Diabetes & Travel
People with both Type 1 and Type 2 diabetes holiday all over the world, their condition certainly being no barrier. If you plan ahead and seek advice wherever necessary, you should be able to minimise any potential problems and have an enjoyable and safe trip. How you prepare for a trip will depend where you are going and what you are doing, i.e. if you are going on an active adventure you need to work out what influence extra exercise will have on your blood sugar levels.
Your diet while away from home
If you generally follow a healthy, balanced diet there is no harm in experimenting with different foods whilst on holiday by making some higher fat/sugar choices from the local menu. You should let your holiday destination know in advance if there are certain foods you want. If you are traveling alone, you may like to let staff know in case you are taken unwell during your stay.
Your diet while away from home
- Get the necessary vaccinations.
- Allow two weeks to buy your travel insurance. Don’t just buy according to price; check the cover for emergency transport home and recovery of charges for replacement of insulin/equipment. Also read the small print. Be honest and declare all medical conditions. It is recommended that all members of your holiday party travel under the same policy.
- Plan to take twice the quantity of medical supplies (insulin, syringes or pens, needles or tablets, BGM supplies and a spare battery for your meter) you would normally use for your diabetes. If travelling with someone else, split the amount between each passenger’s hand luggage in case one of the bags is lost.
- Ensure you have the new European Health Insurance Card (EHIC) if you are travelling to a European Union member country for easy healthcare access in that country.
- A basic first aid box.
- A list of all current medication.
Air travel and insulin
Diabetics can still take insulin with them onto an aircraft despite new security restrictions. If you are traveling you should bring a letter from your doctor explaining your need to carry syringes/injection devices and insulin for presentation to airline staff. If you encounter any problems, ask to speak to a more senior member of staff. Some GPs charge you for writing such a letter. Therefore if you travel frequently, it would be a good idea to ask your doctor to phrase the letter so that it can be used again.
Additionally a Diabetes UK Insulin user’s identity card (available from www.diabetes.org.uk) or engraved jewellery may help you verify your need to carry syringes and medication.
Airlines do bring in restrictions in emergency situations about what items can be brought onto their aircraft in hand luggage. Insulin manufacturers have always advised to avoid storing insulin in baggage which goes into the hold as travelling at altitude may freeze the baggage and damage insulin. Insulin that has to go in the hold should be placed in an airtight container (such as a flask) in the middle of your suitcase, or wrapped in bubble wrap, then in a towel and again place in the middle of your suitcase. On arrival to your destination you must examine your insulin for crystals and discard if any are found. Even if the insulin looks okay, you should test your blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged and ineffective.
Once on board some airlines, cabin crew may request that your medication be handed over for storage during the flight. For this reason you should put the insulin and syringes/needles in a separate carrier bag/hand luggage.
- If travelling for many hours, specific advice regarding adjustments to insulin regimes/medicine timings across the different timezones can be obtained from your diabetes care specialist. Be prepared for transport delays.
- Travel to areas of high altitude can cause insulin to expand and contract, resulting in air pockets within the cartridge or pen. You may need to do a few “air shots” to make sure that there are no air bubbles present when you inject, or alternatively use a syringe and needle.
People with diabetes need to eat regularly to help control their blood glucose levels. Special ‘diabetic’ meals are not necessary on board planes as they are often low in carbohydrate. Thus it is recommended that diabetics select meals from the standard airline menu items and that:
- Bread or fruit or biscuits are available between meals on flights over three hours (you should carry extra carbohydrate in the form of sandwiches, fruit, cereal bars etc in your hand luggage if required, especially for long haul flights).
- Low-calorie/diet beverages are freely available.
Using insulin abroad
- Insulins used in the UK and many other countries are of strength U-100. In some countries insulin may come as U-40 or U-80 strengths; these insulins are not interchangeable and appropriate syringes are required.
- Insulin may be absorbed faster in warmer climates. Regular glucose monitoring is important to allow for safe adjustments in dose. High altitude and humidity can sometimes affect meters and test strips – you should be aware of false readings.
Keeping insulin cool
Firstly check if you are going to a very hot country or on a long, hot car journey as you will need to keep your insulin cool and protected. Insulin can withstand short trips when not refrigerated but it’s the exposure to direct sunlight and extremes of heat that can deactivate it. Below is a list of bags, wallets, fridges and travel friendly accessories that will allow you to keep your insulin cool on the move:
- Medicool: PenPlus range
- Frio Wallets and Carry Cases
- Chillerz Packs, Polar Gear and Generic Cool Packs.
Foot care whilst travelling
- Travel with comfortable, well-fitting shoes in case your feet swell.
- Do not walk barefoot, particularly on hot sand.
- Keep checking your feet every evening and morning. If you develop a blister stay out of the sea, cover it with a plaster and keep it clean.
If you are planning to drive while on holiday, ensure your licence is valid for the duration of the trip and that you are covered by your insurance policy for driving, especially when abroad.
UK Standards for drivers with diabetes – updated 20th September 2011 – https://www.gov.uk/diabetes-driving
Dealing with illness while abroad
- If you suffer from sickness or diarrhoea, insulin or tablets should never be stopped – even if solid foods cannot be tolerated.
- Carbohydrate intake should be maintained in the form of regular sugary drinks.
- Monitor your blood glucose levels frequently.
- Urine should be tested for ketonuria as an early sign of decompensation.
- If sickness or diarrhoea persists, seek medical advice.