Holidays & travelling with T1 Diabetes

Posted on Aug 26th, 2016

by The Artisan Diabetic

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Hopefully, all of us will get away for a few days or travel to more far-flung places this year. A little preparation will ensure that you stay well while you are away. There’s no point in getting away if you end up struggling with blood glucose (BG) levels, feeling awful and possibly ending up in hospital.

I’ve learned (sometimes the hard way!) what I need to bring and what to plan for when away. The following list is worth considering:

It’s best to keep your meter in its original case or another suitably padded bag to protect it from damage and temperature changes. Meters may not work in very cold or hot temperatures. Remember sweat and sun protection lotion on your hands can affect BG reading, so wash your hands or use a hand wipe before testing.

The correct temp range for most ‘in use’ insulin is 15 – 25°C. I take extra care of my ‘in use’ insulin once the temperature goes above 20°C because I have experienced issues with BG in the past which I eventually determined was from my insulin not working properly because it had been damaged by excessive heat. Spare insulin ‘not in use’ should be stored in a fridge between 2 – 8°C. Check the leaflet (DFU) that came with your insulin for the correct temperature or ask your pharmacist or practitioner.

If the temperature at your destination is very hot, use a cool bag/box with an ice pack (do not place the ice directly onto insulin or test meter) or purchase one of the specialized insulin cooler bags.

Even a bottle of water from a chiller cabinet will keep insulin cool for a couple of hours if the weather isn’t very hot. When going to very cold countries protect your insulin from going below the correct temperature. Keep your daily supplies in an inside pocket of your clothes.

Calculate how much insulin, test strips and other medication or equipment you will need. I would recommend that you bring 3 times the quantity that you would normally use in the length of time.

A lot of hotel rooms have minibar fridges which can be used to store your spare insulin and glucagon. Don’t forget it when you are leaving! Anything that is used to keep food cold, like thermal lunch bags/boxes are good. If you have access to a freezer, a portable wine cooler wrapped in a towel is good). Just remember to pop it back in the freezer each evening.

Some cars have an air conditioning vent in the glove box making it an ideal place to store your insulin while traveling in hot weather. Check that it is switched on before using. Remember that once the car is switched off the temperature will creep up quickly in the glove box.

The best meal compilation is the same as at home:
- Low carbohydrate salad or vegetables
- Lean protein (eggs, milk, cheese, yogurt, fish, lean meat, nuts)
- Good fats (avocado, egg yolk, salmon, trout, mackerel, nuts and seeds)
- Slow release carbohydrates (oats, butternut squash, beans, legumes, wholemeal/multigrain bread).

Use a high factor sun protection. Sunburn is painful and your healing power may be compromised due to diabetes. Better safe than sorry.

Staying hydrated by drinking plenty of bottled water or herbal tea. Take precautions not to pick up tummy bugs from food or water, which affect diabetes control as well as being unpleasant.

It’s important to deal with any high or low BG trends while you are away. Take a few minutes every day to review them and make any changes necessary. I stick to basic foods that I know or new foods that I can determine the carbohydrate content and take some exercise, especially for the first few days until I get used to the food etc. I find I need more insulin than normal when the weather is hot. It’s not just a blanket ‘give more’; it has to be done in a controlled way. Of course reducing insulin again after your holiday/change in weather also had to be done in a controlled way.

Have T1 identification and a Dr letter stating that you have T1 and have to carry T1 medications with you. This will prevent you being delayed going through customs with your insulin, needles etc.

Your prescription and your GP letter should be enough for you to get replacement insulin if the unforeseen should happen. Go straight to a Dr or A&E if all else fails.

Keep your insulin and BG meter with you at all times. It’s easy to miss place them when you are out of routine and have to carry baggage etc. They are more important than your phone or your ticket.

Ensure that you always have your usual hypo treatment with you. It’s best to stick to what you know will work quickly for you. You can have a low BG even though you are eating more and it’s important to be able to deal with it quickly and easily.

If you put your phone number with your diabetic supplies it may help you be reunited with them if you loose them. There are free online translation sites if you need your message to be understood in a non-English speaking country.

Bring enough spare test strips, insulin, needles, pump supplies, glycogen injection, batteries etc. in an easy to find, brightly coloured plastic see through box or bag so that it’s protected and easy to find in your baggage. Bring a spare test meter if you have one. Maybe keep your night hypo kit there too. If several people are travelling together it’s a good idea to divide up your spare supplies between cases.

When flying, don’t pack your insulin or glycogen in your checked in bags because it will be affected by the temperature and pressure in the baggage hold. I know from experience…… It’s not affected by normal cabin pressure.

Plan your insulin strategy if there is a time difference. An hour is easily managed. I just move my long acting insulin a half hour for a few days before I travel and again when I get back. If the time difference is more than an hour a structured method is best. Ask your Dr which is the best way of handling your particular insulin routine.

When I travelled to New Zealand I changed my usual evening time long acting insulin to the morning to account for the time difference. We went in October when there is a 12-hour difference but came back in November when there is a 13-hour difference! I had to step it back and forward due to the long travel time and different time zones. You could just give your insulin every 12/24 hours and not change times at all (unless your injection time is the middle of the night where you are going!). A phone reminder or alarm would be useful.

If you are driving on your break, ensure that you take the usual precautions before you sit in the driver’s seat. Ensure that your BG level is stable and do a check prior to driving. Never drive under 5 mmol/L (90 mg/dl) is a mantra worth repeating every time you drive. Take regular driving breaks and check BG level regularly.

You definitely don’t want to allow your BG level to drop to an unsafe level while driving because it can lead to loss of concentration, poor driving decisions and if left untreated a loss of consciousness, which can cause a serious road accident causing injury or death. A high blood sugar level over a period of time can cause tiredness, blurred vision, and confusion so is equally dangerous.

Always keep a sugary drink, sweets or glucose tablets in the glove box and make sure they are replenished if you use them.

If you are doing activities like parachuting, water sports or anything like that make sure you keep you BG level high enough to account for the extra energy needed and the difference in food if it is dissimilar to what you normally eat. Nothing is off limits as long as you keep you BG at a suitable level and monitor and take action if it isn’t within a safe range. Always have your usual hypo kit with you.