Traveling with diabetes

VOL 105 / NO 2 / FEBRUARY 1999 / POSTGRADUATE MEDICINE

It's always wise to plan ahead for travel, but it's especially important if you have diabetes. Although you may face special challenges while traveling, you can usually anticipate and avoid serious problems by thinking them through in advance. Your doctor and diabetes team can be a great help as you get ready to go.

The very first step in planning an extended trip is to schedule an office visit with your doctor. Ideally, this should be done 4 to 6 weeks before departure so you have time to make any changes needed and see how they work before you leave. Speak with your diabetes educator or dietitian if you have specific questions about diet, exercise, or signs and symptoms of high or low blood glucose. Travel medicine clinics are very helpful if you are going to a place where touring might be more hazardous than normal.

The American Diabetes Association (ADA) hotline (800-342-2383) and Web site (http://www.diabetes.org) are excellent resources. In addition, the International Association for Medical Assistance to Travelers (716-754-4883, http://www.sentex.net/~iamat) publishes a directory of English-speaking physicians worldwide and can provide other helpful information.

Meals
Check with your airline if you have food preferences during travel. Give the airline at least 2 days' notification. Your hotel probably can provide information about restaurants and cafes that offer menus you need or prefer. If you think food choices might be limited, ask your dietitian for help in choosing appropriate foods of the countries you plan to visit.

Insulin
Insulin in open vials is safe if stored at normal room temperature for about a month, but warm climates with temperatures above 80°F might cause problems. Ask for an air-conditioned room or make sure the room has a refrigerator. It may be wise to take a thermally insulated bag or canister for storing insulin as well.

If your insulin is lost or stolen or if bottles are broken, you usually won't have problems replacing them overseas. However, be sure to buy the proper type of insulin. If you have to switch preparations for any reason, make certain that you have the right syringe as well. It's a good idea to carry a letter from your physician stating your insulin and syringe needs. Ask your doctor to write the letter on official letterhead and include the office address, phone number, and fax number.

What and how to pack
Plan to take along all medications, supplies, and documentation on every trip, even very short ones. Be ready for travel delays. That means packing at least twice the amount of medications and supplies normally required. Always carry prescriptions for insulin and other drugs, as well as your doctor's instructions written in English and in the language of your destination, if possible. In addition, always carry or wear some identification that informs others about your diabetes.

Be sure your carry-on luggage contains everything you need to manage your diabetes, preferably in two different bags. Never pack medications in checked baggage or bags that must be stowed out of your reach.

Wrap your insulin vials in socks or pack them among soft clothing during travel. Make certain that they are always out of direct sunlight and safe from extreme temperatures. If you are driving, place the vials under the seat or in a cooler or thermally insulated bag. Never put insulin in the car trunk, on the dashboard, or directly on ice. If your insulin is exposed to cold, check to make sure crystals have not formed; they signal decreased potency. If you have concerns, check your blood glucose levels more often and replace old insulin as soon as possible.

Be prepared to treat low blood sugar. Carry glucagon injection kits or glucose tablets or gel with you. Because you may not be able to eat when you need to, have some simple sugars, such as candy or a soft drink, available. And remember to eat food that contains complex carbohydrate (cheese, crackers, granola bar, trail mix, a peanut butter sandwich) after you consume the quick sugar. Even if you are just going on a short excursion away from your hotel, take along sugar, water, dried foods, and other supplies.

Adjusting medications
It's not likely that you will need to change your insulin doses if you're traveling through fewer than six time zones. However, if you cross more than six time zones, you usually need to change meal times and adjust medication schedules. Check with your doctor about how to make these changes. Don't hesitate to ask questions if you are confused about how to best travel with diabetes. It is a complicated disorder, but many resources are available to help you.

Your travel checklist

Visit your doctor 4 to 6 weeks before you leave.

Receive a letter from your doctor (on office letterhead) explaining your diagnosis and listing medications and supplies you need.

Make sure you have identification stating that you have diabetes.

Obtain needed prescriptions and twice the amount of medication, insulin, and syringes you normally need.

Pack plenty of supplies (swabs, lancets, urine test strips, blood test strips, glucometer, extra batteries).

Check your health insurance. Carry the company name, policy number, and emergency phone numbers with you.

Gather education materials on diabetes and travel and take them along.

Prepare a personal medical kit that includes:
     Analgesics
     Antacids
     Antibiotic and fungal creams
     Antidiarrheal medications
     Bandage materials
     Cold and allergy medications
     First-aid manual
     Insect repellent
     Motion sickness medicines
     Other prescription medications
     Sunscreen

Carry sources of both simple and complex sugar, such as:
     Breakfast bars
     Candy
     Crackers
     Glucagon injection kits
     Glucose gel or tablets
     Raisins, trail mix
     Sandwiches

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste