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Diabetes Monitoring


If you use insulin, a continuous glucose monitor or blood glucose meter then you should be aware of the issues of carrying insulin, injecting equipment, medical devices and glucose monitoring equipment during travel.

You should consider the following points prior to departure.

Insulin

  • You should discuss your travel plans with your diabetic specialist pretravel to ensure you are confident in altering insulin doses/regimes in response to varying blood glucose levels.
  • Twice as much insulin as required for the length of trip should be carried, to cover lost, stolen or damaged insulin and to account for extra insulin that may be required during illness.
  • You must carry a secure means of disposing of needles and lancets.
  • A medical letter is required in order to carry insulin and associated equipment through security/customs.
  • Your particular brand of insulin may not be available in other countries, or may be sold under a different trade name.
    • Pharmaceutical companies can be contacted pre travel to advise on whether their product is available at the destination, and under which name.
    • Insulin is available in the UK as U-100, but may be sold in different strengths in some countries, U-40 or U-80. These are not directly interchangeable and will require different syringes/needles.
    • During air travel, changes in air pressure can alter the amount of insulin delivered by prefilled devices/pumps and blood glucose should be monitored more closely on flights.

Effect of Climate on Insulin

  • Insulin is absorbed faster in hot weather.

    • Blood glucose should be checked more frequently and dosing adjusted accordingly.

  • Insulin is absorbed slower in cold temperatures, but absorption increases as the body warms which can lead to subsequent low blood glucose levels.

    • Blood glucose should be checked more frequently and dosing adjusted accordingly.

    • Cold climates can make obtaining blood from fingertips more difficult. Gloves should be worn and hands can be warmed.

Insulin Pumps/Continuous Blood Glucose Monitoring Devices

Spare equipment and batteries should be taken in case of malfunction.

If you use an insulin pump/continuous glucose monitor, check with the airline and airport prior to travel to ensure the device is allowed on the aircraft and through security.

  • Additional paperwork may be required as detailed by individual airlines.

On occasion the device may have to be removed during transit and travellers must ensure they are aware of what to do in this situation.

  • Your diabetic specialist might discuss switching to a bolus regime pre-travel, however this will not be suitable for everyone.

Storage

Insulin must be stored within a particular temperature range (as detailed by the manufacturer) during transit and at the destination or its potency is affected:

  • insulin may freeze in the hold of an aircraft
  • insulin may overheat in direct sunlight/ hot car journey
  • hotels may agree to store insulin in fridges on arrival
  • insulin should be checked for crystals after a flight, and discarded if any are found

Insulin should be carried in suitable containers to maintain this temperature range during travel, insulated bags, wallets and travel accessories are available, or insulated lunch boxes can be used (insulin must not be placed directly on ice packs due to the risk of freezing).

Glucometers

The accuracy of glucometers is affected by temperature, humidity and altitude. 

Altitude

Glucometers tend to under read at altitude. The altitude at which the deviation seems to become significant is about 1500 - 2000 metres.

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 from your diabetes specialist).

  • Drier air and wind at altitude may cause rapid drying of blood samples.
  • keep the meter and test sticks warm (in insulated pouches worn under clothing and near to the skin)
  • take readings in the shade and away from winds and to use a large drop of blood to prevent rapid drying
  • Light is bluer at altitude and can be a factor in visual comparisons of reagent sticks.

Further information on high altitude travel and diabetes is available from medex.org.uk

Temperature

Meters are specified within a given temperature range +10 -+40°C.

  • Extreme heat can affect the accuracy of glucose meters.
  • Glucose meters may misread in cold weather.
  • Glucometers designed to work in higher and lower temperature ranges are available and should be considered by those travelling to destinations where extremes of heat may be an issue.

Useful Contacts

Diabetes UK

Diabetes.co.uk

Both websites provide extremely useful information, including travel guides and links to additional sources of information for diabetics travelling overseas.

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