Blogger Round Table Session 3: Travel with Type 1 Diabetes

Moderated by Allison Blass

Traveling with diabetes can be very tricky when trying to balance blood sugars when changing time zones or getting medical supplies through the heightened security of our airports. Although it can sometimes seem like you’re packing to move rather than go on a simple one-week vacation, it’s important to bring enough supplies to stay safe. In anticipation of the summer season, our blogger round table discusses their methods and secrets for a successful — and fun — vacation.

How do you prepare to go on vacation?

Amy: Pack, pack, pack. I usually spend a separate day just on packing for diabetes–at least two of everything. I also make a detailed list of my current medications with dosing specifics to take along, in case I need to go to an unfamiliar pharmacy.

Sandra: First, we meet with Joseph’s endocrinologist to discuss strategies for diabetes management while we’re away–and to make sure we have current prescriptions–including one for Lantus in case of a pump failure. Next we put together a list of those supplies we’ll need for each day of the trip–padding it with an extra bottle of short- and long-acting insulin, extra infusion sets, test strips, meter, syringes, etc.

Scott S: It’s a good idea to have your doctor write prescriptions for insulin, testing supplies, and any other medicines you get from the pharmacy to take with you, even if you don’t need them (they also come in handy in security on occasion); that way if something happens, you can always get a new supply.

What kind of experience do you usually have with airport security? Have you ever had an issue with your medical supplies?

Scott J: I am always paranoid that my pump will set off the walk-through scanner. Seems that nine times out of 10 it doesn’t. If it does, all of the TSA personnel I have encountered are knowledgeable about insulin pumps.

Kerri: My biggest hurdle has been bringing juice through security, but I’ve found that ditching the liquids and opting for glucose tabs solves that problem without issue. It also helps to have a letter from my endocrinologist, on her office letterhead, explaining my medical devices, should a question arise.

Gina: I actually had a run-in with a TSA official because I had juice in my bag and it clearly stated on the airline’s Web site that if you have diabetes, you can bring juice if it is over 3 fl. oz. She got really snippy with me and went through my whole bag and took everything out. I repeatedly had to tell her I had diabetes and I had a note. She totally ignored me. She said that I am not supposed to have liquids over 3 fl. oz. I gave up and she let it all go through anyway so I really don’t see why she had to make such a big deal if she was going to let me go through. My whole carry on was medical supplies for diabetes. I am glad they actually looked through my bag for the whole security thing though.

Allie: I believe Medtronic did a decent job of keeping the metal to a minimum when designing the pump. When I wore mine I never had any trouble in the security checkpoints at airports. Plus, they were mostly accommodative. I’m sure the fear in my eyes (yes, irrational fear of flying) said give this girl a break. Thank goodness for those with a knack for reading body language.

Scott S: Just be sure to follow the FAA’s rules and that all your supplies have the pharmacy label attached. Never pack your supplies in your checked baggage, always take them in your carry-on, especially insulin, or you risk freezing or boiling it in the cargo area of the plane, which will destroy it. I have also found it helpful to place my supplies in large zip-lock bags, making it easier for the FAA security people to sort through your supplies. Several have thanked me for making that so much easier and faster for them. Also, give yourself at least an hour more time than you think you’ll need; you never know how long it will take to get through security, and it’s better to kill time reading a magazine at the gate than worrying about missing your flight.

If you’ve been on a long-term (2 weeks or longer) trip, how do you manage all the supplies you need?

Amy: We travel to Europe for a whole month every summer. I usually make my husband carry some of my backup supplies, because apparently he doesn’t need as many shoes and outfits as I do. It’s a pain lugging all that stuff along, but I’ve learned that you really never know when you might need it. Better safe than sorry.

Manny: Instead of doubling up on things, I take four or five of everything. Once, when we flew into Spain, I got my meter stolen on the plane. I know, why on earth would someone care about a meter? When I landed and was about to go through customs, I realized my meter was no longer with me. I had been foolish enough to only pack a single meter, so I ended up having to buy a new one there, where insurance was not accepted, and paid something like $150 for the meter and the strips while I was there.

Sandra: For long road trips, we always keep supplies in two different bags–in case one were to get lost or stolen. And we never leave them out in the car or any other place where they might get overheated.

What’s your personal secret to handling changes in time zones?

Amy: I’m terrible with time zones. I get exhausted and cranky. But as far as insulin dosing, when I was on Lantus, I just split my regular dose the first night between morning and evening, and then I transitioned to taking my bedtime dose at the local bedtime hour the second night. Now that I’m a pumper, I just reset the time on my pump the minute we land, and usually use a “temp” setting to lower my basal rate for the first night, so I don’t go too low.

Allie: My personal secret is my personal wireless thief–Verizon Wireless! I set my daily alarms to go off at 7 a.m. and 7 p.m. So even if I’m traveling out of my time zone, the clock will adjust. If my sugar readings are remarkably off where they were in the last time zone, and where I suspect they should be at the new adjusted region, I skip a dose or bump up the coverage. Call me Abacus. It’s all a numbers game to me.

Scott S: Plan to eat according to a schedule from your departure time zone, especially if you aren’t wearing an insulin pump. You may need to pack a sandwich or grab something at the airport, but I find it easier to make the adjustments after I’ve arrived at my destination. You want to avoid lows while traveling if possible; it’s easier to correct once you’ve landed!

How do you manage blood sugars while long-term flying or driving?

Scott J: Temporary basal rate adjustments, usually cranking it up a bit because I’m sitting in a car or on a plane, and frequent testing.

Gina: I keep snacks and juice on me at all times. Enough in case I get stuck. Depending on how far I will be traveling I will estimate how much I will need. Those small juice boxes and cheese and crackers or peanut butter crackers work for me.

Manny: I test often, at least every couple of hours, to make sure things are in check. I have glucose tablets and juice in hand, in case of lows. Unfortunately in recent years meals in flights have become a bit unpredictable, resulting in cases where you may find yourself without the foods you need to get yourself out of a low being available on board.

Sandra: We run a “temp” basal on Joseph’s pump–increasing his basal insulin rate by as much as 50 percent–and give him more insulin for his meal boluses. During particularly long road trips, you might also spot me and my son jogging around rest stop parking lots.

How do you protect your pump and/or your insulin when you are out in hot weather, like at the beach or pool?

Manny: At the beach, I carry a cooling pocket where I put the pump. I always make a point to carry a beach umbrella and make sure that the pump in the pocket is well covered by the umbrella. I also don’t spend too long on the beach!

Sandra: We stow Joseph’s pump inside its case in a cooler, but never right up against ice or an ice pack.

Kerri: If I could live on the beach every day of my life, I would. So during the summer months, I spend a lot of time on the shore of the Atlantic Ocean. If I’m going to be at the beach for more than an hour or two, I bring a small cooler with me and keep my pump (wrapped in a T-shirt) safely contained while I’m disconnected. While connected, I either have my pump clipped to my bathing suit bottom or wrapped up in a shirt, towel, etc. next to me while I’m on the blanket. However, I always keep an insulin pen either in my cooler or in my beach bag, just in case of pump failure or overheated insulin.

What other tips do you have for traveling successfully?

Kerri: Always pack more than you think you need–bring back-up juice boxes, extra insulin and test strips, or a replacement pump infusion set, just in case the elements align against you. And if your pump infusion site happens to get clogged with salt from the ocean or sand, have a water bottle on hand to rinse your infusion set. A little splash of fresh water does wonders for a salty, gritty site!

Amy: Check your blood sugar a lot. But try to relax, too. As long as you have plenty of backup supplies and an “emergency plan” for getting replacements if necessary, you will be just fine. So you ate some foreign dish, got the carb count all wrong, and spiked your blood sugar to new heights? So what? Take a correction and a deep breath. Just keep swimming…

Sandra: On long driving trips, pack plenty of healthy snacks so that you’re not always eating road food. And be flexible. Know that things won’t always go the way you’ve planned, and that’s okay–just don’t get so worried or stressed over miscalculations or unanticipated junk food that you forget to have fun. You’re on vacation, after all.