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Travel Tips for People With Diabetes
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 forethought 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.
Planning 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. There are many disaster stories such as lost luggage or encountering a hurricane. 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 entails. That way, a suitable itinerary can be planned to meet your needs. A missed connection or illness can ruin the best-laid holiday plans.
Visit your doctor or diabetes educator
It is a good idea to 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 - particularly oral medications for diabetes and insulin. 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.
Airlines and some countries require you to have written documents from your doctor stating that you are allowed to carry medicines or supplies. Syringes and needles in particular can present a problem when flying and when entering some countries.
Managing 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 soft drinks). If you are not sure how to convert carbohydrate to fluids, ask your diabetes educator.
When you are sick, you 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, a condition that can cause seizures or a loss of consciousness. 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 its use.
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 on how to contact the Canadian Diabetes Association or the Canadian MedicAlert Foundation, see below).
Travel Insurance
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.
Packing
Divide your medications and diabetes supplies, and pack them in more than one place, in case you lose one of your bags. Most importantly, make sure that you have a portion of medications and supplies in your carry-on luggage. Take extra supplies and medication in case of loss, theft or accidental destruction. Also consider other supplies you may need, including treatment for hypoglycemia, food, drinking water, walking shoes, sunblock and medication for nausea and diarrhea.
Planes, Trains and Automobiles - Tips for different types of travel
By Air
Most airlines are more than happy to help with passengers with special needs . Be sure to allow yourself extra time to check in before your flight, should your items be 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. Always 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. If you choose to sleep while on travelling by air, use a travel alarm clock or ask the flight attendant to wake you at meal or medication time.
If you take insulin, be sure to carry it with you at all times. Manufacturers indicate that, ideally, insulin should not be exposed to x-rays during travel and that it be inspected manually whenever possible. However, the security scanners used at check-in will not normally damage your insulin or blood glucose meter. If baggage remains in the path of the x-ray for longer than normal, or if the baggage is repeatedly x-rayed, the insulin may lose potency. Insulin is affected by extreme temperatures and should never be stored in the unpressurized baggage area of the aircraft. As always, 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.
Notify 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 an insulin pump, so you can ask the screening officer to perform a physical search in a private location.
Try to do some form activity during your journey: walk around in the terminal before boarding, consider doing simple stretching exercises in your seat, or move your ankles in circles and raise your legs occasionally.
If you are planning to travel by air, 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. It’s important to have any prescription medicine with you and know how to use it, when to use it and any common side effects you might have. This will better prepare you to let air attendants know what to do.
By Car
Whether you are a driver or a passenger, checking your blood glucose regularly is very important. Check it before you leave home and then again every four hours during your journey. Stop every few hours to stretch your legs and do some physical activity. This will help improve blood circulation. 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 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. 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. You may not always be able to get to a restaurant on time, so bring supplies with you to treat low blood glucose (e.g. 15 grams of glucose tablets, six Lifesavers or 175 mL of fruit juice or regular pop) in case of traffic jams, car trouble, or wrong directions.
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. Talk to your diabetes educator before you leave about how to fit some of these 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 an aerobics 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 all of your medications well documented.
On 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. Most importantly, there is 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. Teach your travel companion when and how to use Glucagon. For more information about the Glucagon Emergency Kit, talk to your diabetes educator.
The key to enjoying a camping trip is to 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.
Be sure that your food and water are not contaminated. Of course, make sure you eat and drink enough to meet your needs - bring extra food, water, medication and sugar. 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.
Insulin Storage and Use
Insulin must be stored properly, as it will spoil if left in temperatures that are too hot or too cold. Insulin retains its potency at room temperature for thirty days.
If you are travelling in hot temperatures, store your insulin in an insulated bag or cooled thermos. In extremely hot conditions, you can 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.
If you are skiing, camping or working in a cold climate, keep your insulin close to your body or an insulated bag to keep it from freezing.
If your trip is short, you may want to keep your needles and sharps and dispose of them on your return home. For longer trips, you can purchase small containers that store or disintegrate needles and syringes.
If you use insulin pens, take a spare one with you. Also, pack some syringes as they can be used in an emergency to withdraw insulin from an insulin cartridge. Remember not to insert air into the cartridge when doing so.
Keeping Blood Glucose Levels Under Control
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 also a good idea to bring the instruction manual for your meter as well as extra batteries and test strips with you.
Carry alcohol swabs or moist towelettes to wipe your fingers prior to testing when necessary. Keep a daily record of injections, medications and test results. If you have trouble with your blood glucose levels, follow the adjustment guidelines as discussed with your doctor or diabetes educator and/or contact your doctor or diabetes educator or contact a hospital in the area for advice. Be sure to have your documented list of medications handy to help the doctor provide appropriate care.
If you have opted for travel medical insurance, take your documents to the hospital with you. Insulins have different names and are supplied in different strengths in some countries. Make sure that the insulin and syringe concentrations are the same as those you use at home. Consider using your own supplies of medications and syringes in third world countries. Avoid using local syringes if not sterile.
Time Zone Changes for insulin users
Long journeys often cross several time zones, so a regular 24-hour day can be extended or shortened, depending on the direction of travel. Either way, you’ll have to adjust your insulin schedule accordingly. 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.
Time Zone Changes for people taking oral diabetes medications
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.
Eating Away from Home – Tips for Making Healthy Choices
It is probably more difficult to follow your meal plan on the road than it is when you’re at home, but it can be done with a little extra planning. Fortunately, a typical diabetes meal plan consists of foods that are generally available in most restaurants.
People with diabetes can fit virtually anything into their meal plan, in moderation. Managing your food intake away from home involves estimating appropriate amounts of these foods. It is a good idea to visit a registered dietitian to learn how to estimate serving sizes. It’s also important to eat a balanced diet while you’re away from home. Try to keep your calorie intake close to your typical level unless you are more active than usual. With the help of a dietitian, you can vary the types of food you eat. For example, you can try different sources of carbohydrate. Monitoring these changes can help you keep your meal plan on track and may help ward off potential problems.
Always have some snacks with you in case your blood glucose level drops or you’re unable to eat your next scheduled meal on time. Cheese and crackers, fresh or dried fruit, granola bars and sandwiches are all healthy choices that are easy to bring along in a carry-on bag, picnic basket or cooler. Also bring some quick-acting sugar with you, such as glucose tablets or juice. Learn more about eating away from home – tips for making healthy choices.
Alcohol and Diabetes – Is Alcohol a Choice for Me?
Like everyone else, people with diabetes can enjoy alcohol - again, the key is moderation.
The Association’s 2008 Clinical Practice Guidelines recommend that:
- People using insulin or insulin secretagogues should be aware of delayed hypoglycemia (low blood glucose) that can occur up to 24 hours after drinking alcohol.
- People with type 1 diabetes should be aware of the risk of morning hypoglycemia if alcohol is consumed 2 to 3 hours after the previous evening’s meal.
- Alcohol should be limited to 1-2 drinks per day (less than 14 standard drinks/week for men and less than 9 standard drinks/week for women).
- People with diabetes should discuss alcohol use with their diabetes healthcare team.
Drinking alcohol can increase your risk of having low blood glucose. To reduce this risk, take the following steps:
Before Drinking Alcohol…
- Eat regular meals, take your medication(s), and check your blood glucose levels frequently (keep your blood glucose meter with you).
- Always have a treatment for low blood glucose with you (such as 3 glucose tablets or ¾ cup regular pop or 6 Life Savers®).
- Wherever you are, make sure someone with you knows your signs and symptoms of low blood glucose and how to treat it so they can help you.
- Be aware that glucagon, a treatment for low blood glucose, will not work while alcohol is in the body. Because of this, make sure that someone knows to call an ambulance if you pass out.
- Wear diabetes identification such as a MedicAlert® bracelet.
While Drinking Alcohol...
- Eat carbohydrate-rich foods when drinking alcohol.
- Eat extra carbohydrate-rich foods if you are dancing, playing sports or doing other physical activity.
- Always pour your own drinks. Use less alcohol and stretch your drinks with sugar-free mixes.
- Drink slowly. Make your second drink without alcohol.
After Drinking Alcohol...
- Tell a responsible person that you have been drinking. They should look for low blood glucose symptoms.
- Check your blood glucose before going to bed.
- Eat a carbohydrate snack if your blood glucose is lower than usual.
- Set an alarm or have a responsible person wake you up through the night and early morning – a delayed low blood glucose can occur anytime up to 24 hours after drinking alcohol.
- You need to get up on time the next day for any food, medication or insulin you normally take. Missed medication or insulin can lead to high blood glucose, ketones and diabetic ketoacidosis (DKA).
Keep in mind that if you plan carefully, discuss any potential risks with your doctor or diabetes educator, and monitor your blood glucose regularly, you can look forward to a fun, safe and rewarding vacation. Bon Voyage!
Learn more about alcohol and diabetes.
The Traveler’s Checklist
Before you leave, remember to get:
- a medical check-up
- travel health insurance from Canadian Diabetes Association
- 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
- 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 oral agent for diabetes
- extra supply of syringes, needles and an extra insulin pen if used *
- blood glucose testing kit and record book
- fast-acting insulin for high blood glucose and ketones *
- fast-acting sugar to treat low blood glucose
- extra food to cover delayed meals such as a box of cookies or crackers and fruit juice
- urine ketone-testing strips *
- anti-nausea and anti-diarrhea pills
- pain medication
- sunblock
- insect repellent
- large amounts of bottled water, if necessary
- 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 insulin users
Resources/For more information
- Stay informed. Sign up for Canadian Diabetes Association Headline News.
- Visit diabetes.ca, call 1-800-BANTING (226-8464) or contact your local branch of the Canadian Diabetes Association.
- Get in touch with a dietitian, ask your doctor for a referral, or visit your local hospital or Diabetes Education Centre.
- Obtain MedicAlert® Identification. Contact the Canadian MedicAlert Foundation.
- 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.
- Travel clinics in larger cities.