order is mixed up, you won't be stuck with an empty stomach.
Have Insulin, Will Travel
When you travel with insulin, give some thought to where you'll be storing your supplies. Insulin does not need to be refrigerated, but insulin stored in very hot or very cold temperatures may lose strength.
Don't store your insulin in the glove compartment or trunk of your car. Backpacks and cycle bags can get quite hot in the direct sunlight. If you plan to travel by car or bike or to be out in the elements, take steps to protect your insulin. Many travel packs are available to keep your insulin cool.
In general, you should stick with the exact brand and formulation of insulin that you have been prescribed by your doctor.
However, if you run out while you are on the road, and your regular brand is unavailable, you may substitute another brand's equivalent formulation (for example, NovoLog for Humalog, Humulin R for Novolin R). Changes in formulation (for example, from rapid-acting Humalog to to short-acting Humulin R) require medical supervision.
Insulins used in the United States are all of the strength U-100. In foreign countries, insulins may come as U-40 or U-80. If you need to use these insulins, you must buy new syringes to match the new insulin to avoid a mistake in your insulin dose. If you use U-100 syringes for U-40 or U-80 insulin, you will take much less insulin than your correct dose. If you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin.
Crossing Time Zones
If you take insulin shots and will be crossing time zones, talk to your doctor or diabetes educator before your trip. Bring your flight schedule and information on time zone changes. Your doctor or educator can help you plan the timing of your injections while you travel.
Remember: eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.
To keep track of shots and meals through changing time zones, keep your watch on your home time zone until the morning after you arrive.
If you inject insulin while in flight, frequent travelers suggest you be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to "fight you." This can make it hard to measure insulin accurately.
Checking your blood glucose while traveling is as important as when you're at home. Also, check your blood glucose level as soon as possible after landing. Jet lag can make it hard to tell if you have very low or very high blood glucose.
When You Get There
After a long flight, take it easy for a few days. Check 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.
No matter what kind of diabetes you have, it's smart to watch what you eat and drink when traveling. Avoid tap water overseas. This includes ice cubes made from tap water.
Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and hurt your diabetes control. But you will also find foods that give you a healthy taste of culture.
Wear comfortable shoes and never go barefoot. Check your feet every day. You should look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation.
Go wherever your heart leads you. Just remember that you take your diabetes with you. Take your self-care along, too.
Traveling with diabetes supplies — Due to increased airport security measures in response to September 11, 2001, the American Diabetes Association is providing the following information regarding diabetes-related equipment, medication and supplies to all airline passengers with diabetes.
Dehydration and heat exhaustion — Special care needs to be taken during extreme heat.