Diabetes and Travel

Diabetics ought to plan travel and holidays in advance and seek advice wherever necessary.

Using Insulin Abroad

Patients should find out what types and strengths of insulin are available in the area in which they will be travelling, refer to the relevant pharmaceutical company.
Insulins used in the UK and many other countries are of the strength U-100. In some countries insulin may come as U-40 or U-80 strengths. These insulins are not interchangeable. Should they need to be used, the appropriate syringes are required.
Insulin should be kept out of direct sunlight and kept cool.
Insulin should never be allowed to freeze, therefore when travelling by air, insulin should always be carried in the hand luggage.
Insulin may be absorbed faster in warmer climates. Regular glucose monitoring is important, to allow any adjustments in dose to be made safely.

Take twice as much insulin, syringes or pens, needles or tablets as will be needed.
If travelling with someone else, split the amount between each passenger's hand luggage just in case one of the bags is lost.
A cool bag for storing insulin.
Blood glucose monitoring equipment - along with adequate supplies of strips, lancets and a spare battery for the meter.
High altitude, heat and humidity can sometimes affect meters and test strips. Patients should be advised to beware of false readings.
Dextrose tablets, Hypostop, Glucagen injection and Ketostix if apt.
A diabetes identity card or jewellery.
Carbohydrate, in the hand luggage to cover any travelling delays.
Do not advise patients to order a special "Diabetic" meal on the plane, as these often contain very little carbohydrate. Instead, patients should be advised to carry extra carbohydrate in the form of sandwiches, fruit, cereal bars etc.
A letter, from either a GP or Hospital Diabetes Team, with a contact telephone number and address confirming the need to carry needles and syringes. A basic first aid box.
A list of all current medication - e.g. a copy of up to date repeat prescription request.

Patients should be advised to find out what vaccinations are required for the proposed destination. Occasionally these can cause sickness or flu-like symptoms and it is best to have them performed 4-6 weeks prior to travelling.

If sickness or diarrhoea develops insulin or tablets should never be stopped even if solid foods cannot be tolerated.
Carbohydrate intake should be maintained in the form of regular sugary drinks.
Monitor blood glucose levels frequently.
Urine should be tested for ketonuria as an early sign of decompensation.
If sickness or diarrhoea persists medical advice should be sought.

Travel insurance is vital. Patients should inform the insurance company that they have diabetes and ensure that the insurance package provides adequate cover. This should include cover for emergency transport home and recovery of charges for replacement of insulin or equipment.
Free or reduced cost emergency treatment is available in countries in the European Union . Form EIII is available at the Post Office.

If crossing time zones or travelling for many hours, specific advice regarding adjustments to insulin regimes can be obtained from the hospital team. Diabetes Specialist Nurses
Patients should bring along a flight schedule and information on time zone changes to help plan the timing of injections.
Travel to areas of high altitude can cause insulin to expand and contract, resulting in air pockets within the cartridge or pen. Patients may need to do a few "air shots" to make sure that there are no air bubbles present when they inject. Alternatively, the patient could revert to using a syringe and needle (it is possible to draw insulin out of a cartridge by this method).
Give advice on avoidance of DVT as for any other patient group

If patients are planning to drive while on holiday, they should ensure that their licence is valid for the duration of the trip and that they are covered by their insurance policy for driving, especially when abroad.
See Diabetes and Driving

Diabetes travel information - www.diabetes-travel.co.uk
Diabetes UK - Country guides are available www.diabetes.org.uk
Diabetes UK Scotland (Tel 0141 332 2700)
Diabetes UK Careline - A confidential information service for patients (Tel 0845 120 2960)
Diabetes UK Central Office (Tel 0207 424 1000 - London switchboard ask for careline)