Traveling with diabetes

Being diabetic should not stop you from traveling: a good preparation will allow you to safely visit any corner of the globe!

Think of consulting a healthcare provider or Volyse remote travel health clinic at least 4 to 6 weeks before your departure and be aware of the medical facilities location of the visiting area.  

TRAVEL HEALTH SPECIALIST

Consult a travel health specialist before you leave. Volyse may help with this ;) They can check if your basic vaccines are up to date and if other vaccines are recommended depending on the destination. Depending on the region visited, certain medications may also be prescribed to prevent certain health problems (traveler's diarrhea, malaria, altitude sickness, etc.).

PHYSICIAN AND / OR NURSE

If you take insulin: review the concepts of adjusting insulin doses (time difference, hypo-hyperglycemia), as well as what to do in case of hypoglycemia, illness, etc. Ask for a copy of your glycosylated hemoglobin (A1C) result showing that your condition is stable. This information may be requested by your travel insurance. Remember to check the coverage and terms of your insurance policy, ideally before booking your trip. Make an official letter with your doctor, in French and in English, that you have the permission to travel with the supplies and drugs, for example: needles, insulin, insulin pump, glucometer, lancets, snacks, etc. Keep this letter with your passport (and a photocopy in your luggage) to avoid problems with customs and security screening at airports. Here is an example of a letter that your doctor can fill out before your departure: https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/getdocument/lettre-medicale-francais-anglais

NUTRITIONIST

A nutritionist can help you adapt your diet plan to the typical dishes of the regions you will be visiting. A pocket guide for your meals in the restaurant is also available on the Diabète Québec website. You can also find it as a phone application.  

PHARMACIST

To help you deal with unforeseen events such as flight delays, having enough medication and supplies to cover the total duration of your trip and at least one extra week (or up to twice the duration of your trip) :

  • Oral medication;

  • Insulins. Bring an extra pen-injector (free in pharmacies!) Or syringes (if you know how to use them) in case your pen breaks;

  • Needles, alcohol swabs, lancets, strips for measuring blood glucose and / or ketones;

  • Medical identification bracelet or pendant indicating that you have diabetes (eg MedicAlert);

  • Glucose meter. A second blood glucose meter may also be useful in case of breakage. If you need to use a blood glucose meter from another country, make sure the units of measurement are the same:

    •  - some devices can display results in mg / dL. You can convert the result to mmol / L by dividing it by 18 (mg / dL ÷ 18 = mmol / L).

  • Extra batteries for your meter and / or insulin pump.

  • Safe hermetic container for dirty needles;

  • Insulin pump and its equipment (eg needles, tubing), etc.

  • Snacks, fast-absorbing carbohydrates (glucose tablets, sugar sachets, etc.);

  • If indicated, take your glucagon kit and explain to the person accompanying you (friend, family, guide) how to use it in case of emergency;

  • Etc.  

Remember to ask for an up-to-date list of your medication.

How to prepare for a plane trip?

Ideally, carry all your medication and equipment in your carry-on baggage: this will avoid extreme temperatures and make sure you have them in case you loose your luggage.  Notify the security personnel that you have diabetes and that you carry medical equipment in your carry-on baggage. Present them the letter filled out by your doctor if needed. If you wear an insulin pump, tell them that you should keep it on you and that you prefer a manual inspection (vs. complete metal detector). Keep your medications, strips and lancets in their original packaging with the pharmacy label. Your meter and pens should be labeled with the manufacturer's name.

Check if a meal will be offered on your flight: some short-term flights no longer offer meals on board. You should then plan snacks containing carbohydrates and proteins (crackers, dried fruits, cereal bars, nuts, etc.).

Should I adjust my medication with the time zones?

It is not usually necessary to adjust your medication during a north-south trip or if the time difference is equal or less than 3 hours for an east-west trip.

If the time difference is more than 3 hours, it is important to plan your meals and adjust the dosage of some of your medications and / or your insulin schedule accordingly.

Do not hesitate to seek advice from your doctor, nurse and / or pharmacist.

Here are some of the general recommendations:

  • Wait until you reach your destination before changing the time on your watch, cell phone or insulin pump. This way, you will know when to take your medication or inject your insulin during your trip. Adjust the time of your watch and your devices (blood glucose meter, insulin pump) to the local time when you reach your destination, then continue taking your medications and administering your insulin at the same time as usual (home time);

  • Take oral hypoglycemic doses at the corresponding meals (regardless of the time) and maintain an adequate time interval between meals;

  • While on the plane, wait for your meal before injecting your dose of fast-acting insulin. The dose can then be adjusted according to the meal and avoids hypoglycemia if the service has been interrupted (eg in case of turbulence);

  • Postpone the injection of intermediate or extended-acting insulin to the first night once at destination;

  • Continue basic routine administration and boluses during the flight if you have an insulin pump.

Note that adjusting your insulin and medication with the times zones changes may be complicated. We strongly recommend taking the advice of a healthcare provider.

How to store my insulin?

Insulin can be stored for up to 1 month at room temperature, between 0 and 30 ° C (note: 42 days for Levemir). The pen injectors should not be refrigerated. Any extra insulin doses should be stored in the refrigerator (in the hotel where you will be staying for example). Avoid exposing insulin to extreme temperatures. In hot weather, you can carry it in an insulation kit (eg Frio) or a thermos. Ice or an ice pack may also be used, but must not be in direct contact with the insulin (loss of effectiveness if frozen and must be discarded in the later case). If you need to carry your insulin outdoors in cold weather (ie hiking), keep it close to your body, such as in the inside pocket of your coat. Glucometers usually operate at a temperature between 10-40 ° C.

How will the trip affect my blood sugar?

It is quite possible that a change in your routine (eg. being more active than usual, changing your eating and drinking habits, changes in your sleep, etc.) may influence your glycemic control. In any case, consider measuring your blood sugar more often!

What to do if a meal is delayed?

Maintaining a regular meal schedule can be difficult when traveling. Taking some oral antidiabetic drugs that increase insulin secretion and / or insulin itself may cause hypoglycaemia if the meal is delayed. Thus, if a meal is delayed, it is recommended to have a snack at the usual time of the meal (15 g of carbohydrates for every hour delay, or 15-30 g of carbohydrates and a source of protein in the case of a 2-3 hours meal delay) and subtract this amount of carbohydrate and protein from the meal that will be taken later. Oral antidiabetic drugs and insulin should be taken with the meal only. Be prepared to treat hypoglycemia if it occurs. Always have snacks or quick sugars with you (glucose tablets, sugar sachets, etc.).

What to do on sick days?

Check your blood sugar more often if you're sick (every 4 hours).

In case of diarrhea or vomiting, keep yourself hydrated. Use rehydration solution (eg Gastrolyte), anti-diarrhea and / or anti-nausea medication if necessary.

Respect your diet plan if you have one. If you can not drink or eat normally, changing the dose of insulin or adjusting your diabeties medications may be necessary. Talk to your doctor, pharmacist or Volyse healthcare provider.

An ill state may initiate the production of energy from your fat and you may see your blood sugar increase. This can lead to an accumulation of toxic waste in your body, called ketones, and eventually lead to diabetic ketoacidosis. If your fasting blood glucose is higher than 14 mmol / L and you have abdominal pain, excessive tiredness, nausea / vomiting or intense thirst, check for ketones in the blood or urine (Ketostix Chemstrip, etc.). If the result is high, see a doctor as soon as possible.

Other useful information  

People with diabetes are at higher risk of infections, particularly in the lower limbs. Opt for comfortable shoes to avoid injuries and blisters, avoid walking barefoot and examine your feet every day. Some mobile applications are available on the Diabetes Québec website, including the "Resto Guide", the "Travel Guide" and "Insulin pumps": https://www.diabete.qc.ca/en/understand-diabetes/resources/mobile-tools.

Prepare well and have a safe trip!

REFERENCES

www.diabete.qc.ca

www.diabetes.ca

http://www.diabetescareguide.com/