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.
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.
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.
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!