Diabetes
and Travel
Before a long trip, have a medical exam to make
sure your diabetes is in good control. Schedule
the exam with enough time to work on your control
before you depart. Get immunization shots -- if
you need them -- at least one month before you
leave. If the shots make you sick, you'll have
time to recover before your trip.
Before
any trip, get two papers from your doctor: a letter
and a prescription. The letter should explain
what you need to do for your diabetes, such as
take diabetes pills or insulin shots. It should
list insulin, syringes, and any other medications
or devices you use. The letter should also list
any allergies you have or any foods or medications
to which you are sensitive.
The
prescription should be for insulin or diabetes
pills. You should have more than enough insulin
and syringes or pills to last through the trip.
But the prescription may help in case of emergency.
In the United States, prescription rules may vary
from state to state.
The
prescription laws may be very different in other
countries. If you're going out of the country,
write for a list of International Diabetes Federation
groups
Using Insulin Abroad
· Patients should find out what types and
strengths of insulin are available in the area
in which they will be travelling, refer to the
relevant pharmaceutical company.
· Insulins used in the UK and many other
countries are of the strength U-100. In some countries
insulin may come as U-40 or U-80 strengths. These
insulins are not interchangeable. Should they
need to be used, the appropriate syringes are
required.
· Insulin should be kept out of direct
sunlight and kept cool.
· Insulin should never be allowed to freeze,
therefore when travelling by air, insulin should
always be carried in the hand luggage.
· Insulin may be absorbed faster in warmer
climates. Regular glucose monitoring is important,
to allow any adjustments in dose to be made safely.
Equipment:
What You Need To Take
· Take twice as much insulin, syringes
or pens, needles or tablets as will be needed.
· If travelling with someone else, split
the amount between each passenger's hand luggage
just in case one of the bags is lost.
· A cool bag for storing insulin.
· Blood glucose monitoring equipment -
along with adequate supplies of strips, lancets
and a spare battery for the meter.
· High altitude, heat and humidity can
sometimes affect meters and test strips. Patients
should be advised to beware of false readings.
· Dextrose tablets, Hypostop, Glucagen
injection and Ketostix if apt.
· A diabetes identity card or jewellery.
· Carbohydrate, in the hand luggage to
cover any travelling delays.
· Do not advise patients to order a special
"Diabetic" meal on the plane, as these
often contain very little carbohydrate. Instead,
patients should be advised to carry extra carbohydrate
in the form of sandwiches, fruit, cereal bars
etc.
· A letter, from either a GP or Hospital
Diabetes Team, with a contact telephone number
and address confirming the need to carry needles
and syringes. A basic first aid box.
· A list of all current medication - e.g.
a copy of up to date repeat prescription request.
Vaccinations
Patients should be advised to find out what vaccinations
are required for the proposed destination. Occasionally
these can cause sickness or flu-like symptoms
and it is best to have them performed 4-6 weeks
prior to travelling.
Coping with holiday illness
· If sickness or diarrhoea develops 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 blood glucose levels frequently.
· Urine should be tested for ketonuria
as an early sign of decompensation.
· If sickness or diarrhoea persists medical
advice should be sought.
Insurance
· Travel insurance is vital. Patients should
inform the insurance company that they have diabetes
and ensure that the insurance package provides
adequate cover. This should include cover for
emergency transport home and recovery of charges
for replacement of insulin or equipment
· Free or reduced cost emergency treatment
is available in countries in the European Union
. Form EIII is available at the Post Office.
Long Haul
· If crossing time zones or travelling
for many hours, specific advice regarding adjustments
to insulin regimes can be obtained from the hospital
team. Diabetes Specialist Nurses
· Patients should bring along a flight
schedule and information on time zone changes
to help plan the timing of injections.
· Travel to areas of high altitude can
cause insulin to expand and contract, resulting
in air pockets within the cartridge or pen. Patients
may need to do a few "air shots" to
make sure that there are no air bubbles present
when they inject. Alternatively, the patient could
revert to using a syringe and needle (it is possible
to draw insulin out of a cartridge by this method).
· Give advice on avoidance of DVT as for
any other patient group
