As we have said before, diabetes doesn't take a vacation. However, that doesn't mean that we can't take a vacation as long as we think and plan ahead and be prepared for any unexpected situations.
Vacations can be fun but travelling to different places or changing our routines can disrupt our diabetes management. Things like delayed meals, too much or too little activity, time changes and unfamiliar food can cause our diabetes to go out of control despite our efforts to manage our diabetes safely. Planning ahead, doing background research on where you are going and letting someone, who is not travelling with you, know your plan(s) are all good ideas. Today I want to provide you with some travelling/vacation tips that I have learned and read about over the years.
Don't let diabetes stop you if you love to travel and explore the world.
Before you go:
Visit your doctor to be sure you are well enough for the trip. Ask for prescriptions for your medicines in case you run out or they get lost. Check if you need to have any vaccinations before travelling. Have a letter from your doctor saying you are a diabetes patient. The letter should state what supplies you will be bringing for your diabetes management. For example, if you carry syringes, the letter will help protect you from being searched and frowned upon when you go through customs. I mention syringes because no matter what you use at home, things can break or go astray so it is important to know how to prepare and inject insulin using the old fashioned needle method.
Be sure to arrange for medical insurance while away. If you have an insurance plan that covers travel, find out what it covers exactly. Ask them to be as precise as possible since you may need additional insurance. Some insurances might only cover expenses of an accident that happened on your trip and not cover any type of illness related to your diabetes because you had the disease before your travelled. Check if the insurance company can be billed directly from the hospital or clinic you attend and if not be sure to save all receipts and that all expenses are itemized on your invoice.
Depending on how you are travelling if you cross time zones, know the time changes and adjust meals and medication accordingly. Contact your diabetes educator to help in learning what to do.
Leave a travel plan with someone at home just in case you do run into problems with your diabetes or someone needs to contact you for an emergency. Checking in every so often isn't a bad idea and will help your loved ones know you are safe.
Visit your dietitian to discuss food choices available at your destination. Foods that are pretty consistent include eggs, sandwiches, yogurt and fruit. Be sure to read the labels. Be careful of sauces and dressings that sound healthy but might contain additional sugars. My first experience with a stir-fry was delicious to I ate it all only to find my sugars hours later were sky high. I thought all it was was vegetables and chicken but come to find out the sauce was very sweet and had a high content of sugar so I learned the hard way.
Talk to your pharmacist to get a complete list of your medications. The pharmacist can help identify the names of your medications in other countries in case your need to buy any of them while you are away.
Check the location of hospitals or clinics near your destination.
Wear identification, such as a bracelet or necklace, to identify that you have diabetes. Some format of identification of who you are, where you are from and who to contact in case of an emergency should also be readily available. Have a copy of your diabetes management regimen, pump settings, dosing, correction dosing and carb ratios.
If you wear a pump and you prefer not to wear the pump while travelling, then arrange an appointment with you care providers to learn what insulins you need to use, dosing and frequency of injections. No doubt, you will need an intermediate/long acting insulin along with a rapid acting insulin and have to give multiple injections daily. Start this a week or two before you go, so doses can be easily adjusted and you know how you will respond to the daily injections. Don't wait till the last minute to have this done, it will only bring you frustration.
Packing
Always carry your diabetes supplies with you and always take extra. By doing this you are in control of how your supplies are stored when not in use. Have one bag for all your supplies and be sure to have snacks in case meals are delayed or you are trending towards hypoglycemia. I
If you wear a continuous glucose monitoring device check with the manufacturer or the web site if it can go through the x-ray machine. You may prefer to request the pat down method at security.
Storing insulin/strips,meter,etc- many insulated pouches are available to keep it cool. Depending on the type of insulin, the storage requirements may vary. Some insulins are good for 28 days at room temperature while others could have a 42 day stability at room temperature. Ask your pharmacist to give you the exact details. Unopened vials/cartridges should be kept in the refrigerator (2-8 degrees C/36-46 degrees F). Room temperature is considered in most references between 59-86 degrees F (15-25 degrees C). Insulin can denature in extremely hot temperatures. The only way to tell if insulin is denatured is that it is no longer working for you and you have higher than anticipated blood glucose values. Clear insulins should always be clear no matter the condition they are stored in, so if you see any clumps, discolouration then do not use the insulin. Your test strips and blood sugar monitor are also sensitive to sunlight and heat so they too should be stored with caution. This is a nice chart I found associated with the American Diabetes Website dated 2018. If you wear a pump and you believe your insulin has been exposed to temperatures greater than 37 degree C (98.6 degrees F) then it could be spoiled so monitor your sugars more frequently until you gain the confidence it is still effective or prepare a new supply.
Extreme heat can increase the absorption of insulin and increase the risk of low blood sugar. If you inject insulin and plan to hike that day, it would be better to inject the insulin into the arm where not so much activity would occur on that body part as compared to the leg.
Always carry some hand sanitizer/wet wipes in your backpack just in case running water and soap isn't close by.
Don't forget the sunscreen and apply frequently.
You've arrived, now what?
Your blood sugar may be out of range at first, but it should adjust in a few days. Monitor frequently and treat highs and lows as instructed by your health care team.
Will you be more active or less active than usual and if either is the case, monitor sugars more frequently.
If you are extremely tired from the travelling and time does allow, take a day to reset and plan your routine. For me, when I get overtired my sugars fluctuate and I have to find the energy to solve the problem. If you will be at the same location for a few days, check out the area for clinics, restaurants, information centers and maybe even a tour guide.
Traveller's diarrhea is a worry and can have a significant impact on your blood glucose levels. It is easily transmitted from person to person or by eating food or drinking water that is contaminated. Take a minute to check the website above to learn more. Be careful drinking water and eating salad greens that may have been washed with the contaminated water. If you think food has been sitting out in the sun for long periods, especially foods made with mayonnaise and dressings then it is probably best to avoid them.
Speaking from experience, if you are eating in open areas where birds are flying overhead or coming directly to your table, be careful and cover your food if you leave the table for a minute. Due to an incident we saw a few years ago travelling, we now choose to eat indoors the majority of the time.
Most importantly make good memories and have fun. Diabetes can make travel more challenging but it doesn't have to keep you close to home. The more you plan ahead, the more you can relax and enjoy all the new experiences, sites and sounds.
The information presented here is for information purposes only. It is not intended to replace that of your health-care providers.
Wishing everyone a safe and happy summer.
#travel&diabetes. #travelplans
References:
https://www.cdc.gov/diabetes/library/features/traveling-with-diabetes.html accessed June 28th, 2021
https://www.diabete.qc.ca/en/understand-diabetes/practice/travels/planifier-son-voyage/ accessed June 29th, 2021
https://www.canada.ca/en/public-health/services/diseases/diarrhea.htmlacc accessed July 1st, 2021
https://community.diabetes.org/discuss/viewtopic/2/14366#p152618 accessed July 1st,2021
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