The Art of Travelling With Diabetes

One of the oldest complaints that anyone with diabetes has is how to deal with going on holiday and travelling in general. As well as all the normal concerns with any journey: destinations, costs, packing etc, anyone with diabetes has the added uncertainties of what medication to bring, what time zones you will be crossing and what food you can expect to have available when you arrive.

I've been through a lot of these situations over the years and with a little planning you will find you can anticipate any problems and ensure that you can take a quick holiday or even travel the world without diabetes getting in your way!

Planning it out

• First off, you'll decide where and when you are going. That's the fun bit then you'll need to figure out how much medication and supplies etc you'll need for the trip. Look at the average number of times a day you test your blood sugar, inject insulin/take meds and all the other stuff to give you an idea of how much you'll need to bring. Don't just bring the average though, bring too much. There is always the possibility that you'll need more than you expect so its better to have too much than not enough. If you are carrying insulin don't worry bout keeping it refrigerated, almost all insulin will maintain its full potency at room temperature for at least 30 days so there's no need for special bags etc unless you are going to a very warm climate, in which case find a fridge to use when you arrive. Bring some dextrose as well to ensure that you have easy access to fast carbs in case you have any low blood sugars.


• As well as this, carry a prescription letter from your doctor that states your condition and the supplies you use, insulins, test strips etc, stated in their brand and generic names. This will be handy for verifying to airport security why you need to be carrying these supplies. I had an incident in Singapore some years ago where a group of guards with very large guns surrounded me when they found "sharp" objects in my had in luggage. They were tiny "6 gauge" novopen needles! Needless to say the doctor's letter proved its worth that day! In some parts of the world they have an odd rule where they also insist on this letter being no more than 6 months old so check before travelling. The other reason to have this letter is that it will help you obtain replacement supplies with local providers in case you end up losing your own.


• If you are travelling in Europe, you can apply for a European Health Insurance Card (EHIC) card. This entitles the holder to free or heavily discounted health cover in most EU/EEC countries. It's a handy thing to have if you fall ill and it's free so why not get one just in case.


• Get some medical ID. You never know where or when you may suffer a hypo, it happens to the best of us. It's even more risky in a foreign country so you can help yourself by having medical ID that identifies you as a diabetic. You may be in a country that doesn't speak your language but any medical professional always looks for these things. Bracelets etc, wallet cards (even tattoos if you want to go that far!) are easily obtained. Another good idea is to add an "in case of emergency" (ICE) contact number in your phone. Paramedics will regularly look for this and it will help them treat you faster and more easily.

The Journey

• Keep your bag of supplies with you at all times. Luggage gets lost. You can live without your bermuda shorts for a few days. Medical supplies are rather more urgent! This is also critical if you are carrying insulin onto a plane. The baggage hold is not heated and the temperature within can get very cold and potentially damage your insulin. If you are an insulin pump user DO NOT LET IT GO THROUGH AN X-RAY! This will reset all of your programmed basal and bolus rates and mess up your pumping regime in a big way. The rule is simple, keep it all with you!


• Don't order any specialist food. This is one I came across myself a long time ago. At the time my regime involved matching carbohydrate to pre-determined insulin doses, today I count carbs and match insulin to what I want to eat, much easier and much more flexible. I had informed the flight company of my diabetes and was given the option of having a specially prepared "diabetic meal". Poor foolish me! I said yes and was presented with a meal that looked a lot like everyone else's but with all the carbohydrate removed! Cue panic as I tried to figure out how to dose for what I perceived to be no food at all (of course the dose would be zero with a zero carb meal but I was some years away from learning that!) I would say to every diabetic that is given this option that they should refuse it. For one thing, there's nothing wrong with you and diabetes shouldn't prevent you from eating anything. And also if you are using an insulin/carb approach (as many people still do) then you are likely to land yourself in a stressful situation. Airlines do not understand the dietary needs of people with diabetes, it is a painful and pointless process trying to educate them!


• Time zones can be tricky for anyone using insulin. We will often take insulin/meds on a 24 hr set routine. Having a shorter or longer day as you cross time zones means you have to adjust your schedule accordingly. If the time change is less than 4 hours you shouldn't have to make any major changes. If you are crossing more then the best course of action is to discontinue your background doses and rely on short acting (bolus) insulin until you reach your destination and return to a set 24 hr day. The re-introduce your background. It may cause your levels to sit a little higher but it allows for a great degree of flexibility over meal and injection times and any highs can be corrected as you go along.


• Insulin pumps may be affected by air pressure. There is a good deal of research that suggests insulin pumps can be affected by aircraft cabin pressure and end up delivering too little or too much insulin. This can be particularly dangerous for insulin-sensitive people as it may lead to hypos. The best advice is to disconnect the pump before take-off then once you reach cruising altitude, check for air bubbles in the line and reconnect. This should be repeated again for landing.

When You Arrive

• If you've changed time zones and have been using bolus doses to control your blood sugar during your journey then now is the time to reintroduce your basal insulin. If you are using a very long-lasting background insulin (e. g Lantus) ensure it has been 24 hours since your last injection, otherwise you can end up "stacking" it and risking a hypo.


• Don't expect it to be normal. You are on holiday, it might be for a week or for a year but the fact is that your daily routine will be different and your diabetes is going to have to come along for the ride. Don't panic about food, the odds are that you'll get your bearings very quickly and scope out where and what to eat within a day. If you have type 1 and you count carbohydrates then it should be easy enough. The only difference is that you'll be "guesstimating" food weights so bring maybe hone those skills a little before you leave. If you have a smartphone I would recommend the "Carbs and Cals" app, it's a carb counting guide for thousands of foods showing pictures of various portion sizes. It makes eating out very easy and is something I've often relied on when abroad. If you have type 1 and don't count carbs, then learn how. I've said it a million times, it's an essential skill for any diabetic, it'll make your management of the condition much easier and allow you'll spend a lot less time worrying about food.

Above all, don't expect to have perfect control. Look after your condition with the same consistency as you always would, but you are on holiday to enjoy yourself so don't let the odd bit of imbalance in your diabetes get in the way of that.
Enjoy your health (and your holiday!!)

Chris | YD

Chris Loughrey is the founder and head coach of http://www.yourdiabetes.co. A personalized diabetes coaching service.

Chris is a fully qualified diabetes coach & personal trainer and has had type 1 diabetes for over 10 years. He specializes in teaching you the skills needed to live a healthier, happier life with diabetes.
So if you want to achieve rock-solid blood sugar control or if you want to train safely and effectively for your favorite sport, visit http://www.yourdiabetes.co/diabetes-coaching.php today to see how diabetes coaching can benefit you!

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