Tips for Diabetic Travelers
Introduction
Persons with diabetes who plan to travel should take the following planning steps:
Before departure:
- Weigh the risks of international travel by discussing your proposed trip with your health care provider and one of our travel medicine advisors. It may be prudent to avoid travel to developing countries if you have complications of diabetes that are unstable (such as coronary artery disease, serious kidney disease, foot ulcers, or advancing eye disease).
- Consider vaccinations against various forms of hepatitis link typhoid link and others depending on your risk. Dukoral link is a new vaccine against a common form of traveler's diarrhea. It should be considered for insulin dependent diabetics.
- Contact airlines and hotels to notify them of any specific meal plan requirements; airlines generally require 48 hours notice. Because airlines' "diabetic meals" are often low in carbohydrates, you may do better with a regular meal.
- Carry medical alert information, preferably a Medical Alert wristband, containing the diagnosis of diabetes.
- Obtain and carry a letter from your physician or our clinic, on letterhead stationery, appropriately signed and dated, stating your medical history and your requirements for insulin or oral hypoglycemic agents and other accompanying equipment. Keep all medications in their original containers.
- Carry your drugs with you rather than packing them in luggage, as the ever-present problem of misplaced baggage may become much more serious if the lost baggage contains your urgently needed medications. Contact Transport Canada about procedures at airport security
- Take along duplicate copies of prescriptions for more important drugs, in case you should misplace or lose the drugs you brought with you.
- Have all prescriptions written using generic names, since trade names vary in different parts of the world.
- Carry twice as much medication as you will need (preferably in 2 different bags in case one is lost), extra strips and batteries for your glucose meter, and a first aid kit.
- Carry a supply of glucose tablets or gel in the event of a low blood sugar reaction and a supply of non-perishable snacks such as boxed juices, peanut butter, fruit trail mix, crackers, etc.
- Before leaving, obtain names of physicians in the cities you will be visiting, in case complications should arise during travel. The International Association for Medical Assistance of Travelers (IAMAT) or the International Diabetes Federation may be able to help in this regard. We will give you a list of IAMAT facilities when you come to the clinic.
- Make sure that your travel insurance covers overseas care and medical evacuations.
Traveling with Insulin
- Depending on the manufacturer, opened vials of insulin can be stored for 30 days at room temperature or for up to 32 to 90 days when refrigerated. Insulin that is stored at temperatures above 86°F will start to deteriorate and may not be effective and reliable for your entire trip. Insulin that becomes frozen is completely useless. Never store insulin on the dashboard or in the trunk of a car, in direct sunlight, or on ice. Look into special cooler carrying cases to help protect against extreme temperatures.
- Aircraft cabin pressure is often lower than that in the insulin vial therefore. Air should not be injected into the vial and most of the air should be removed before air travel.
- Also, at high altitude and at lower oxygen levels, glucose meters may underestimate blood glucose. Most manufacturers of glucose meters indicate that this should not be a problem; however, it would be prudent to check with the customer service representative of your meter manufacturer before travel.
- There are no simple sets of rules to deal with the problem of glucose control through many time zones. The key is to avoid hypoglycemia. Traveling east shortens the day and therefore lowers insulin requirements. Traveling west lengthens the day, requiring additional insulin and snacks. No matter which direction you travel, test your sugar more often.
- Remember to adjust your insulin by frequent glucometer readings for changes in activity level.
Air Travel
- On an aircraft, don't take your pre-meal insulin until the meal is on your tray in case turbulence interrupts the meal service. Also, be prepared for flight delays and lost luggage.
- Teach your traveling companion how to deal with an emergency, especially low blood sugar, and how to give glucagon (discuss this with your physician).
- Ensure that you remain well hydrated since the aircraft often has low humidity.
- On long flights, exercise your legs every two hours if possible and walk in the aircraft to prevent a clot developing in your legs.
Staying Healthy Abroad: Special Precautions
- Particular attention to food and water precautions is important to avoid traveler's diarrhea and its adverse effect on diabetic control.
- Avoid dehydration in hot climate. Read our tips for dealing with the heat. Acclimatization to hot climates may be impaired with diabetes. Frequent rest stops, adequate hydration with extra salt, and a reasonable pace of activity are important to prevent dehydration and heat illness.
- Carry loperamide and an antibiotic (e.g., ciprofloxacin, levofloxacin, azithromycin) for self-treatment of traveler's diarrhea, and consider carrying oral rehydration salts. Those with type 1 or difficult-to-control diabetes may want to consider taking an antibiotic to prevent traveler's diarrhea for trips of less than 4 weeks.
- Some oral hypoglycemic agents (e.g., glyburide, glipizide) may increase sun sensitivity, and additional sun protection (Ombrelle extreme) may be necessary.
- Foot care is important. Carry a spare pair of well broken-in shoes, inspect feet daily, don't walk barefoot, and don't break in a pair of shoes during travel. Take care of any foot conditions before you leave such as sores, fungal infections.
- Urinary tract infections can be reduced by staying well hydrated, and yeast infections of the skin can be prevented by frequent bathing and keeping the skin dry.