If you have diabetes, it should not keep you from doing the things you love, and travel should be no exception. About 10% of people with diabetes experience problems with diabetic control when traveling, but a little extra planning can keep diabetes from putting any kinks in your vacation plans.
Planning for Your Trip
To begin planning your trip, you may want to have a medical exam or at least a conversation with your healthcare provider, who can work with you to make sure your blood sugar is under control well in advance of your trip. Your provider should prescribe enough medication to last you while you are away and also give you a prescription for insulin or diabetes pills and/or supplies in case you run out or are away longer than expected.
Do some research on prescription laws in the places you will visit, in case they are different from the U.S., and also research where pharmacies and hospitals are located near your destination. Ask your insurance provider about coverage of medical expenses, including evacuation, if necessary.
If you will be crossing time zones, you may need to adjust the timing of your insulin injections. Insulin pump users may consider changing to injections while on vacation, especially if vacationing at the beach, since not all pumps are waterproof and the sun may heat up the insulin inside it. Anyone using an insulin pump should always have insulin pens or a backup plan in case their pump fails or breaks.
Packing for Your Trip
When packing for your trip, do not store your insulin in your checked luggage. The cargo hold can get very cold or even freeze, which would make the insulin ineffective. An even bigger concern is lost luggage. The safest way to ensure your supplies make it to your destination is to have them in your carry-on bag. You may want to keep a separate smaller bag beneath the seat in front of you where you have easy access to your meter, testing supplies, insulin, syringes, extra batteries, oral medications, other medications such as glucagon, antibiotic ointment or anti-nausea drugs, and diabetic identification card. Pack at least twice as much medication and blood testing supplies as you think you will need.
Meals may be delayed during travel, so be prepared for a drop in blood sugar by bringing along a well-wrapped air-tight snack pack of crackers with cheese or peanut butter, fruit, juice box, and hard candy or glucose tablets. You can contact the airline to request a special meal that is low in sugar, fat or cholesterol, but you must make the request at least two days before the flight. If the flight does include a meal, do not take your insulin until the food tray is set in front of you.
On the day of your travel, make sure you are wearing a medical ID bracelet or necklace, which will provide critical information about your health status in case of an emergency, including that you have diabetes, if you take insulin and any allergies you have.
What to Expect at the Airport
Despite the general rule prohibiting passengers from bringing most liquids and gels through airport security, people with diabetes may take their insulin and other medications, as well as juice or gels, through Transportation Security Administration (TSA) checkpoints, even if the containers hold more than 3.4 ounces. Things will go more smoothly if your doctor writes a letter to inform the TSA that you are diabetic and need to carry insulin, syringes and related items.
To prevent contamination, you may be asked to remove your medical supplies from your carry-on luggage for inspection and then repack them yourself. Carry your medication in pharmacy-labeled pill bottles and insulin vials or pens to avoid having to explain their purpose. Instead of juice, you may want to consider alternative forms of carbohydrates to treat low blood sugar, such as glucose tablets or hard candies.
Your medical supplies do not have to go through the X-ray baggage scanner; but to avoid the scanner, you must request an alternative inspection before the screening process begins. Patients with insulin pumps can be screened without disconnecting from the pump but must inform the screening officer about the pump before the screening process.
If you have any problems during the airport screening process, you can always ask for the Passenger Support Specialist or supervisor. If your problem is still not resolved, you can ask for the TSA’s Customer Service Manager for the specific airport.
During the Flight
On the flight, don’t be afraid to mention to a flight attendant that you are diabetic and that in the event of a low blood sugar may need soda or juice immediately. If you are on an insulin pump, you may need to briefly disconnect it during takeoff and landing, as some studies have shown that the change in pressure on a flight can make the pump deliver more insulin. It is safe to reconnect once the plane has reached its cruising altitude, but first make sure there are no air bubbles. If there are bubbles, re-prime your pump.
Federal regulations require all U.S. airlines to have a medical kit on board, but regulations on foreign and budget airlines may not require one. Call the airline ahead of time and find out what you can expect.
Travel by Sea
There are no regulations about medical facilities on cruise ships, but industry guidelines say medical care should be available for passengers. If you are traveling by sea, contact the cruise line to find out how medical emergencies are handled. Would they be able to administer IV fluids if you develop the potentially fatal condition called diabetic ketoacidosis in which an insulin-deprived body breaks down fat instead of glucose? If an emergency does occur, could you be airlifted to a medical facility or would you have to wait until you reached the next port?
After Arrival at Your Destination
Once you get to your destination, make sure your medical supplies are properly stored before you begin your rest and relaxation. If it is warm enough for you to sit outside in a swimsuit, it is probably too hot for your insulin. Regardless of whether you will be in a hot or cold climate, insulin vials should be kept at room temperature (under 86°F) or refrigerated. Insulin pens should not be refrigerated. Even glucose monitors should not be out in extreme weather, as they can malfunction. Cool packs specifically for storing insulin vials or pens are available on the Internet.
Staying Safe While on Vacation
While vacationing at the beach – in addition to wearing plenty of sunblock – avoid walking around barefoot. Sharp shells, bottle caps and similar items can cut your feet, which is a particular threat to diabetics who have peripheral neuropathy, a condition that results in a lack of sensation on the bottom of the feet. Without feeling, a cut could go unnoticed until it is infected. Always inspect your feet when returning from the beach and wear sandals as well as water shoes.
Be careful about what you eat and drink. Avoid tap water when you are out of the country and ask for a list of ingredients in unfamiliar foods. Pace yourself if you drink alcohol. Moderate amounts of alcohol can cause blood sugar to rise, while excess alcohol can cause blood sugar to fall. If you are going to drink, avoid drinking on an empty stomach and test your blood glucose levels frequently. Choose wine or light beer and forego drink garnishes. Be aware that the effects of alcohol can last up to 24 hours.
Keeping these tips in mind and preparing early for your next vacation will allow you to be safe and enjoy your time away. For general information about safe traveling in various destinations, including medications you may need, whether tap water is safe to drink and recommended vaccinations, visit cdc.gov/travel. For more information on how to travel with diabetes, visit VoyageMD.com.
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Michael Marchese, MD, endocrinologist, is board certified in internal medicine. He attended medical school at the Ross University School of Medicine and completed a residency in internal medicine at Stamford Hospital, followed by a fellowship in endocrinology, diabetes and metabolism at Albany Medical Center. He sees patients on the Phelps campus at the Diabetes, Osteoporosis and Metabolism Center in Suite 300 of the 777 Building (914-366-2270).
