Travel

Travel

TRAVEL, VACATIONS,
AND DIABETES

by Celia
Henderson

You have insulin-dependent diabetes;
it's time for vacation. How should you handle your diabetes? Will you be able
to go away for more than a day? Could you go to Europe, or on an extended cruise?
There is no reason to avoid travel just
because you have diabetes. With a few extra precautions, you can take as many
trips to as many places as your imagination can suggest. A little advance planning
and common sense are all that is required.
General Do's and Don't's
Do carry extra supplies with you, enough
to last longer than you plan to be away. That way, if you decide to stay longer,
or if you are delayed, you won't have to worry about finding the supplies you
need. A good rule of thumb is to carry twice the supplies you normally need
for trips of a week or less, and one week's extra for longer trips. You'll need
your insulin, syringes, swabs, blood testing and urine testing equipment. Make
sure you also have some form of ID that advises that you have diabetes, such
as a bracelet or wallet card. Make sure your equipment is in good repair, and
that batteries are fresh; carry MORE test strips than you need. If you need
special meals, call the airline one week ahead to request; check again the day
before departure. Carry extra food, in case meals are missed, or are inappropriate
to your dietary requirements.
Don't pack diabetes supplies in your
checked luggage; it and you can become separated. Pack your diabetes supplies
in your carry-on case. Remember to include a letter and prescription from your
doctor, covering your insulin, syringes, and any other prescription medication
you carry with you. Don't forget to pack your glucose tablets, motion sickness
pills, medicine to relieve possible vomiting or diarrhea, and any other appropriate
medications. Consider packing the emergency medication glucagon. Discuss travel
plans with your doctor.
Traveling By Car
Auto trips can be very enjoyable. If
you are doing the driving, be on guard against low blood sugar and possible
insulin reaction. Take frequent breaks (every two hours is recommended--specially
if you have to cope with foreign traffic!), watch yourself for disorientation,
and test your blood glucose levels frequently. Keep a small piece of fruit,
a package of raisins, some graham crackers, and your glucose tablets close at
all times.
Buses and Trains
When you travel by bus or train, regular
rest stops and meal times may not match your schedule. There can be unexpected
delays, and the available food can be very inappropriate. Carry a snack so that
you can provide your body with the sugar it needs. Although it is best to travel
with a companion who understands your condition and what to do about it, if
you are traveling alone it may be a good idea to let the driver or conductor
know that you have diabetes, just in case you should have a problem.
Travel By Air
On a long flight, you may be scheduled
for an injection while you're in the air. Follow your normal procedure, with
one difference. Put only half as much air into your insulin bottle as you normally
would. Cabin air pressure in high-altitude flight is lower than pressure on
the ground, so you won't need as much pressure inside the bottle to balance
the insulin you draw.
Crossing Time Zones
Your normal insulin dosage is designed
to protect you for a set period of time. When changing time zones quickly, as
you do when in East/West flight, you may need to adjust your dosage. Discuss
such adjustment with your doctor in advance. On a long flight, leaving your
watch on "Home" time might make it easier for you to know your schedule,
especially if you will need to inject while in flight. Once you arrive, reset
it to local time, and note the difference. If you are mixing insulins, time
your injections so that your insulin will have the same relationship with your
new meal times as it does at home. If your meals will be timed or spaced very
differently from at home, ask your doctor if you should use a different injection
schedule or proportion of short- and long-acting insulins.
Again, carry your insulin, syringes,
swabs, and diabetes ID card/bracelet, with you rather than in your luggage,
just in case your luggage becomes lost. Keep the name and phone number of your
doctor at hand. Many foreign physicians speak good English, and a surprising
number studied in U.S. or British medical schools.
Care of Your Insulin
Unopened insulin can keep at room temperature
(approx. 68 Fahrenheit, 20 Celsius) for a month without refrigeration (the "expiration
date" applies to refrigerated storage), but extremes of heat or cold can
damage it and make it ineffective. Once you start using vial or pen cartridge,
the manufacturers recommend you store the product no more than 30 days, and
one week in some cases. Be sure to read and follow the cautions and instructions
packed with your product; consult the insulin manufacturer's "help line"
for further information.
Summer heat can raise the temperature
inside a parked car to over 140 Fahrenheit, so avoid storing insulin in your
car's trunk or glove box. Airline baggage compartments are unheated. They get
cold at 35,000 feet! Your insulin can freeze, severely damaging it. Insulin
you suspect has been exposed to extremes should be discarded.
Foreign Travel
In some foreign countries U-40 insulin
is the only strength available. Your dosage is based on U-100 strength insulin,
so you'd have to take 2.5 times as much U-40 (by fluid volume) to get the same
amount of insulin. In other countries, U-80 insulin may be the standard. Know
before you go! Although you are bringing all your supplies with you, just in
case, you should find out which insulin strength is standard in your destination
country, and know how to use it. Remember that "U" describes how many
units of insulin are in one cc, or cubic centimeter. U-100, the dilution sold
in the U.S., is more concentrated, and U-40 contains only 40 units of insulin
per cc. It is important to remember you need the right number of UNITS OF INSULIN,
regardless of the concentration. The UNITS are marked on the syringes of each
insulin strength, so as long as you use the correct syringe (the syringe DESIGNED
FOR THE CONCENTRATION YOU'RE DRAWING), you can still measure your dose accurately.
If you must use local syringes, make sure you understand their markings! If
you will be staying somewhere long enough to need locally-available insulin,
discuss this with your doctor, as source and brand differences should be considered
as well. Note that in many countries, syringes and bottles are color coded--but
in other countries the same color codes may mean something different. Be cautious!
It is best to bring more than enough of what you're used to, and leave local
insulin and syringes strictly for emergencies.
It may sound trivial, but if you have
sensitive skin, pack a familiar soap. Many foreign brands are very different,
and in some places soap may be in short supply. Veteran world travelers often
carry a supply of toilet paper as well. The same goes for toothpaste. (From
the Editor: The newsletter, THE DIABETIC TRAVELER, offers a free list of diabetes
associations in 84 countries, along with other useful advice. For information,
contact: THE DIABETIC TRAVELER, PO Box 8223 Rw, Stamford, CT 06905; telephone:
(203) 327-5832.)
Get your immunization shots ahead of
time. Some immunizations can upset your system and put you "out of balance."
It's much easier to deal with these reactions at home. Plan your shots three
to four weeks before you are ready to leave home.
Carry A Sugar Source
Always carry some form of sugar that
can be eaten easily. This could be food such as raisins, sugar cubes or a piece
of fresh fruit. Glucose tablets are very convenient.
While traveling, chances are your routine
will be different from home, with increased risks of an insulin reaction. Even
people who are normally aware of the signs of a reaction can be caught off guard
by the stress and excitement of travel. The odds are your vacation will impact
your diabetes; be ready to deal with it.
Blood Testing
The changes in your daily routine, meal
timing, and kinds of food can all affect your blood sugar levels. Test your
blood for sugar at least four times a day. It may be better to try to control
you blood sugar levels with small adjustments to your activity levels and food
intake than by changing your insulin dosage--discuss this with your doctor.

Caring For Your Feet
Never go barefoot. Cuts and scrapes
on your feet can lead to infection and ruin your vacation. Don't wear new shoes
for more than an hour the first day. If you're planning a lot of walking, wear
a thin pair of socks under your regular socks, or choose seamless athletic socks
of cotton or new materials like Thorlo. It is best to travel with shoes that
are well broken in and comfortable. If you develop blisters, don't break them.
Unbroken skin is your best defense against infection.
Diets and Meals
Extra pounds are easy to put on during
vacations. Chances are your eating schedule will be harder to stick to when
you're away! The foods available may be different from what you're used to eating.
Note that many restaurants can provide foods that will fit your meal plan, even
though they do not appear on the menu.
Foods to Avoid
Diarrhea is unpleasant for anyone. For
a person with diabetes, it can be downright dangerous, because diarrhea eliminates
both fluids and unabsorbed glucose. If that happens, you will find it difficult
to balance your insulin. Where sanitary conditions are in doubt, for your safety,
be prepared to avoid ice cream, milk, soft cheeses, cream sauces, raw leafy
vegetables and fruits peeled by someone else. Drink bottled water or beverages,
and be cautious of ice cubes. Coffee and tea are OK if the water is brought
to a boil first.
Activities
Exercise burns sugar, so watch your
carbohydrate intake, cut down for lazy days, increase for busy times, and test
blood sugars when in doubt. Discuss exercise plans and insulin adjustment with
your doctor.
Have a wonderful, happy and safe trip.
Bon voyage!