The Definitive Guide to Traveling with Diabetes

It is Marcel Proust who said that "the real voyage of discovery does not consist in seeking new landscapes, but in looking at things with new eyes." Recently, new technologies, ideas and innovations have appeared which make it possible for people with diabetes to better travel with their insulin and to take more responsibility for their health. Diabetes is no longer today a condemnation to a sedentary lifestyle.

The secret of an enjoyable travel experience for a person with diabetes is in the way in which it is prepared, and taking just a couple of precautions before departure can make all the difference. Insulin is sensitive to heat and should ideally be kept in a refrigerator with a temperature between 2 and 8°C. People with diabetes are much more sensitive to certain events or changes of routine which might affect their metabolism or their lifestyle.

Today, the diabetic who is in control of his disease can travel almost anywhere. This being said, it is necessary before leaving:

- To ensure that his diabetes is well controlled.

- To get information about the availability of local diabetic care. The best way to do this is to get in touch with the local diabetes association. Almost without exception, every country in the world has an association dedicated to diabetes information. Simply go on the net, and type the name of the country, together with "diabetes association", and you will quickly get all the info you need. Alternatively, phone your local association and they will most certainly give you the contacts you need.

- Try not to travel alone in countries with extreme temperatures where you do not speak the local language.

THE HARDWARE REQUIREMENTS

Being autonomous is the first priority for the diabetic on a journey.

- Check with your doctor that you have a sufficient stock of insulin (always take enough insulin for 10 days more). It is important to realize that in several countries, insulin is sold mainly in 10 ml bottles and not in prefilled pens, like in Europe. You must thus ensure that you have enough of your own insulin and must never assume that the country that you are visiting will have exactly the same form of insulin as you use.

- Check that you have all the necessary hardware for your daily controls. If you travel in a country with a different time zone, unusual temperatures or where you might eat some strange food that your body is not used to, you will probably have to control your glycemia more often than normal. So ensure that you have all the necessary supplies (control strips, injector pens, needles, syringes, etc).

- If it is a long trip (more than a couple of days), check the battery in your glucometer.

- Ensure that your insulin is always sheltered from heat and/or cold. Insulin should ideally be stored in a refrigerator between 2 and 8°C. Ensure that the hotel of your choice has a refrigerator available for you to store your insulin. If this is not possible, think of taking a portable fridge (such as Medifridge). For the day trips use an isothermal case.

- Pack some sugar bags (in case of hypoglycemia) and some quick-release insulin (in case of hyperglycemia) in your travel case.

ALL THAT IRRITATING PAPERWORKS

- Download a diabetes travel certificate and ask your doctor to sign it. This will make it a lot easier for you at the airport as you get ready for that full body-cavity search.

- It is also a REALLY GOOD IDEA to have a diabetic passport in your wallet in case you faint or have an accident, so that the paramedic who "looks" in your wallet can immediately find out that you are diabetic and that it is necessary to give you sugar.

- Always ask your doctor to give you a prescription for your insulin, in case your insulin gets lost. Make sure that it is legible by international standards (English normally works best).

YOUR CHECKLIST

Made a checklist the day before leaving and put a notch next to each item:

- USUAL INSULIN (+ 10 DAYS)

- FAST INSULIN

- SUGAR

- SYRINGES WITH NEEDLES AND/OR PREFILLED PENS

- TEST STRIPS

- LANCETS

- GLUCOMETER WITH GRESHLY TESTED BATTERY

- DOCTOR'S CERTIFICATES

- DIABETIC PASSPORT

- PRESCRIPTION FOR SPARE INSULIN

THE TRIP ITSELF

- Check your sugar levels before departure; if possible, leave after a normal breakfast taken at the usual hour. As a precaution, reduce by 2 to 4 units the amount of insulin you take in the morning in order to maintain a safety level.

- If you are in the car, make regular pauses (a 10 minutes stop every 2 hours is a good rule) and take a collation sufficiently rich in slow glucids.

- Check your capillary glycemias more frequently; if it is under 0, 8 g/l, keep some sugar nearby and keep some fast glucids (fruits, biscuits) within range.

- Drink water regularly if the weather is hot.

- In the event of a car breakdown, eat some food if you must change a wheel or if you have to walk to a rescue station.

- Always keep your insulin with you in the plane and in the airport. As a habitual traveler, I have sometimes been stuck in airports for over 24 hours.

- NEVER put your insulin in the baggage compartment of the plane. The temperatures in the compartment are often under freezing point and your insulin will be damaged. And if your luggage is lost, so will your insulin. Another reason is that the flight might be delayed by several hours while you are stuck in the airport.

- Warn the staff on the plane that you are diabetic and that you need your meals on time (this is also a great excuse to be served before everyone, like a VIP).

TIME ZONES AND REMOTE DESTINATIONS

- Beyond 3 hours of jet lag, insulin intake must be managed systematically. An essential rule consists in NOT CHANGING YOUR WATCH TIME before your arrival and your first meal in the country of destination; this will help you to follow the action of your insulin and to distribute the food intakes.

- Take about 1/4 of your usual daily insulin needs with every meal (to be taken every 6 hours). Because the meals are very regular on planes, they are a good safety to avoid hypoglycemias.

- If your plane is delayed, check your sugar levels every 6 hours, and correct if need be with an addition of ordinary insulin.

FOOD, FOOD, OH GLORIOUS FOOD...

Even if you are on holiday, try not to upset too your usual dietary habits:

- Locate the equivalents of your traditional starchy foods and use them in the composition of your meals.

- Be careful with excesses of sweet fruits or those delicious Italian ice creams that are likely to disturb your glycemia! Avoid sodas...

- Digestive embarrassments are very frequent in tropical countries. Rather than resorting to anti diarrhea or antiemetic medication, drink lots of water and eat white rice that will bring you the necessary glucids.

- Take care to drink water regularly.

GENERAL ADVICE

For people with diabetes, it is super important to watch your feet. For a diabetic, the risks of amputations are much higher following banal infections or an unnoticed wound. Always use very comfortable shoes and change them several times per day in order to vary the points of frictions. Never walk barefoot, especially on a beach or on other surfaces exposed to the sun. Do not forget to examine your feet several times per day.

If you follow the above simple rules, you will be able, like Marcel Proust, to look at the world with new eyes.