Diabetes

• Preparation
• Travelling
• Maintaining Health and Glucose Control
• Temperature and Altitude
• Useful Contacts
• Additional information on Diabetes Monitoring

Approximately 3.5 million people in the UK have been diagnosed as diabetic, around 10% of whom have Type 1 diabetes. There is no conclusive proof that those travelling with diabetes are more likely to become unwell during travel than those without diabetes. However, a change in diet, activity levels and environment (temperature, altitude) during travel can all affect blood glucose levels and represent a challenge to maintaining good health.

Many people with diabetes need to travel with medication and/or medical devices and be able to access medical attention if needed. Careful pre-travel education and preparation should allow travellers with diabetes to enjoy a rewarding and pleasurable trip.

Preparing for Travel

Ideally you should start planning your trip well in advance of your departure date( a minimum of 8 weeks). Dedicated diabetes websites (see Useful Contacts) offer excellent advice including Travel Check Lists and Travel Guides  As well as receiving information on vaccination and prevention of travel-related illness you also need to consider:

• travelling with a chronic medical condition
• maintaining health and glucose control during travel
• the effects of temperature and altitude

Travelling with a Chronic Medical Condition

Before travelling overseas you should ensure that your health is optimized and can be maintained throughout your trip. You should consider:

Pretravel Medical Check-up

You should attend your diabetic specialist or GP for a pre travel check up and discuss your travel plans. This pre-travel appojntment will include assessment of:

• Glucose control
  • you must continue to take your medication regularly while you are travelling
  • if you are crossing time zones, alteration of the timing of medication willbe discussed
  • blood glucose levels can be disrupted during travel – altering the doses of medication in response to this will be discussed
  • sick day rules – ensure you are aware of how to maintain glucose levels when ill, how to check urine for ketones and when you need to seek medical attention
  • management of hypoglycaemia/low blood glucose levels
• Diabetic complications
  • need to be recognized and managed before travel

Medical Letter

If you are travelling with medication or medical devices you should obtain a letter from your GP or diabetic specialist in order to transit through security/customs. This letter can also help if you need to replace lost/damaged/stolen medication or seek medical attention abroad. This letter should detail:

• all prescribed medication
• all necessary monitoring and dispensing equipment
• the necessity of carrying medication, insulin, needles, syringes etc in hand luggage
• diabetic team contact details in case information or advice is needed during long trips

There may be a charge for this service, an undated letter is helpful as it can then be used for future travel.

Medication/Monitoring Equipment

You should request all medication and glucose monitoring equipment from your GP well in advance of the trip.

Further information on travelling with insulin is available on Diabetes Monitoring:

• twice as much medication required for the trip should be taken to cover unexpected delays, damages or losses
• spare monitoring equipment with supplies and batteries should be carried in hand luggage
• medication should be kept in its original packaging and carried in hand luggage to avoid loss or damage in the hold
• be aware that many medications (including insulin) may be available under different trade names in other countries. Knowing the generic name of your medicine as well as its brand name can help if you need to replace it during travel
  • pharmaceutical companies can be contacted pre-travel to ensure they supply the relevant medication/equipment in the destination country, in case of loss or damage
• blood glucose may be measured in different units in other countries. A conversion chart is available on Diabetes UK
• many medications, including insulin, must be stored within a particular temperature range, this will be detailed in the product information leaflet; a cool bag may be necessary; see Diabetes Monitoring

Maintaining Health and Glucose Control

During Transit

Unexpected travel delays and cancellations can occur. You should plan for any eventuality by considering:

• carrying extra food and snacks, including fast acting carbohydrates, to ensure adequate intake or to supplement airline food
  • some countries may not allow certain fresh foods through customs and cereal bars, crisps and biscuits may be more appropriate to carry in hand luggage
  • Blood glucose should be monitored more frequently during travel due to the change in meal times and activity levels, especially on long haul flights:

• you may have to give medication/monitoring devices to flight attendants for storage
• check with airlines pre-travel for the timing of meals so that insulin doses can be planned
• avoid alcohol on flights to reduce the risk of hypoglycaemia
• inform travelling companions or flight attendants of your diabetes in case of ill health during travel

Travel sickness

• If you are prone to motion sickness, using anti-sickness tablets in advance of travel or wearing pressure point wrist bands may help. Persistent vomiting can lead to hypoglycaemia.

During Travel

A number of factors may upset blood glucose control during travel, including missing your medication, change in diet, altered sleep patterns, illness, change in exercise habits and climatic factors such as temperature and altitude.

If travelling alone, you should consider alerting staff at accommodation of their diabetes in case of ill health.

Food and Drink

Whilst travelling, healthy eating and drinking should be maintained. Your usual dietary foods may not be available at your destination. Travel guides and online resources will provide information on the types of food and drinks available, particularly which forms of starchy carbohydrate are commonly eaten.

• Alcohol and recreational drug use can quickly upset diabetic control, and you should exercise caution with these.

Activities

Some people are more active on holiday, others less so. You should monitor your blood glucose levels and know how to adjust your diet/insulin in response to this. These dose adjustments should have been discussed at your pre-travel diabetic check-up.

• Dose Adjustment For Normal Eating (DAFNE) are educational courses aiming to teach Type 1 diabetics how to successfully manage their diet and insulin requirements.

Illness

Those with diabetes are generally not more prone to travel related illness than non diabetics, but the consequences can be more serious due to the upset in blood glucose control, for example, vomiting can lead to low blood glucose due to reduced calorie intake and fever can lead to high blood glucose levels:

• to reduce the chances of food and water-borne illness you should practice Food and Water Hygiene
• you should be aware of and can follow the sick day rules. Advice on this should be sought at the pre-travel diabetic check up
• if medical attention is required, or medication must be replaced, the medical letter received pre-travel can facilitate this

Effects of Temperature and Altitude

Climate

Environmental temperatures can affect glycaemic control and blood glucose monitoring.

Hot Climate

• Prolonged sun exposure may raise blood glucose.
• Dehydration is a risk in very hot weather and this is worsened if your blood glucose is also high.
• If you have peripheral neuropathy, be cautious in strong sunlight as you maybe unaware of sunburn.
• Raised temperatures can affect insulin storage, absorption and glucose monitoring.

Cold Climate

• Low blood glucose levels are more common in cold weather as the body uses more energy to maintain its temperature.
• Low blood glucose levels are more dangerous in cold climates due to the risk of hypothermia.
• If you have peripheral neuropathy, frostbite can be a risk.
• Lower temperatures can affect insulin storage, absorption and glucose monitoring.

Altitude

Diabetes is not a barrier to high altitude travel. Careful planning pre-trip is necessary, and the following must be considered:

• altitude can affect insulin storage, absorption and glucose monitoring
• the reduced air pressure at altitude leads to various hormone responses that help you adapt to this
  • these adaptations can alter the usual rises in blood glucose levels after meals. You should increase blood glucose monitoring and adjust insulin doses as required
  • these dose adjustments should have been discussed at your pre-travel diabetic check-up
• low blood glucose is a risk at altitude due to the reduced appetite associated with acute mountain sickness and the physical exertion involved in walking/trekking
• fast acting carbohydrates and glucagon kits should be carried
• the symptoms of low blood glucose and acute mountain sickness can be similar
• diabetic complications, i.e. retinopathy, nephropathy should be assessed pre-travel as each may be worsened by, or affect the body’s acclimatization to altitude

Further information on high altitude travel and diabetes is available from medex.org.uk

Diabetic Identification

Consider:

• carrying or wearing some form of alert that they are diabetic, particularly if hypoglycaemic attacks are a concern and they are travelling alone
• Diabetes UK provides links to sites producing these alerts
• informing/educating travelling companions and/or group leaders that you are diabetic and what they should do if you become hypoglycaemic, particularly if you are undertaking sporting activities or adventure travel

Travel Health Insurance

• Diabetes is considered a pre-existing medical condition and must be declared to the insurer before travel.
• Many regular insurance companies do not charge extra for insuring people with diabetes if they have no complications.
• Some insurance companies will not replace lost, stolen or damaged insulin or other supplies.

Accessing Healthcare Abroad

It is wise to establish the location of local health facilities prior to travel – this information can be found in travel guides and online resources.

• Purchasing comprehensive travel insurance is strongly recommended to pay for medical expenses or repatriation costs.
• Check the FCDO website to see if there is any reciprocal health arrangements between the UK and the country you are visiting to cover the costs of emergency medical treatment whilst you are abroad.

Useful Contacts

Diabetes UK

Diabetes.co.uk

Both websites provide extremely useful information, including travel guides and links to additional sources of information for diabetics travelling overseas.

Dose Adjustment For Normal Eating (DAFNE) are educational courses aiming to teach Type 1 diabetics how to successfully manage their diet and insulin requirements.

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