There is no reason why your diabetes should be a barrier in travelling, whether you are staying in the United States, or travelling half way across the world.

Planning ahead

Diabetes brings a number of extra considerations, some of which will depend on how your diabetes is treated.

Planning accordingly and seeking medical advice beforehand will help you work through any issues you have with factors such as diet, exercise and medication.

Variables such as going on an active holiday, or what the staple dishes are in your destination should be considered so you can assess if you need to bring extra supplies.

Your research will be crucial before you set off, but whether travelling by car, plane or train, there is no reason your diabetes should hinder your holiday, providing you’ve prepared sufficiently.

Travelling with medication

Taking your medication abroad should not pose an issue. However, if flying, you will need a letter from your doctor confirming your diabetes and requirement to bring insulin and needles on board the plane.

Insulin

You should also investigate what types and strengths of insulin are available, and where from, in your choice of destination, in case you need insulin while away. This can often be found via the pharmaceutical company that makes your insulin.

The strength of insulin used in the US is often U-100, but U-40 and U-80 strengths may be predominantly used by pharmacies in other countries.

If you need to change your type of insulin while on holiday, you will need to ensure that the delivery device matches the insulin. If you need to use U-40 insulin, this must be delivered with a U-40 syringe.

Insulin, sulfonylureas and glinides

if your diabetes is treated by insulin, sulfonylureas or glinides, you will need to bring hypo treatments on board the plane with you in your travel luggage.

Storage (GLP-1 agonists and insulin)

All insulin and GLP-1 agonists should be carried in your hand luggage as the cold of the holding deck can damage these medications.

Otherwise, you need make sure your insulin or GLP-1 agonist is in suitable condition to use on the plane and upon your arrival. When travelling, you should do the following:

  • Keep medication out of direct sunlight and make sure it is cool – Cool pouches can keep injectable medication cool for up to, and sometimes over, a day.
  • Never allow medication to freeze – Carried it in your hand luggage and don’t let insulin get too cold if travelling to a cold climate.
  • Regularly check blood sugar levels – Insulin and GLP-1 agonists may be absorbed faster in warmer climates so this will allow for any adjustments in dosage to be made safely.

Metformin

Taking metformin on holiday should not pose any issues with your diabetes, but if you are unsure it is best to consult your doctor prior to departure.

What will I need to take?

Travel lists will be longer for people with diabetes, but ensuring early on that you are fully prepared will allow you to maximise your holiday enjoyment when you arrive.

Taking precautions when packing will also help to account for unexpected events that can hinder travel plans, such as snow, delays and air travel crew strikes.

When packing, you should plan to take with you:

  • Medicine (insulin, sulfonylureas glinides, glp-1 agonists) – Twice as much as normal, including cartridges, pens, needles and tablets
  • Cooling pouches – For storing medication
  • Blood glucose meter – With backup supplies of strips and lancets, as well as a spare battery for the meter or another meter in your luggage
  • Identification – Either an identity card or jewellery that proves your diabetes
  • A doctor’s letter – Confirming your need for insulin and to carry needles, as well as a list of all your current medication and repeat prescriptions
  • Food supplies – If you are at risk of hypos, take fast acting carbohydrate, such as sweets or glucose tablets, and some slower absorbed carbohydrate to help with treatment and prevention of hypos

People with diabetes on insulin should also consider bringing ketone testing supplies in case of high blood sugars.

If you are travelling with somebody else, split your supplies in their hand luggage to ensure that if anything happens to one of your bags, you will still have some medical provisions.

Long haul flights

Medication

Whether you do or don’t have diabetes, long haul flights can be very tiring, especially when you have to consider how your medication schedule may be subject to change.

If flying for many hours, and crossing time zones, you will require information on how to manage your medication and when to time injections.

Consulting your doctor or health care professional prior to your departure will be wise in establishing how best to adjust your medication when travelling. A flight schedule and information on time zone changes can help you plan the timing of injections.

Insulin

Insulin can expand and contract at high altitudes, with air pockets developing within the cartridges of pens or in the reservoir of an insulin pump.

You should test “air shots” to make sure no air bubbles are present in the insulin before injecting.

If you are using an insulin pump, be aware that the change in altitude could affect insulin delivery, which can lead to unexpected changes in blood sugar levels.

For this reason, test your blood glucose levels regularly during the flight and after landing and watch out for any signs of hypos.

High altitude and humidity

Meters and test strips can be affected if you are travelling at high altitude and humidity, with false readings likely to occur. Your blood can also thicken at high altitude due to dehydration.

Keep your meter and test sticks warm, which can be done with pouches under clothing that stay close to the skin. Take readings in the shade and use a large drop of blood to ensure a more accurate result.

Eating

Some airlines may offer ‘diabetic’ in flight meals, but these are often high in complex carbohydrate and fibres and can still raise your blood glucose levels.

Bring your own snacks, such as a selection of nuts to help keep you full and your blood sugar levels stable. You can then read the nutritional labels to assess how much carbohydrate you may have.

Diabetes devices and X-ray machines

If you have an insulin pump or a continuous glucose monitor, these could be affected by X-ray machines. It’s important to check with the device’s manufacturer as to whether the device is safe to go through the X-ray machines.

If your CGM or insulin pump cannot go through the X-ray machines, you may ask to have a “walk through” or “pat down” inspection.

Coping with holiday illness

Holiday illnesses can be extremely inconvenient, but it is important to plan for them in case you need to manage your diabetes while ill on holiday.

In certain countries such as India, Pakistan and Kenya, stomach upsets are common, so being aware of some basic responses for sickness and diarrhoea is crucial, such as:

  • Never stop insulin or tablet medication, even if you cannot tolerate solid foods
  • Maintain carbohydrate intake with sugary drinks
  • If on insulin, test for ketones if you have high blood sugar above 240 mg/dL
  • Frequently monitor blood glucose levels

Medical advice should be sought if sickness or diarrhoea persists, or if you are displaying any other unusual signs of illness.

Securing travel insurance

You will need to inform your insurance company that you have diabetes and travel insurance is crucial to purchase in case of any diabetes-related emergencies you suffer on holiday.

You should ensure your insurance package provides adequate cover for emergency transport home and charges being recovered for the replacement any expensive medication or equipment.

Driving on holiday

There are a number of things to consider if you are planning to drive on holiday, including:

  • Ensuring your driving license is valid for the duration of your trip,
  • Establishing whether you will need an international driving license to drive in your destination.
  • Ensuring your travel insurance covers you for driving, especially when abroad.