the guidebooks. You’ve written out an itinerary. Pretty soon you’ll be dipping
your toes in the ocean or sightseeing a far-off city.
you hightail it out of town, make sure you’ve considered your diabetes.
"The evidence … shows that about 10 percent of people with diabetes
experience problems with diabetes control when traveling," says David
Kerr, MD, FRCPE, a diabetes expert with the Bournemouth (England) Diabetes and
Endocrine Centre and developer of the diabetes travel website VoyageMD.com. A
little extra homework will keep diabetes from putting any kinks in your trip.
you’re hitting the road or flying halfway around the world, these tips can help
you have a healthy and hassle-free trip.
diabetes aren't alone in their desperation for a healthy midflight meal. The
fact is, the food available on long flights is notoriously unhealthy, and
sometimes it runs out. When booking your flight, many airlines will give you
the option of picking a meal suited to your health concerns, but if you don't
have that option, call the airline. Request a diabetes-friendly or vegetarian
meal. Many airlines will offer heart-healthy or low-sodium options, too.
thought of eating airline food turns your stomach, buy snacks in the airport.
Find nuts, seeds, fruit, yogurt, veggies and dip, sandwiches with lean meat,
and salads at various vendors. If you didn't bring glucose to treat lows, this
is also a good time to stock up on candy, soda, or juice.
through airport security will go smoother if you plan ahead: Ask your doctor to
write a letter alerting the Transportation Security Administration (TSA) to
your diabetes and your need to carry insulin, syringes, test strips, and other
supplies. Also carry with you pharmacy-labeled pill bottles and insulin vials.
You'll spend a lot less time explaining that the thingamabobs attached to your
abdomen are what we in the diabetes world like to call insulin pumps and
continuous glucose monitors.
zones is tricky for people with diabetes because it requires adjustments to
insulin injections and is highly individual. That's why you should mention your
trip to your doctor at least a month before you leave. Along with the rest of
your health care team, he or she can help you plan for the changes you'll need
to make to your insulin regimen.
For a general
idea of how traveling may affect your insulin needs, go to VoyageMD.com, which
has a flight calculator, developed by Kerr, that can help you determine what
changes to make to your insulin regimen. Still, it's important to discuss the
suggestions with your doctor.
You and your
health care provider can also discuss other travel-related changes you may need
to make to your insulin plan. You might need to dose more or less insulin
depending on your itinerary: "If [you're] walking all the time, you may
need to adjust insulin," says Kruger.
As heavy as
the bag on your back might be, avoid the temptation to store all of your
diabetes supplies in your checked luggage. The cargo hold can get pretty chilly
at 30,000 feet (not such a pleasant atmosphere for insulin). An even bigger
worry is lost luggage. The safest way to ensure your supplies make it to your
destination is to keep them on you while flying. If you plan to stuff your
carry-on in the bin above your seat, keep a smaller bag beneath the seat in
front of you so you have easy access to your meter, test strips, syringes and
insulin, snacks, and fast-acting glucose. After all, meals may be delayed
because of turbulence. To deal with eating uncertainties, consider dosing
rapid-acting insulin after your meal arrives.
traveling alone, it's important that someone on the flight know about your
diabetes in case of an emergency. Alert a flight attendant when you board. You
don't have to go into details, but let him or her know that you may need soda
or juice if you become hypoglycemic.
You may want
to consider briefly disconnecting from your pump during takeoff and landing.
"Some studies have shown that the change in pressure on a flight can make
the pump deliver more insulin," says Sheth. Once the plane has reached its
cruising altitude, it's safe to reconnect. Before reconnecting your pump after
takeoff and landing, check for air bubbles caused by altitude changes. Reprime
the pump if necessary. Bubbles can cause you to get less of the medication than
regulations require U.S. airlines to have a medical kit on board, and the law
specifies which necessities must be included. But that's not the case for
international travel. "I've seen medical kits that you could run an entire
ER with, and I've seen some medical kits with hardly anything in them,"
says Mark Gendreau, MD, assistant professor of emergency medicine at Tufts
University School of Medicine and an expert in travel health. Regulations
abroad often aren't as stringent as those in the United States, and certain
budget airlines may not even have a medical kit. Call the airline ahead of time
and find out what you can expect on your flight.
in the middle of the ocean might not sound like the ideal vacation for many
people with medical conditions, but today's cruise ships are essentially
floating metropolises. The following steps will help you stay healthy and safe
Anyone who's ever
faced a cruise ship buffet knows how easy it is to go overboard—nutritionally
speaking, that is. Just as with any other buffet, moderation is the name of the
game. Forget about seconds and stick with one plate of healthy food, such as
fresh fruit and vegetables, low-fat dairy, whole grains, lean protein, nuts,
and beans. If you're going to indulge—and, let's be honest, once you see that
dessert spread, you'll have a hard time resisting—mind your portions.
When you book
your trip, talk to the cruise line about its medical offerings, says Kruger.
There are no regulations regarding cruise ship medical facilities, but industry
guidelines say ships should be able to provide care to passengers.
important to determine how the cruise line will handle emergencies. Is the
medical facility equipped to give you an IV if you develop diabetic
ketoacidosis? (It's a condition in which an insulin-deprived body breaks down
fat instead of glucose, leading to a toxic buildup of ketones in the blood that
can be fatal.) If an emergency occurs, can you be airlifted off the ship or
will you have to wait until you reach the next port?
Be aware of
easily at sea (and in port), but you will need to pace yourself. Too much
high-carb alcohol, such as beer or sugary cocktails, can make your blood
glucose spike. If you're trying to lose weight, opt for water or diet soda
instead. Alcoholic drinks are loaded with calories, so if you must imbibe, pick
wine or light beer—and avoid anything garnished with a paper umbrella.
The flip side
to the alcohol problem is that it can also lower your blood glucose. That
effect can last up to 24 hours. Scarier still: "Even a small amount of
alcohol can blunt the warning symptoms of hypoglycemia," says Kerr. If
you're going to drink, don't do it on an empty stomach, and test your blood
beach life may zap your work-related stress, but it takes some planning to be
on your way to a carefree day.
Keep meds and
If it's warm
enough for you to sit out in a swimsuit, it's probably too hot for your
insulin, which should be kept at room temperature. Bring along cool packs for
storing your insulin. Cool, not frozen—freezing kills insulin. Keep your diabetes
devices out of the sun in a cool place, too. "Even blood glucose meters
don't like extreme temperatures," says Kruger.
injections instead of a pump.
are waterproof enough to swim with, though check your user's manual before you
jump in. Certain pumps require you to disconnect before going in the water
(it's usually OK to suspend your pump for an hour). But even if your pump can
handle being dunked, do you want to risk it? If your day consists of lying out
on the sand, the sun can heat the insulin in your tubing, Kruger says.
Injections, on the other hand, will use insulin that's been kept cool.
Debris on the
beach—sharp shells, bottle caps, and other trash—can cut the skin on your foot.
If you can't feel the cut because of neuropathy, you may not notice a problem
until it's too late and infection has set in. Always wear sandals or water
shoes when walking the beach or stepping on the bottom of a lake or ocean. Do
foot checks when you return from the beach.
The Big City
pharmacies, hospitals, health clinics, and grocery stores all within walking
distance, major metropolitan areas ease some of the stress that comes with
traveling with diabetes. Still, taking a few precautions before you set off to
sightsee can mean the difference between spending your day touring the
Smithsonian or the inside of an emergency room.
you'll easily be able to find the diabetes supplies you need—even if you're
visiting a city such as New York or Chicago. Carry everything you need
(insulin, a blood glucose meter, test strips, syringes, backup infusion sets,
and glucose tablets or gels) in a bag you'll have on you at all times. If your
blood glucose dips after a long walk on Fifth Avenue, you'll want to treat
immediately with a glucose source you're carrying.
Into the Wild
diabetes go on wilderness trips all the time. (Some have gone so far as to
climb Mount Everest, weather Antarctic terrain, and cross the Sahara Desert.)
The following tips will get you going.
insulin cool when you're miles from the nearest refrigerator or ice machine
isn't as impossible as it may sound. Instead of packing a cooler with
traditional ice packs, which need to be refrozen when they get warm, pick a
cool pack, such as those made by Frio, that doesn't require freezing or
refrigeration. Just run it under cold water for five to 10 minutes, and
crystals in the pouch will keep insulin cool for hours.
If you spend
any time away from running water, you may run into a problem: You need to test
your blood glucose, but you have no way to clean your hands. Prevent this
scenario by bringing small packets of alcohol wipes or wet wipes with you when
camping, hiking, or otherwise spending time in an isolated area. Use them to
clean dirt and food residue (such as leftover fruit juice, which can give you a
falsely high reading) off your finger before pricking. If you forgot to bring
wipes, use this diabetes educator–approved trick: Lance your finger, squeeze a
drop of blood, then wipe it away. Do this again once or twice more before
taking a reading to ensure you're using blood untainted by whatever dirt was on
vacations require more preparation than U.S. trips. There are passports to
procure, language barriers to consider, and currency to exchange. With
diabetes, vacation planning involves a bit more homework.
you're headed across the globe or making a cross-border day trip, always pack
more supplies than you think you'll need. It's even more crucial if you're
headed to a country where you don't speak the language and where you may have a
hard time finding medications and supplies.
travel, you can never be too prepared. Start the minute you book your trip: Go
to cdc.gov/travel for a list of destinations with information on safety
concerns, medications you might need, tips for staying healthy in the country,
whether tap water is safe to drink, and recommended vaccinations. For trips to
less-developed countries, start with your primary care physician. Gendreau also
suggests visiting a travel clinic, which can be found in many hospitals, to get
all vaccinations, medications, and tips for minimizing health risks.
You may also
want to study up on the local cuisine and get a feel for the types of food you
may encounter on foreign menus. Sheth suggests eating at restaurants rather
than street vendors because there's a greater chance someone will speak English
and can answer any questions you may have. Sanitation and food hygiene may be
better in restaurants, too.
About six to
eight weeks before your trip, visit your endocrinologist and ask for
prescription refills, a doctor's note that may ease your route through airport
security, and any advice on adjusting your medication while traveling across
time zones. It's also a good idea to ask your doctor for the chemical name of
each medication you take because many countries will carry foreign versions of
the brand names you're used to. Keep in mind that your body may react unusually
to the same medication obtained at a pharmacy in another country because the
drug may have been mixed differently or might use varying additives, says
have to be fluent in a country's native tongue in order to safely travel there,
but you should prepare a few key phrases ahead of time, such as "I have
diabetes" and "Where is the hospital?" Write them down on your
phone or on note cards that you can keep on you at all times. That way, you can
flash the phrase at a person in an emergency.
Talk to your
unlikely to be the poor traveler who's sick enough to require thousands of
dollars' worth of medical treatments, but if it happens to you, you'll want to
be covered. Start by calling your insurance company and asking what medical
expenses it will pay for, what you need permission for, and what you'll have to
cover on your own. "A lot of insurance companies won't do full
evacuations," says Gendreau. Instead, they may cover only a fraction of
the total cost.
reason many people buy travel insurance is to cover the steep cost of medical
evacuations, which can run higher than $100,000. Gendreau recommends
WorldClinic (worldclinic.com) because it offers travel insurance with perks:
The company can send a Learjet and medical team to evacuate you and can airlift
you to an American hospital instead of what many medevac companies consider the
"most reasonable medical facility."
hospitals and pharmacies.
around for local medical care options is a smart idea. Find out what pharmacies
and hospitals are closest to your hotel before you leave for your trip. If you
skip this step and are in a bind, ask the hotel for recommendations. Staff
there may even be able to help you track down a doctor if needed.
Get to know
traveling abroad, it's important to know where to turn during a medical
emergency. "Become familiar with the [U.S.] embassy in the country that
you're traveling to, and make sure it has a health branch," says Gendreau.
The embassy will have a list of physicians whose credentials have been
evaluated and approved and who speak English. Embassy staff can also help you
with medical evacuations if needed.