Whether you’re a seasoned traveler or a casual one, living with diabetes can create some quandaries before you hit the road. This doesn’t mean you should be discouraged from travel adventures. Your passport to success for traveling with diabetes is obtained by planning the trip, preparing for situations, packing wisely, and focusing on positive solutions when challenges arise.
Give yourself plenty of time to plan your trip. This will give you a better opportunity to get an adequate stock of your daily diabetes medications and other medications and testing supplies. In particular, check the refill timing on your prescriptions so that you don’t run out.
You’ll probably be eating at different times and taking part in different activities on your vacation, so keep a sharp eye on your blood glucose levels so you can feel your best and enjoy your trip. In fact, pack extra testing strips to monitor responses to new experiences and foods. Review your itinerary and adjust your meal schedule to avoid hypoglycemia (low blood sugar), or plan how to fit in some walking to help avoid hyperglycemia (high blood sugar). If you’re working with a travel agent, tell him or her that you have diabetes so you can develop a workable itinerary for your journey based on your usual routine. Ask about the meal service on planes; nowadays, meals are the exception, not the norm, so carry items with you.
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Type 1 diabetes requires insulin treatment for survival. Treatment may also include taking other drugs to prevent kidney damage or to treat diabetes-related conditions such as high blood pressure.
Furthermore, if you take insulin, talk to your doctor about developing a correction scale and having some fast-acting insulin with you in case you need it, such as Apidra, NovoLog, or Humalog. An insulin correction scale — or sliding scale, as it is sometimes called — is a written plan to help you address hypo- and hyperglycemic events as they occur, and it can be extremely valuable on the road, when you’re away from your usual health-care team. The correction scale, written by your physician or health-care provider, has various ranges of blood glucose values and the corresponding insulin doses you would need to take for each range of blood glucose. It’s tailor-made instruction from your provider on how to deal with excursions with your blood glucose levels while you’re traveling.
If you take any prescription medications, ask your pharmacist to print out two copies of your current medications. Put one copy in your suitcase and keep the other with you at all times.
The Internet is a great resource as you prepare for some of the decisions you will need to make. You can look up guidelines from the FAA, the airlines, and train and bus lines regarding baggage, carry-on rules, and ordering special meals or services. If you’re traveling by car, you can use online mapping sites to plot a route. You can also explore your restaurant choices, plan stops for bathroom breaks and stretching, and locate chain pharmacies or health-care facilities. (Click here for a list of websites that offer helpful travel tips for people with diabetes.)
An important part of preparation is learning the baggage rules you’ll encounter, including guidelines for transporting medications, devices, gel cooler packs, and food. For example, if you wear an insulin pump (or other diabetes-related device) and you’re at an airline security checkpoint, inform them of your device; they’ll probably have you step aside and simply use the scanner wand so that you can keep your insulin delivery uninterrupted. Check the manufacturer’s guidelines of your device for additional advice about going through security scanning, water-resistance parameters for those hours by the pool, and temperature limitations. Plan to take extra pump or insulin device supplies, write down help-line numbers, and take along user tip sheets.
If you take insulin with syringes, think about how you’ll carry and dispose of your syringes or pen needles en route. Padded insulin travel packs — which include handy straps for organizing your supplies, cool pack inserts, and pockets for alcohol pads and other items — are available. Portable sharps containers and needle clips also can be found online. Some airports, hotels, and public restrooms have sharp containers, but many do not.
When you’re traveling by car, fill a small plastic food container or Thermos with cotton balls to nestle your insulin vials in, secure the top, and then place it in a small cooler; do not freeze or place on ice. Follow the manufacturer’s guidelines to store insulin pens or vials and avoid spoilage or trips to a local ER for help. (Spoiled insulin often has visible clumps or crystals and should be discarded.)
Always carry your medical insurance card, pharmacy card, and physician/health-care provider phone numbers with you. Consider wearing a medical ID, since you could become separated from your purse or wallet.
Whether you’re looking at a two-hour trip or a 20-hour trip, always take extra water and fluids to stay hydrated, along with hypoglycemia treatment items, medications, blood glucose testing supplies and snacks for meals. Anyone can dehydrate during a long car ride on a hot summer day or walk on the beach, but your diabetes puts you at a higher risk. A good sturdy refillable water bottle can be an advantage when traveling and is more affordable and environmentally friendly than constantly buying bottled water.
While you’re traveling, you’re likely to be more active than usual — walking more, sightseeing, engaging in activities with friends and family — and the increased activity may alter your usual blood glucose levels even several hours later. When you can, schedule physical outings and activities after a meal; hopefully, this prevention strategy will allow a balance of “energy in” and “energy out” to avoid a hypoglycemic event.
Keep a hypoglycemia treatment item or two with you at all times, whether you’re just out for an early morning walk on the beach looking for seashells or wandering through a museum — gels, tablets and bottled “shots” are convenient choices. You might prefer the tablets, which have a long shelf life, if you’re traveling on airlines that don’t allow liquids or gels. Use a small travel purse, camera bag, beach bag or pack to carry the items. If your provider advises it, take along a glucagon emergency kit and know how to use it before you leave town. Access to help or normal supplies may be difficult in unfamiliar locations.
Packing medications requires special attention. Medications should always be packed in your carry-on bag — wherever you are, until you reach your room or the place you’re staying, you should be in possession of your medications. Always keep the medications in their original containers, and pack them in padded or sturdy cases to prevent them being crushed or damaged. If you’ll be changing time zones, talk to your provider or pharmacist about possible gaps or overlaps in your medication routine to avoid glucose problems. If you use insulin and are traveling abroad, be aware that outside the United States, insulin is sold in different concentrations, which could have significant consequences if your dose isn’t adjusted by a trained health-care provider, so carry extra. In addition, ask about safe over-the-counter meds for people with diabetes that you can take with you in case of minor health issues.
Medications and blood glucose testing devices and supplies are all sensitive to temperature extremes. If you’re traveling by car, these items should be carried in the main compartment of the vehicle, where there is temperature control. Most meter kits come with a handy carrying case to hold supplies; if you stop at a cute diner for lunch, take these items into the diner.
The temperature inside a vehicle can change dramatically, especially in summer and winter, and a big temperature swing can damage medications, devices and supplies. Put them in a cooler or insulated lunch bag in the vehicle to maintain a constant temperature.
The cooler is also convenient for carrying beverages and snacks. If appropriate, choose products that are packaged in single servings so you don’t have waste; if that’s not workable, use resealable plastic bags or food storage boxes to portion out snacks so that you don’t overeat (and to keep the crackers from becoming crumbs). Good travel snacks include small pieces of fresh fruits that don’t bruise easy (apples, oranges), dried fruit, whole grain crackers, unsalted roasted nuts, dry whole-grain cereal and granola bars. When you’re on the road, picking up an extra snack can be tempting, but if you usually don’t snack, try to stay consistent to avoid glucose swings. However, if you’re exerting yourself physically, on a varying meal schedule or in a flight/travel delay situation and skipping meals, eating a small snack every two hours may actually help keep your glucose more stable.
When you travel with medical devices, remember to pack extra batteries and recharging cords. You’ll also need to change the time on your devices to local time for accurate record-keeping — know how to do this before you leave. Finally, feel free to break the rule “travel light.” Pack more of all your diabetes supplies than you use normally so you can cruise through your trip with confidence.
(Click here for extra tips on camping trips, long drives, days at the beach and more.)
When you’re traveling, you’ll inevitably be faced with some challenges for your diabetes. Some of the most common situations involve food. If you think you’ve overeaten on a particular day, try to increase your activity and drink plenty of water to prevent hyperglycemia; if you think you didn’t eat enough, eat snacks to avoid hypoglycemia.
At restaurants, ask the server, chef or bartender to provide you with information about recipes — and don’t be afraid to ask them to “go off the menu.” Grilled, baked or broiled meats or fish might be a safe choice, combined with a side salad and a vegetable offering. If you have limited choices, split the meal with a travel companion, or if the restaurant is buffet style, go with small portions. If you’re concerned about a food’s impact, test your blood glucose two hours after consumption to investigate and resolve.
If you take insulin, follow your doctor’s plan for correction if needed to get back on target. In this situation, a correction scale can help you solve high blood glucose problems away from home — you’ll have instructions on how much to take, based on your blood glucose level, to help you get back to target. If you don’t take insulin and obtain a high blood glucose result after a meal, try to get some exercise, drink extra water and be conservative at the next meal to help balance the day out.
In addition, food choices at airports and transportation centers can be rather limited. A plain small hamburger or grilled chicken sandwich with a side salad with low-calorie dressing and a diet soft drink or water can at least give you a quick meal before you board another plane.
Finally, you may encounter situations that require quick decisions. Breaking an insulin vial, experiencing a pump malfunction, having a low blood sugar level, and facing meal plan dilemmas can happen with no warning when traveling. Don’t panic: By planning ahead, packing extra supplies, and having strategies in place, you can negotiate these minor setbacks so they don’t interfere with your travel plans and memories.
Diabetes should not cause a detour in your travel plans, so long as you give yourself adequate time to plan, prepare and pack for the trip. Your travel may require a little more planning — and a bit more room in your suitcase — but the journey will be worth it in the end. Enjoy your destination!
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