Diabetes should not be a barrier to traveling. However the diabetic traveller’s planning needs to go well beyond the usual itinerary and clothing list. We often plan many details of our trips, but things often go wrong on trips. Imagine the following scenario. Your early morning flight to Morocco sits on the runway for three hours in a snowstorm. The lovely breakfast you anticipate never materializes. You forgot to pack the granola bars ‘just in case’. The flight attendant seems to ignore your requests for orange juice. What about the time zones? When should I take my next dose of insulin? How much? Where is my insulin? Great! It’s in my suitcase in the hold! It’ll freeze. Finally you land in Morocco. Your baggage lands in Tokyo! The lovely customs agent takes away your syringes. What do you mean there’s no diet pop in Morocco! I wonder what my blood sugar is now… Get the picture? Close or tight control of blood glucose is paramount in the treatment of diabetes. However while traveling, particularly during long flights, the goal should be to avoid any extremes that might result in symptoms from high or low blood sugar. Once you have arrived at your destination, you may then get back to a pattern of tighter control. But in order to achieve this, you must plan ahead.
Travelers should take enough supplies for their Diabetes with them. You never know when something might get damaged, lost or stolen. It is probably prudent to carry double the supplies that you will actually require. That goes for your insulin, syringes, batteries for your blood glucose monitor and alcohol swabs. It may not always be possible to purchase the same supplies abroad. Carry your supplies in your hand baggage. Insulin that travels in the baggage compartment may freeze and lose its potency. Or it may end up in Tokyo! Consider giving a bottle of insulin to your traveling companion, just in case you become separated from your hand luggage. It is important to carry some identification such as a Medic Alert bracelet or a wallet card’ and a letter from your doctor explaining that you have diabetes. A written prescription for your insulin, needles and other supplies will smooth your passage through customs, as well as help you out should you require more supplies abroad.
The insulin you are using should be comfortable going wherever you go. It does not need to be refrigerated as long as the duration of the trip is less than a month. However, it must be protected from temperature extremes and direct sunlight, or it may lose its potency. Crossing the Sahara in a Land Rover while your insulin swelters in the glove compartment is not ideal! And remember, unpressurized airline baggage compartments may lead to your insulin freezing. Unopened bottles of insulin should be refrigerated as soon as possible. Insulin may be protected from temperature extremes by carrying it in an insulated container such as a thermos. Cool down the thermos, put the bottle in a plastic bag, and line the thermos with a wet washcloth. This will ensure that your insulin remains effective and unbroken. Specially designed kits for carrying diabetic supplies and for protecting insulin are available and may simplify your life while traveling.
CHANGING TIME ZONES
The keys to avoiding significant hypo- or hyperglycemia during travel are frequent self-monitoring of blood glucose, and flexibility. There are several ways to calculate insulin requirements, and it is best that you discuss this with your doctor. People on oral hypoglycemics (pills) do not usually have to make any adjustments in their dosage, though they should be aware of all of the potential problems that can arise. Eastward travel results in a shorter day and hence lower insulin requirements. For westward travel with a longer day, your requirement will increase depending upon how many time zones you are crossing. Insulin dosages and schedules need to be individualized. Discuss your plans with your doctor or diabetes educator. With all of the newer insulins and monitors available, control of diabetes during travel should be much easier than it used to be. With a little bit of advice, lots of planning, frequent blood sugar testing and flexibility, the traveller with diabetes should be able to choose where, when and how to travel.