Having diabetes shouldn’t get in the way if you want to see Paris, take a cruise, or simply spend time with your grandchildren in another state. Sure, traveling may require some planning and changes to your routine for controlling and monitoring your blood glucose, especially if you use insulin. But people with diabetes go on business trips, explore exotic destinations, and travel all over the world every day.
Here are some commonsense steps to take before you head down the interstate or hand over your boarding pass.
Check in with Your Doctor
Schedule a visit with your physician several weeks before taking an extended trip. Be sure your recommended vaccinations (flu shot, pneumococcal vaccine, and hepatitis B, for example) are up-to-date, and check on what preventative medications or other specific vaccinations are recommended before visiting certain parts of the world. The Centers for Disease Control and Prevention (CDC) has the latest information on vaccination and medication recommendations.
If you're traveling on an airplane, ask your doctor for a signed letter indicating that you have diabetes and what medical supplies you may require, such as insulin, syringes, pumps, or lancets. If you don't already have a bracelet, a necklace, or some other form of identification (such as MedicAlert) showing that you have diabetes, now is a good time to get one.
Also, be sure you have more than enough medication in case of an emergency. Extra, undated prescriptions may be a good idea, with drugs listed by their generic as well as brand names, since brand names vary from one country to another.
Ask your doctor how your travel plans might affect your dosing schedule. It might make sense to gradually change the time you take medications, especially if you cross many time zones. If you're taking a short trip—say, under a week—and the drugs don't have to be taken in the morning, you might just keep your dosing schedule on your home time every day. For instance, there is a 12-hour time difference between New York and Beijing, so pills usually taken at 8 a.m. would be taken at 8 p.m Beijing time. If your medications have to be taken, say, just before breakfast, ask your physician about how best to gradually make the change.
Traveling when you require insulin is the trickiest. If you take only one shot of long-acting insulin a day, you may not have to change the timing of that shot. If you use both long-acting and short-acting insulin, test frequently and take the short-acting insulin before every meal, whatever time that may be in your current location, with an adjustment made in the dose if your blood glucose is higher or lower than usual. You can always adjust your glucose most quickly with short-acting insulin.
Learn the language. If you are traveling somewhere that English is not widely spoken, learn to say, "I have diabetes," and, "Please get me to a hospital," in the native language of each country you plan to visit; or write the phrases down and carry them with you.
Savvy travelers know that packing light makes luggage less burdensome while globe-trotting. However, you're better off packing too much when it comes to your diabetes medications and supplies, and if you are flying, they should be in your carry-on bag, not checked luggage. Following are the essentials to pack:
- Insulin and oral medication To be on the safe side, bring twice as much insulin and oral medication as you would normally need for the duration of your trip. Insulin does not need to be constantly refrigerated but should stay cool. Extreme temperatures will damage insulin and may make it entirely inactive, so don't keep it in a suitcase that will be stowed in the cargo compartment of a plane, where it could freeze, and don't leave it in the glove compartment or trunk if you're in a car that may overheat. Travel packs are available to help keep insulin cool. Also, if you're flying, tell the security officer at the checkpoint that you have diabetes and that you are carrying medications and supplies. Keep all insulin supplies in their original packaging. Putting all of your syringes and other tools for diabetes management in a separate pouch can make security screening easier.
- Syringes, lancets and test strips As with medications, double up on syringes, lancets and blood glucose strips. You can bring an unlimited number of carry-on syringes as long as they are accompanied by insulin or other medication that requires injection. Bring along a "sharps" container to safely discard used syringes and lancets.
- Monitoring devices and pumps Bring extra batteries for your equipment, since you never know when you'll need them.
- Emergency medical kit Include such items as glucagon to treat hypoglycemia (make sure one of your travel partners knows how to administer it), other prescription medications, over-the-counter pain relievers, a first-aid manual, antidiarrheal medication, insect repellent, sunscreen and talcum powder (to keep your feet dry if you do a lot of walking). Avoid the temptation to walk barefoot in hot climates, especially if you have neuropathy. Also, beware of blisters.
- Identification If your insurance policy covers emergencies abroad, bring the necessary insurance paperwork. In addition to your diabetes identification card or a medical alert necklace or bracelet, take your insulin, pills and testing supplies with you every day in case there is a delay getting back to your home base.
- Snacks Always carry a source of sugar with you when traveling in case your glucose level drops. Snacks that are easy to slip into your carry-on and will make it through security include nuts, grapes, crackers, granola bars, hard candies, and small juice boxes. (Air travel regulations limiting carry-on liquids to 3.4 ounces or under may be waived for juice if you have medical clearance.)
Follow Your Routine
You may be tempted to ditch healthy eating habits while traveling, but don't do it. On the contrary, try to be especially aware of what you're eating and how it affects your blood sugar. If your flight serves food, request a diabetes-friendly meal in advance—and wait until you see the food cart coming down the aisle before administering a fast-acting insulin.
Whether you're in the United States or rural China or on a ship in the middle of the ocean, remember that a fruit is a fruit, a carb is a carb, and a fat is a fat. Do your best to calculate the amount of carbohydrates you are eating, whether you're having rice, roti or papaya. Watch out for oils and fats, and remember if a food or drink tastes sweet, it is probably high in carbohydrates.
And always pay close attention to any water (or ice) you drink. A good rule when traveling in most foreign countries is to drink only bottled water from a reliable source.
Checking your blood glucose while traveling is even more important than when you're home. Eating different foods, being more physically active than usual and time changes can all wreak havoc on your diabetes control. The only way you'll know—and the best way to prevent emergencies—is to check your blood glucose regularly.
Finally, be prepared for the unexpected. Canceled flights, lost reservations and other travel frustrations may lead to stress, which can itself affect glucose control—so pack a healthy dose of patience.
Source: from our sister publication Diabetes Focus (Fall 2015)