Diabetes Mellitus and Travel

If you anticipate problems or your diabetic control is unstable take advice from your professional advisor at home before booking the trip.

For information on insulin and blood monitoring - See below for details about Diabetes U.K. Careline (formerly The British Diabetic Association)

Preparing for Travel

Modern day travel can be stressful for anyone and sometimes especially so for those with a medical condition such as diabetes. However with careful preparation there is no reason why the trip cannot be a pleasurable, rewarding experience. Not all people with diabetes require insulin, therefore some advice (where stated) will not apply to everyone.

If possible, plan well in advance of the trip

  • Discuss travel plans with your Diabetic Consultant, Diabetic Nurse Specialist or General Practitioner (GP) depending on where you receive diabetic care.
  • Request a covering letter from your GP explaining the need to carry medication, insulin, needles, syringes etc. If there is a charge for this service, ask for a certificate that can also be used for future travel.
  • Consider carrying/wearing some form of diabetic identification, particularly if hypoglycaemic attacks are a concern.
  • Appropriate travel health insurance is recommended for all overseas travellers and diabetes is considered a pre-existing medical condition and must be declared to the insurer before travel. Many regular insurance companies do not charge extra for insuring people with diabetes, if they have no complications of diabetes or other problems. Some insurance companies will not replace lost, stolen or damaged insulin or other supplies.
  • If travel is within Europe then to access reciprocal health care, UK residents should produce their European Health Insurance Card (EHIC); available from post offices with form T7 or online at http://www.dh.gov.uk/ Medical insurance is still recommended to cover non-refundable costs. Difficulties are sometimes encountered finding National Health Service doctors in holiday resorts.

During the Journey

  • Be prepared for any eventuality e.g. delays, cancellations, re-routing or stopovers.
  • Carry extra food and snacks to ensure adequate intake or perhaps supplement airline food.
  • Some countries may not allow certain fresh foods through customs and cereal bars, crisps and biscuits may be more appropriate to carry.
  • If prone to travel sickness you may consider taking an anti-sickness tablet in advance of travel or wear pressure point wrist bands. Persistent vomiting can lead to hypoglycaemia.
  • It can be important to let a travelling companion and/or group leader know you have diabetes particularly if undertaking sporting activities or adventure travel.
  • Ideally for more adventurous trips you should travel with someone familiar with possible problems that might occur such as hypoglycaemia.

Food and Drink

  • When travelling to a country where English is not spoken and you do not speak the local language a phrase book can be useful to translate menus and to ask for specific foods such as bread, potatoes, rice pasta etc.
  • Those with diabetes are generally not more prone to gastric upsets but the consequences can be more serious. For example vomiting can lead to hypoglycaemia due to reduced calorie intake while more severe diarrhoeal illnesses especially if associated with fever may lead to hyperglycaemia and ketosis in those dependent on insulin.
  • Taking care over food and water hygiene can prevent some gastro-intestinal infections and this should be considered before travel since equipment for water sterilising, for example, may be purchased in advance.
  • Diet soft drinks are available in many countries but in some of the less affluent they may not available outside major cities. Diet drinks may be available in shops but sometimes not in cafes and restaurants.
  • In North Africa, Middle East and Asia, for example, some commonly available 'sterile drinks' such as mint tea, apple tea and coffee are often full of sugar unless you request otherwise.
  • If unwell follow the 'sick day rules'. Information can be obtained from your diabetes specialist or from Diabetes UK (see address below).

Climate

  • Maintaining a high fluid intake is important to compensate for loss in hot climates due to sweating.

Foot and Skin Care

  • During travel make sure shoes are not too tight as feet can swell, it might be helpful to slacken laces or straps.
  • A walk each hour can reduce the chance of ankle swelling.
  • If considering 'flight socks', discuss this with your diabetic care provider as they are not suitable for everyone and may require careful measuring beforehand.
  • If hospital shoes are normally worn then also wear them on holiday. Changing to ordinary shoes could cause ulcers.
  • Avoid walking barefoot; wear protective footwear on the sand and in the water.
  • Avoid sunburn, particularly to feet and legs by using protective sunscreens or covering up.
  • Prevent dry skin by using moisturizers, especially on heels that crack easily particularly if wearing sandals.
  • Moist skin can lead to fungal infections such as athletes foot.
  • Examine feet regularly and seek medical attention if any problems arise.
  • Take first aid kit for minor injuries.

Advice on Insulin and Blood Glucose Monitoring

If possible, plan well in advance of the trip

  • Pack adequate amounts of medication, insulin, needles, syringes/pen devices and glucose monitoring equipment. If possible, take spare equipment packed separately in case of loss, theft or faults.

During the Journey

  • Carry insulin, medication and necessary equipment in hand luggage where it can be easily accessed. Remember insulin may freeze in the cargo hold of the plane or get over-heated in hot countries in the luggage compartment of a bus. If travelling with a companion they can be asked to carry spare equipment in case of loss or theft.
  • Carry a secure means of disposing of needles and lancets.
  • Monitor blood glucose levels regularly especially during prolonged travel. This is particularly important for those on insulin or concerned about hypoglycaemic attacks.

Time Zones

  • All international flights east or west involve crossing time zones. If travelling across time zones and taking insulin it is essential to discuss the timing of insulin with your Diabetes Consultant or Diabetes Nurse Specialist in advance.

Insulin Storage

  • Normally keep vials in a cool, dark place. Polystyrene containers, vacuum flasks, face cloths in a sandwich container, are all useful. Special travel-carry systems are available from specialist suppliers.
  • Some manufacturers state that insulin can remain stable for up to one month at normal room temperature (8 - 28° C), however some preparations are even more stable than this.
  • Extremes of temperature can reduce its potency so try and avoid freezing and storing insulin in direct sun light.
  • If a refrigerator is available it should be used; hotels may be willing to store insulin if asked.

Glucometers and Altitude

Glucometers tend to under-read at altitude, particularly those dependent on a glucose oxidase reaction. The altitude at which the deviation seems to become significant is about 1500 - 2000 metres. Important features are:

  • Temperature - meters are specified within a given temperature range +10 - +40°C.
  • Light - light is 'bluer' at altitude and can be a factor in visual comparisons of reagent sticks.
  • Humidity - Altitude air tends to be dry and may cause rapid drying of blood sample.
  • Wind - Can also cause rapid drying of the blood sample.

Because of the possibility of blood thickening at high altitude due to dehydration it is important to take an appropriate type of meter (seek advice), to keep the meter and test sticks warm (in insulated pouches worn under clothing and near to the skin), to take readings in the shade and away from winds and to use a large drop of blood to prevent rapid drying (see below for information from Medex).

Climate

  • Insulin absorption may be greater after injection in warm climates, requiring a reduction in dosage (which has previously been agreed by Diabetes Consultant or Diabetes Nurse Specialist).
  • Cold climates can make obtaining blood from fingertips more difficult. Gloves should be worn and hands can be warmed.
  • Insulin and test strips should be kept out of direct sunlight and in colder climates do not let them freeze.

Activities

  • Some people are more active on holiday, others less so. Blood glucose levels must be monitored and diet/insulin adjusted to compensate.

Further Information

Diabetes U.K. Careline (formerly The British Diabetic Association)

  • Address: MacLeod House, 10, Parkway, London NW1 7AA
  • Phone: 0845 120 2960.
  • Website: www.diabetes.org.uk/How_we_help/Careline/
  • Provides assistance with specific concerns related to diabetes.
  • Provides leaflets and information including 'Travel Guide' to the more popular countries visited abroad, with advice pertinent to the needs of diabetics.

MAD Mountains for Active Diabetics

Medex

  • Website: http://www.medex.org.uk/
  • Medex is a club that provides support for the charitable works of Medical Expeditions, a research charity dedicated to investigating the mechanisms of altitude related illness.