Traveling with Diabetes

By Kalia Doner

No matter where you’ll be spending your vacation, summer is a time to kick back and relax. For a person with diabetes that might sound easier than it actually is, but with just a little bit of planning, a relaxing vacation can be simple. “Just give yourself plenty of time to get organized,” advises Donna Tomky, C.D.E., M.S.N, R.N. C-NP, president of the American Association of Diabetes Educators, who has type 1 diabetes. “Being prepared means you’ll have more fun and less stress.”

Whether you are driving through the back country of Utah or jet setting to an island in French Polynesia, here are some tips to help you plan for a great getaway!

Getting Ready
4 Steps to make sure you’re prepared

1. See your health care provider.

Make an appointment to see your child’s doctor or a certified diabetes educator (C.D.E.) at least two weeks before you depart. There are some important details that you should share with your doctor or C.D.E., so keep these in mind during your visit:

  • Your travel and flight schedules. If there are time zone changes, you and your doctor can discuss how to best keep insulin dosing on schedule. Make a plan. Write it out carefully for each day and then be prepared to test, test, test, and adjust your dosing schedule to make sure your glucose levels are on target.“If there is a time change, there are three things I usually suggest,” says Howard Wolpert, M.D., director of the insulin pump program at Harvard’s Joslin Diabetes Center in Boston. “If you use an insulin pump, you should change its clock by only an hour or two a day until it is in line with the new time zone. And test your glucose levels frequently. You may have to make some corrections and adjustments, but that is a good starting point.” If you take insulin injections you also need to devise a gradual schedule adjustment; talk with your doctor about the smart way for you to proceed.
  • A list of diabetes-related supplies. Ask your doctor to help you estimate how much insulin, and how many syringes, test strips, alcohol swabs, sugar tablets and/or other remedies for low blood sugars you will need. Also, try to figure out how many extra batteries you should bring for your monitor and/or pump. Then double it! And remember, never put medicines in checked luggage.“I travel with glucagons kits for lows, ketone testing strips and two back-up glucose meters,” says Tomky, who uses an insulin pump and a continuous glucose monitor. “And of course I always take syringes and long-acting insulin in case of a pump failure. With technology anything can happen. You really have to think ahead. Don’t leave anything to chance.”
  • Emergency prescriptions. As an added precaution, Tomky suggests you ask your health care provider about taking antibiotics with you, and stocking up at the drug store with stomach-soothing, over-the-counter medicines such as Pepto-Bismol for an upset stomach and Imodium for diarrhea.
  • Vaccinations for international travel. Also make sure to get a flu shot, if you haven’t already. “Everyone with type 1 should have a flu shot every year,” says Tomky.
  • Doctor’s note. These days you may not need it, but it’s always good to have one explaining why you or your child need to pass through airport security carrying syringes, multiple vials of insulin, and a host of other supplies, foods, and liquids, and why you may be wearing a pump and or a continuous glucose monitor. “We have a standard note, but a lot of people don’t use it any more,” remarks Dr. Wolpert. “So many people are wearing pumps and so many people have diabetes that most airport personnel are very familiar with diabetes supplies. Pumps, insulin, and syringes don’t strike them as out of the ordinary.”

2. Know the locations of hospitals and doctors who speak English (if necessary) at your destinations.

The longer the trip and more exotic the location, the more research and planning you may need to do—especially when it comes to finding out the names, locations, and phone numbers of the nearest hospitals, clinics, and emergency services. For a list of English-speaking doctors and local hospitals in countries around the world, go online or contact the International Association for Medical Assistance to Travelers at 716-754-4883.

Your Child’s Checklist

If you have a child with type 1 diabetes, the same guidelines apply to them as to an adult. You want to talk with your child’s doctor and…

  • review the diabetes care supplies you may need to take for your child
  • receive the prescriptions you want to obtain from the doctor
  • review the adjustments you will make to his or her insulin schedule
  • obtain a doctor’s note to show airport security if necessary, explaining your child’s need for diabetes supplies and food/liquid

3. Research local foods.

Before you leave home, do some research on the local foods at your destination. Then try to figure out how they will influence your carbohydrate intake and how to control it. “In China for instance, it can be pretty difficult to count carbs, especially when you have a lot of rice and noodles,” says Tomky. “You do your best assessment of what you are eating, hoping that you are dosing yourself correctly. And you have to do a lot of monitoring and pay attention to the results.”

Your Child’s Nutritional Needs

Wherever you go, always keep a healthy snack on hand. Bring a cooler bag stocked with familiar and simple foods such as crackers or cheese, peanut butter, fruit, a juice box, and some form of sugar (like hard candy) to treat low blood sugar. You never know when you will be stuck on the tarmac, or in a locale without good food choices.

One tip: If you are headed somewhere that may be a peanut-free zone, find an alternative to PB&J.

4. Pack the right footwear.

Planning to hike the Rocky Mountains or spend the day sightseeing in Rome? Your bound to have a great time, but don’t leave home without shoes and socks that protect your feet. If you decide to get new shoes for the trip, allow time to break them in and discover any problems with the way they fit. Doctors recommend that you buy walking and hiking shoes at a store that is familiar with people who have diabetes and to bring someone along to help you with the fitting (particularly if you have lost some feeling in your toes or feet). If you are uncertain about whether the shoes you are buying are right for you, don’t hesitate to buy several pairs and take them to the orthopedist for evaluation. Then select what you want and return the others. To find shoe stores in your area that specialize in diabetic footwear, Google “how to find diabetic shoes” followed by your zip code and you should get a pretty good listing of local retailers.

On the Move

Traveling can be very stressful, and stress can affect your blood sugars. Here are some tips for traveling without dialing up the angst.

1. Don’t be shy

As you go through airport security check, you may feel self-conscious or worry that the screeners will take away some supply that you need. That kind of anxiety can make blood sugar levels plummet. “It’s best to just accept that they have a job to do,” says Tomky. “Because I carry liquid glucose with me, I always tell them that I’m diabetic and show them my plastic bag with my different supplies and my insulin. I don’t always mention the pump because some times they just let it go through. But if they catch it, they are really very good about it.”

No matter where you are or how you are traveling, don’t hesitate to tell someone that you have diabetes if it will help ensure your safety or well being.

2. Avoid lows

Long layovers, missed connections or delays on the runway can make it tough to get the food you need when you need it and that can cause both stress and a serious low. “I think these situations are often the biggest travel challenge for people with type 1,” says Dr. Wolpert. “If you are going low, I typically recommend glucose tablets—the type that will dissolve in the mouth. They’re much more rapid-acting than juice. Besides, airports don’t always have a good source of carbohydrates easily available.” Make sure you are well prepared by packing snacks like whole grain and/or peanut butter crackers, granola, or trail mix bars that you can carry with you wherever you go.

At Your Destination

So your bags are unpacked and the hassles of travel are behind you. Now you have to adjust to being in a new location that may be in a new time zone, have unfamiliar customs about eating, offer different kinds of stores where health-care supplies are sold—and may all be in a different language. Let the fun begin!

1. Get your day’s supplies at hand. When you head out to the beach, or for a day of shopping, chances are you will be getting more physical exercise than usual. Increased exercise will burn up more blood glucose, so test after a few hours of activity. In addition, you want to guard against dehydration, so carry plenty of liquid with you and a supply of snacks to protect against lows. Also, carry an extra pair of clean, dry socks with you in case your feet become sore or irritated.

2. Check your feet after every adventure. Do a thorough check on the bottoms of your feet and between toes for any red or sore spots. If you spot an irritated area, clean it well and apply an antibacterial ointment, if prescribed by your doctor. Plan to take a day off to allow your feet to repair. To avoid hard-to-heal foot sores and infections in the first place, keep feet dry and clean; change shoes to avoid blisters, and never go barefoot. Swim shoes and sandals will protect you on the beach and in the water.

3. Enjoy the local cuisine a bite at a time. When dining in a foreign country, start with the food groups that you are familiar with—perhaps a grilled or broiled fish and vegetables and then gradually add a tapas here and a curried chicken there. Before and after you eat, monitor frequently, and pay attention to the results.

4. If you are traveling with a group, let others know that you have diabetes. On day trips, tours or cruises, don’t hesitate to let your fellow travelers know you have diabetes, and that you may need to inject yourself with insulin sometime during the day. Ask if any of your companions are doctors or health care providers. Always tell the group leader that you have diabetes, and describe signs of a low.

5. Be wise about alcohol. A couple of margaritas by the pool may seem like the perfect vacation indulgence. They’re cool, tangy, and refreshing…but happy hour can turn pretty unhappy if you throw your glucose levels out of balance. You may not be aware that alcohol can cause low blood glucose levels (hypoglycemia) shortly after you consume it, and then, says the American Diabetes Association, for 8 to 12 hours after you have had a drink. To be safe, check your glucose level before or while you are drinking. Then check again before you go to bed to make sure it is at a safe level—between 100 and 140 mg/dL. If your level is low, eat something to raise it. Two other important issues: If you do happen to go low, the symptoms are similar to being drunk and people around you may not understand what is happening to you and may not offer the help you need to avert a crisis. And drinking can erode your discipline and make it difficult to stick to a healthy eating plan. So in all things, moderation, one more time.

Kids On the Go

Here’s how to keep them healthy and happy:

1. To keep insulin safe from damage or contamination, check out our tips by typing How to Pack Insulin into your Google search. JDRF’s website is the first on the page.

2. Remember kids get stressed too, cautions Tomky. You want to check glucose levels more frequently when traveling and when going to exciting locations such as amusement parks and entertainment venues.

3. Build in rest time. Just because you are not at home, that doesn’t mean that younger kids don’t need their naptime. You will have an easier time regulating blood sugar and keeping the grumpies away if you can schedule in a nap as regularly as possible.

Kids & Camping

Here are some tips for camping and hiking safety from Mary Simon, M.D., who has type 1 diabetes and is the medical director for the Diabetes Youth Foundation and its Bearskin Meadow Camp in California, and Claudia Retemal, backpacking nurse specialist, who leads teens on backpacking excursions for the camp. For more from these experts on preparing your child to go away to sleep-over camp, click here.

  • Always keep water with you. On hikes, carry water purification tablets. Adults and children with diabetes are at extra risk of dehydration.
  • Carry your diabetes supplies, particularly insulin, in a cold pack, and place it in the middle of your pack next to your back, so they are somewhat protected from the sun.
  • Always carry a spare set of supplies and medication—let your child carry one and you carry the other. Back-ups are always important, but never more so than when you are out in the wilderness.
  • Does your child use a pump? Always carry supplies for taking insulin injections in case your pump fails, and make sure to have extra batteries for the pump.
  • Bring extra batteries for the glucose monitor as well. (And, yes do bring the monitor, even for short hikes. You never know what you may need to know.)
  • After a day of strenuous hiking, always check your child’s glucose levels in the middle of the night to be sure a low isn’t about to happen.
  • Sleeping out? Keep your child’s glucose meter inside a sleeping bag. The meters won’t work or will provide inaccurate readings if they get too cold.

Be Prepared: At amusement parks

Amusement parks can offer unforgettable trips for families—kids can get close to their favorite ogre at the Shrek 4-D mini-movie and shake paws with the Cat in the Hat. And don’t forget the water slides! But for children with type 1 parks pose particular challenges—long lines for rides, lack of healthy food options and baking summer sun. Add to that the excitement kids feel and how much running around they do, and you have a formula for a crashing low. So test often, make sure they drink plenty of water, and bring extra snacks and supplies for handling lows and meals. Also, remember to keep insulin safe in insulated packs. (If you are an adult with type 1 who takes their child to an amusement park, these same cautions apply!) Fortunately, most parks have guest-relations specialists who will help you plan your day in a way that minimizes the risks to your child. Stop in to see them when you first arrive. Ask for maps of food stands and first aid stations. They may even allow you to go to the head of the lines!