HELP ON DIABETES

Managing Your Diabetes While Traveling

With proper planning, there is no problem traveling with diabetes. The things you need to think about and plan for include the following:

• Managing diabetes supplies

• Diabetes management during your fl ight

• Adjusting insulin for time changes

• Managing diabetes complications

• Avoiding and/or treating traveler’s illnesses, especially gastroenteritis

Managing Diabetes Supplies

Take adequate supplies for your diabetes management when you travel. In fact, take twice the amount of diabetes medication and supplies that you will normally need.  

If you are on an insulin pump, take some basal insulin such as insulin glargine and syringes in case you have a pump failure. Keep the insulin cool by packing it in an insulated bag with refrigerated gel packs, or use Frio packs.

Also take glucose tablets, gels, and snacks for treatment of hypoglycemia and a glucagon kit and ketone testing strips. Ideally, take two glucose meters and pack them in separate bags. Keep most of your supplies in your carry-on luggage, but keep some supplies in your checked luggage, just in case you lose your carry-on luggage.

Some health insurance companies will only fill your prescriptions with one month’s supply of medicines at a time, but if you call ahead, they will usually autho­rize an additional supply with a “vacation override.”

You should also carry a travel letter from your doctor explaining that you have type 1 or 2 diabetes and the medications you are using to treat it. This note should also include the medicines you are taking for other conditions as well as any food and drug allergies you have. Also obtain a spare prescription for all your medica­tions in case you lose your supplies or your stay is prolonged. Wear your MedicAlert bracelet at all times, and carry a card or letter explaining that you have diabetes written in the languages of the places you are visiting. Keep a list of emergency phone numbers: your doctor’s office, your pharmacy, your insulin pump company, and (if you’re traveling abroad) the American embassy or consulate and a list of English-speaking doctors in the country you are visiting. The International Diabe­tes Federation website (see Resources) has contact information for diabetes organi­zations in many countries.

If you are traveling by airplane and are concerned about new (and ever-changing) regulations concerning fl uids in your carry-on bag, call the airline well in advance of your fl ight.

Diabetes Management on the Airplane

 If food will not be served on your flight, take food and fast-acting carbohydrate with you. If it is a long flight with a meal (and keep in mind that in-flight meals are rare these days), it is not necessary to order a special meal on the plane, but it is a good idea to have some food with you (two to three snacks) in case the meal is delayed. Inject your insulin dose after your meal arrives. Since the pressure in an airplane is different than the pressure on the ground, do not inject air into the vial before draw­ing up your insulin into the syringe. Check your blood glucose frequently during the flight. You may need a little more insulin because you are inactive. If you are travel­ing alone and are concerned that you might experience hypoglycemia, tell the fl ight attendants that you have diabetes so they can keep an eye on you.

Drink plenty of fluids during the flight. Wear loose-fitting shoes because your feet might swell, and walk around the airplane when possible and do some leg-stretching exercises to avoid blood clots.

Adjusting Your Insulin for Time Changes

The body’s sensitivity to insulin varies throughout the day and night. You are most insulin sensitive early in the night and most resistant early in the morning. These changes in insulin sensitivity are due to the daily fluctuations in the levels of hor­mones, particularly cortisol. The internal body clock that regulates these hormones gets cues from environmental light and temperature. When you go to a different time zone, the body clock and the hormones reset to the new light-dark cycle. This resetting process takes time and explains why you feel “jet-lagged.” The challenge for people who are on insulin is to figure out how to adjust basal insulin levels while the body is getting used to being in the new time zone. The solution is to make sure that you have a safe basal rate and to use bolus insulin doses to cover any high blood glucose levels:

• If the time zone adjustment is only one to three hours, ignore it and just give the basal insulin at your usual time in the new time zone. For example, if you give your insulin glargine at 10 P . M ., then do so at 10 P . M . in the new
  time zone. 
• If you travel east (shorter day) and the time zone change is long, give bolus insulin every four hours and delay giving the basal insulin until at least twenty-four hours have passed since the last basal insulin injection. 
• If you are traveling west (longer day), inject bolus insulin every four hours until you inject your basal insulin at your usual time in the new time zone. 
• If you are on a pump, you can change the pump clock to the new time. If the time zone change is long, you may go on the lowest basal rate until the jet lag has resolved and then you can set up new basal doses. 

Since activity and diet may be different when you are traveling, you may have to adjust your basal insulin even if the time difference is negligible.

If you have other diseases associated with diabetes, keep the following in mind as you travel:

• Protect your feet if you have peripheral neuropathy and loss of protective threshold. Take walking shoes that you know will work for you rather than buying new shoes for the trip. Limit the amount of walking you do if you have significant foot deformities. 
• If you have autonomic neuropathy, make sure that you drink plenty of fluids to avoid getting light-headed. 
• If you have heart disease, be careful not to overexert yourself. 
• Continue taking all your medications as prescribed. 
• Avoid too much sun exposure, especially if you are taking oral medications for your diabetes. 

Preventing Illness While Traveling
Get the appropriate immunizations and take the usual precautions to avoid getting ill (see Resources). Take antinausea (prochlorperazine) and antidiarrheal (loper­amide) medications and a supply of antibiotics with you. If you do get sick, the sick day rules apply (see Chapter 12).