As any travel agent or stranded tourist will tell you, planning ahead is the key to a successful trip. And this is particularly true for people with diabetes - a little consideration will take you a long way and help keep you healthy once you are there.

Whether you want to hike in the Canadian Rockies or lie in the Florida sunshine, you can turn to the Canadian Diabetes Association for travel tips to help you to make your journey safer and more successful.

Did you plan ahead?

Diabetes shouldn’t stop you from doing the things you want to do. If you want to travel, and you have diabetes, you must plan ahead carefully. Although you can’t avoid the odd surprise, preparing before you leave can help avoid undue stress.

Consider telling your travel agent that you have diabetes and explaining some of the particular requirements that travelling with diabetes involves. That way, a suitable itinerary can be planned to meet your needs. A missed flight connection or illness can ruin the best-laid holiday plans.

Did you consider the following ideas before you travel?

  • Visit your doctor for a check-up several weeks before you leave for a holiday.
  • Discuss your itinerary with your healthcare team and work out plans for your meals and medication, especially if you are travelling through different time zones.
  • Be sure to get any required vaccinations at least four weeks before you travel, so you have time to deal with any possible side effects.
  • Ask for a list of your medications (including the generic names and their dosages) from your pharmacist.
  • If you take insulin, record the types of insulin and whether the insulin is rapid-acting, short-acting, intermediate or long-acting. Be sure to carry a copy with you at all times.
  • Have a letter from your doctor stating that you are allowed to carry medicines or supplies because some airlines and some countries require you to. Syringes and needles in particular can present a problem when flying and when entering some countries.

Do you need identification?

Take identification with you that explains your condition in case you are unable to give instructions yourself. Consider getting a MedicAlert® bracelet or necklace that indicates you have diabetes. For more information, contact the Canadian MedicAlert Foundation.

Does your travel insurance cover you?

Some insurance plans do not cover pre-existing medical conditions, which includes diabetes. The Canadian Diabetes Association partners with Ingle Insurance to offer travel insurance. For more information, visit Ingle International.

What do you need to remember when you are packing?

  • Divide your medications and diabetes supplies, and pack them in more than one place, in case you lose one of your bags.
  • Make sure that you have some of your medications and supplies in your carry-on luggage.
  • Take extra supplies and medication in case of loss, theft or accidental destruction.
  • Consider other supplies you may need, including treatment for hypoglycemia (low blood glucose), food, drinking water, walking shoes, sunblock and medication for nausea and diarrhea.

Are you travelling by AIR?

It might be a good idea if you are travelling by air to consider the following:

  1. Plan Ahead
  • Review the latest Transport Canada and Canadian Air Transport Security Authority information about packing your supplies and what is permitted (and not permitted) in carry-on and checked baggage.
  • Have any prescription medicine with you and know how to use it, when to use it and any common side effects that you might have. This will better prepare you to let air attendants know what to do. Most airlines are more than happy to help passengers with special needs.
  • Be sure to allow yourself extra time to check in before your flight, in case your items are thoroughly searched by airport screening officers.
  • Airlines usually offer special meals for people with diabetes, but most often the regular airline meals can fit into your meal plan with some planning.
  • Have appropriate snacks with you in case your flight or in-flight meal is delayed, or the meal provided does not have enough carbohydrate.
  • Be aware of time zone changes, and schedule your meals and medication accordingly. Your diabetes educator can help you with this.
  • If you choose to sleep while travelling by air, use a travel alarm clock or ask the flight attendant to wake you at meal or medication time.
  1. Insulin
  • Be sure to carry your insulin with you at all times.
  • Never store insulin in checked luggage, because it may be exposed to extreme (often freezing) temperatures, which can change its effectiveness.
  • The security scanners used at check-in will not normally damage your insulin or blood glucose meter.
  • It is important to inspect your insulin before injecting each dose.
  • If you notice anything unusual about the appearance of your insulin, or notice that your insulin needs are changing, contact your doctor.
  1. Pumps
  • Advise the screening officer in advance if you use an insulin pump. The walk-through metal detector and the hand-held metal detector may affect the functioning of insulin pumps, so you can ask the screening officer to perform a physical search in a private location.
  1. Stay active
  • Try to do some form of activity during your journey:
    • Walk around in the terminal before boarding
    • During the flight, consider doing simple stretching exercises in your seat or moving your ankles in circles and raising your legs occasionally. This will improve your circulation.

Are you travelling by CAR?

Whether you are a driver or a passenger, checking your blood glucose regularly is very important.

  • Check blood glucose before you leave home and then again every four hours during your journey.

It might be a good idea if you are travelling by a car to also consider the following:

  • Stop every few hours to stretch your legs and do some physical activity. This will help improve blood circulation.
  • If you take insulin, avoid driving in the time between your injection and your next meal.
  • Limit your driving to a maximum of 12 hours per day, or six hours between any two meals.
  • Keep your medication, meal, and snack times as regular as possible.
  • Bring supplies with you to treat low blood glucose (e.g. 15 grams of glucose tablets, six Lifesavers or 175 mL (3/4 cup) of fruit juice or regular pop) in case of traffic jams, car trouble, or wrong directions.
  • At the first sign of low blood glucose or hypoglycemia, pull over to the side of the road and take a form of fast-acting sugar, such as 15 grams of glucose tablets (preferred) or 175 mL (3/4 cup) of fruit juice or regular pop. Follow this with a longer-acting carbohydrate and a protein such as a sandwich. Do not start driving again until the symptoms have disappeared and glucose values are above 6 mmol/L.

Are you travelling by SEA?

Cruise holidays are known for all-you-can-eat buffets. With a wide array of mouth-watering foods available, it’s easy to overindulge.

It might be a good idea if you are travelling by sea to consider the following:

  • Talk to your diabetes educator before you leave about how to fit some of the cruise line foods into your meal plan.
  • When possible, obtain a sample menu from the cruise line, so you’ll have an idea of the types of foods served; then you can plan your meals accordingly.
  • Keep active to compensate for any extra food you eat. Cruise ships offer some great activities; try a fitness class, go for a swim, or stroll the deck at sunset.
  • It’s a good idea to make the cruise staff aware of your diabetes in case any problems arise.
  • Have a written record of all your medications.

Are you travelling by FOOT?

A vacation in the great outdoors can make for an excellent retreat from the pressures of everyday life, but there are a few things to consider before you go:

  • Think safety in numbers - avoid going camping or hiking alone.
  • Tell someone where you will be and when you expect to return, so you can be found in case of an emergency.
  • Bring along a first aid kit and if you use insulin, a Glucagon* Emergency Kit.
  • If you use insulin, teach your travel companion when and how to use Glucagon. For more information about the Glucagon Emergency Kit, talk to your diabetes educator.
  • Try and avoid things that severely alter blood glucose levels, such as significantly more intense physical activity than usual. Also try to avoid getting cuts, bruises, sunburns, blisters, or insect bites.
  • Make sure you eat and drink enough to meet your needs - bring extra food, water, medication and sugar. Be sure that your food and water are not contaminated.
  • If you are extremely active you may need to decrease your diabetes medication, so be sure to discuss this with your diabetes educator or physician.

*Glucagon is administered when a person has severe hypoglycemia or low blood glucose.

How do you store and use your insulin while travelling?

Insulin must be stored properly, as it will spoil if left in temperatures that are too hot or too cold.

  • Insulin keeps its strength at room temperature for thirty days.
  • If travelling in:
    • Hot temperatures:
      • Store your insulin in an insulated bag or cooled thermos.
    • Extremely hot conditions:
      • Freeze water in plastic bottles and keep these in your insulated bag along with your insulin and food supplies. When melted, the water can then serve as drinking water.
    • Cold climate, such as skiing or camping:
      • Keep your insulin close to your body or an insulated bag to keep it from freezing.
  • For short trips, you may want to keep your needles and sharps and dispose of them when you return home.
  • For longer trips, you can purchase small containers that store or break down needles and syringes.
  • If you use insulin pens, take a spare one with you.
  • Pack some syringes to be used in an emergency so you can withdraw insulin from an insulin cartridge. Remember not to insert air into the cartridge when doing so.

How do you keep your blood glucose levels under control while travelling?

While on vacation, test your blood glucose regularly.

  • Regular testing is the only way you’ll know whether your blood glucose levels are in their target range.
  • It is a good idea to bring the instruction manual for your meter as well as extra batteries and test strips with you.
  • If hand-washing facilities are not available, carry alcohol swabs or moist towelettes to wipe your fingers prior to testing.
  • Record injections, medications and test results in a logbook.

 If you have trouble with your blood glucose levels, contact your doctor or diabetes educator or contact a hospital in the area for advice. Be sure to have your list of medications and travel insurance handy to help the doctor provide appropriate care.

How do insulin users adjust for time zone changes?

Long journeys often cross several time zones, so a regular 24-hour day can be extended or shortened. Either way, you’ll have to adjust your insulin schedule accordingly as blood glucose control can be upset by a change in time, altered activity, or disturbance of body rhythm and sleep patterns.

While travelling, keeping your blood glucose close to target levels can be a challenge. Here are some guidelines:

  • When travelling east, your travel day will be shorter. If you lose more than two hours, you may need to take fewer units of intermediate or long-acting insulin.
  • When travelling west, your travel day will be longer. If you gain more than two hours, you may need to take extra units of short-acting insulin and more food.
  • You can change the time of your injections and meals by up to two hours in a day without adjusting your insulin dose or your meal plan.
  • Follow your usual meal plan as closely as possible.
  • If you are crossing more than two time zones, you will need to prepare a meal and insulin schedule with your doctor or diabetes educator.

How do people taking oral diabetes medication adjust for time zone changes?

  • If the time difference is less than three hours, you can move the time you take your oral agents by one to one-and-a-half hours.
  • If the time difference is more than three hours, ask your doctor or diabetes educator for advice.

How do you manage your blood glucose when you are ill?

Ask your doctor or diabetes educator what to do if you get sick on your holiday.

  • Generally, if you experience motion sickness while travelling, take carbohydrate in the form of fluids (e.g. juice or regular soft drinks). If you are not sure how to convert carbohydrate to fluids, ask your diabetes educator.

When you are sick, your blood glucose levels may fluctuate and be unpredictable. During periods of illness, it is VERY IMPORTANT that you:

  • Test your blood glucose levels every two to four hours;
  • Continue to take your diabetes medication;
  • Drink plenty of extra sugar-free fluids or water; try to avoid coffee, tea and colas as they contain caffeine, which may cause you to lose more fluids;
  • Replace solid food with fluids that contain glucose, if you can’t eat according to your usual meal plan;
  • Try to consume 15 grams of carbohydrate every hour;
  • Call your doctor or go to an emergency room if you vomit and/or have had diarrhea two times or more in four hours;
  • If you are on insulin, be sure to continue taking it while you are sick. Check with your healthcare team regarding guidelines for insulin adjustment during illness;
  • Rest.

If you use insulin to manage your diabetes, you should also ask your doctor or diabetes educator about Glucagon.

  • Glucagon is given by injection, and is used to treat severe low blood glucose
  • If you are travelling to a remote spot that does not have ambulance service, it is important that your travel companion learn how to give Glucagon.
  • See your doctor or diabetes educator if you are unfamiliar with how to use Glucagon.

The Traveler’s Checklist

Before you leave, remember to get:

  • A medical check-up
  • Travel health insurance
  • An identification card and MedicAlert ™ bracelet or necklace
  • Information on the local foods and drinking water
  • A list of your medications
  • A letter from your doctor stating:
    • Your diabetes treatment plan so doctors in the places you travel can understand your needs
    • That you need to carry syringes or needles for insulin pens and lancets as part of your insulin treatment. Having this will be helpful if your luggage is examined at airport security checkpoints.
    • The supplies you need for your diabetes care. Be sure to keep your syringes, needles, pens, and lancets in the same boxes that they came in with the original prescription label on them.
  • Any needed vaccinations
  • Information on local medical facilities or organizations

Ask your doctor or health care team about:

  • Illness management
  • Hypoglycemia management (Glucagon for insulin users)
  • Adjustments for meals, insulin and medications in different time zones
  • Avoiding illness caused by contaminated food and water
  • Tips for adjusting your medication if required

Packing list:

  • Extra supply of insulin or pills for diabetes
  • Extra supply of syringes, needles and an extra insulin pen if used *
  • Blood glucose meter and record or logbook
  • Fast-acting sugar to treat low blood glucose
  • Extra food to cover delayed meals such as crackers and fruit
  • Urine ketone-testing strips *
  • Anti-nausea and anti-diarrhea pills
  • Pain medication
  • Sunblock
  • Insect repellent
  • Bottled water
  • Comfortable walking shoes
  • Glucagon *
  • Telephone numbers of your doctor and diabetes educator
  • Supplies for the trip home in case you run into any problems

* Supplies for travellers with type 1 diabetes and those who use insulin to manage their diabetes

Where can you get additional resources and find more information?

  1. Visit diabetes.ca, call 1-800-BANTING (226-8464) or contact your local branch of the Canadian Diabetes Association.
  2. Get in touch with a dietitian or ask your doctor for a referral.
  3. To obtain MedicAlert® Identification, contact the Canadian MedicAlert Foundation.
  4. The International Association for Medical Assistance to Travellers (IAMAT) can provide you with a directory of English-speaking doctors around the world and helpful travel tips.