Type 1 Advice on being fully prepared to travel abroad when living with T1 Diabetes

[•BethanyJayne•]

So... summer is approaching and I have my 1st holiday booked to Sorrento, Italy in June! I have only been T1 for 7 months and this will be my first holiday abroad since then..

If I am honest I don’t really know how or what I can do as of yet, to ensure I am as prepared as I can possibly be for that trip in mind.

Your advice and help with this one would be very much appreciated.. a few things that have crossed my mind are;

• Should you take all meds/kit with you as hand luggage?
• Do you need letter from your doctor to support why your require everything?
• Is there anything I should be aware of?
• What do you need to have with you to ensure if you need to pick up insulin in another country that this is possible? Say if something were to go wrong..
• I know that heat can have an impact on your BG and also medication... so any tips here?

I may be overthinking it but any advice or tips on this type of thing would be really helpful for me!

Thanks

Beth x

 

[MeiChanski]

You should speak to your diabetes team for
A) a medical letter to provide evidence that you are a diabetic etc
B) Ask your GP for extra insulin etc incase of an emergency.
C) put your medication in hand language and when security checks it, make sure they give it back.
D) if you are carrying extras and have a partner going with you, get him or her to carry your other supplies. Incase one gets lost etc
E) store insulin properly when you get to your destination, make sure there’s a fridge at the correct temperature, freezing insulin is a big no and if you are out and about, get a Frio bag for your pens to keep it cool.
F) carry hypo treatments like dextrose tablets in your bag. I always get drinks after passing security incase of a hypo when waiting for my plane.
G) travel insurance - just incase you need a doctor.
Have a nice holiday

 

[MeiChanski]

I will tag @helensaramay, I know she travels a lot. She might have something more to add

 

[•BethanyJayne•]

You should speak to your diabetes team for
A) a medical letter to provide evidence that you are a diabetic etc
B) Ask your GP for extra insulin etc incase of an emergency.
C) put your medication in hand language and when security checks it, make sure they give it back.
D) if you are carrying extras and have a partner going with you, get him or her to carry your other supplies. Incase one gets lost etc
E) store insulin properly when you get to your destination, make sure there’s a fridge at the correct temperature, freezing insulin is a big no and if you are out and about, get a Frio bag for your pens to keep it cool.
F) carry hypo treatments like dextrose tablets in your bag. I always get drinks after passing security incase of a hypo when waiting for my plane.
G) travel insurance - just incase you need a doctor.
Have a nice holiday

So helpful! Thankyou Mei! Appreciate you comments. Will have a look into this!

I can’t wait for holidays just want to be able to enjoy it without worrying about anything - so want to be prepared x

 

[•BethanyJayne•]

Sorrento? we were there about 9 years ago lovely place nice to walk around plenty of cafe's and pizza places.

Agree with what Mei says just make sure you travel with a least double of everything, place everything in your hand luggage. Make sure your pens and any spare insulin you are carrying are in clear plastic bags.

I have not had a problem with heat and insulin but most places have fridges you can stash your stuff in when you get there. If your really worried then look for Frio Bags, these keep things cool for long periods of time.

Have fun and take lots of pictures , Pompeii is great place to go but it gets really crowded

Hey Knikki,

Yes I cannot wait! I love Italian food - however most of it is very high in carbs! If only I could pack my food scales with me I use the carbs and Cals app which is pretty good so will use that to get me by!

Thankyou for the tips! I will definitely keep those in mind when travelling.

Haven’t seen the frio bags so will have a look to check them out aswell.

My family went to Pompeii and loved it! Definitely one on the list to experience at some point

Beth x

 

[urbanracer]

If you look at the security pages for LGW or LHR they tell you that a doctor's letter is a must. In practice I have never been asked for it and I travel a fair bit for both work and pleasure. But get an undated (and thus reusable) letter from your GP (maybe a charge) or from the hospital (usually free).

An empty 330ml water bottle makes a great sharps bin.

Enjoy and stay safe.

 

[•BethanyJayne•]

If you look at the security pages for LGW or LHR they tell you that a doctor's letter is a must. In practice I have never been asked for it and I travel a fair bit for both work and pleasure. But get an undated (and thus reusable) letter from your GP (maybe a charge) or from the hospital (usually free).

An empty 330ml water bottle makes a great sharps bin.

Enjoy and stay safe.

Good thinking with the undated letter! That would be much less faff.

Love the idea for the travels sharps container too. Thankyou & have a good day!

Beth

 

[Scott-C]

Hi, Beth, you've probably learned by now that exercise is one of the things to take into account alongside insulin and carbs as muscles contracting bring GLUT4 glucose transporters to cell surfaces to let glucose in without insulin.

If you're going to be strolling around a lot seeing the sights, even though it is not exactly the same as going to the gym, it still counts as exercise.

It's easy to rack up the miles and that can have a big impact on dosing requirements, so have a think about reducing usual meal doses if you have been or will be walking around a lot before or after a meal.

Obviously can't advise on dosing, as we're all different, but just as an example, it wouldn't be unusual for me to rake back the amount by a third or a half depending on how active I've been.

Also, many of us tend to drink a bit more when on holidays. Remember that, while your liver seeps glucose out throughout the day to fuel background processes and immediate energy needs, as soon as alcohol is in the picture, the liver prioritises metabolising that and drops by about a half the amount of glucose it releases, so you can end up with a bad drop in the night as the same amount of basal is still there. So, it's a good idea to make sure to have a slow carby snack before bed to replace the missing liver glucose supply.

You'll be fine - we've had many posts from newly dx'd being cautious about their first holiday, but they all go, have a fine old time, and come back with reassurance that if they can do T1 here, they can do T1 anywhere - it's an important step towards acceptance of T1, just that idea of, yeah, I can do that.

 

[•BethanyJayne•]

Yep Italian food can be fairly carby, pizza round here is known as "The Devils Food" because it can be tricky to inject for, doesn't stop me eating it by the way.

Just something to bear in mind, things like pasta take a long time to digest and break down, so you may inject for the right amount of carbs in the meal but find you have dropped BSL a fair bit say 2 hours later, but then gone on the high side 6 hours later. Also add into that things like cheese fats and other things you get with Italian meals, these to can slow the digestion of carbs.

Oh hea of he day? yes that too can also play havoc with some people BUT not everyone.

It might be worth experimenting with some home foods before you go just to get an idea of how it can/may effect your BSL, least at home it is easier to deal with than being abroad.

Like I said it is nothing to be scared or worried about, its just something to be aware of.

As you will soon find out we are all different and handle things like foods etc in many ways some will not touch pizza for the reasons above where as I will happily eat it

Good shout knikki! I will give that a go before I head out and tbh I am quite confident in adapting and trying things out to recognise patterns! I love cheese so that will definitely not be an issue.

I had a pizza the other night and my BG didn’t spike at all, if anything I overcompensated for the amount of carbs but I was still in a normal range afterwards. I have also started taking my insulin 15 minutes before eating when at home, which is working quite well for me!

Thanks again!

 

[•BethanyJayne•]

Hi, Beth, you've probably learned by now that exercise is one of the things to take into account alongside insulin and carbs as muscles contracting bring GLUT4 glucose transporters to cell surfaces to let glucose in without insulin.

If you're going to be strolling around a lot seeing the sights, even though it is not exactly the same as going to the gym, it still counts as exercise.

It's easy to rack up the miles and that can have a big impact on dosing requirements, so have a think about reducing usual meal doses if you have been or will be walking around a lot before or after a meal.

Obviously can't advise on dosing, as we're all different, but just as an example, it wouldn't be unusual for me to rake back the amount by a third or a half depending on how active I've been.

Also, many of us tend to drink a bit more when on holidays. Remember that, while your liver seeps glucose out throughout the day to fuel background processes and immediate energy needs, as soon as alcohol is in the picture, the liver prioritises metabolising that and drops by about a half the amount of glucose it releases, so you can end up with a bad drop in the night as the same amount of basal is still there. So, it's a good idea to make sure to have a slow carby snack before bed to replace the missing liver glucose supply.

You'll be fine - we've had many posts from newly dx'd being cautious about their first holiday, but they all go, have a fine old time, and come back with reassurance that if they can do T1 here, they can do T1 anywhere - it's an important step towards acceptance of T1, just that idea of, yeah, I can do that.

Hey Scott!

Thanks for your advice - really useful to hear!

I had done a couple of classes which were medium strength classes and my BG dropped significantly so like you say I need to bare that in mind and carry snacks with me I guess!

I will have a word with my medical team about adjusting this when strolling for long amounts of time... this is one I didn’t think of.

Drinking is something thankfully I’m not a massive fan of so don’t tend to do that too often! Even on holiday ahaha.. I’m more of a foodie! I have been out and had a few drinks and realised the impact of that too - it plays havoc with me the day after drinking and is kind of annoying! How do you find it?

Thanks again for all of the advice!

Beth

 

[KK123]

Hey Scott!

Thanks for your advice - really useful to hear!

I had done a couple of classes which were medium strength classes and my BG dropped significantly so like you say I need to bare that in mind and carry snacks with me I guess!

I will have a word with my medical team about adjusting this when strolling for long amounts of time... this is one I didn’t think of.

Drinking is something thankfully I’m not a massive fan of so don’t tend to do that too often! Even on holiday ahaha.. I’m more of a foodie! I have been out and had a few drinks and realised the impact of that too - it plays havoc with me the day after drinking and is kind of annoying! How do you find it?

Thanks again for all of the advice!

Beth

Hi there Bethany, I am just back from Sorrento a couple of weeks ago, you will LOVE it. Just one thing to add (as mentioned also by Scott), maybe test a few more times than usual. Sorrento is extremely hilly as are the surrounding towns. I am a big exerciser but I can safely say I was puffing and panting a few times on some of those 'strolls'. The minute you leave your hotel you are virtually having a gym workout. I ate pizzas/pasta (which I don't normally) along with my usual medium carb diet and still ended up going low constantly and having to adjust my insulin right down to almost nothing. We are all different of course, so as I say just be aware. I'm jealous, the place is lovely, where are you staying? x

 

[Daibell]

I use Frio bags whilst travelling and before reaching the hotel fridge. It can be difficult if you are back-packing over a long period of time. Don't forget to take your prescription copies with you in case you need to get more supplies abroad and the GP needs guidance. Take all medication outer packs with you to prove what the meds are.

 

[Scott-C]

it plays havoc with me the day after drinking and is kind of annoying! How do you find it?

Lol, as a middle aged Scottish male, we have local by-laws which require us to get drunk at the weekend, so I've had plenty of practice!

I certainly made a lot of mistakes in the year or two after dx, as I was a young man in a big city who was still very naive about how insulin worked (no internet in those days, carb-counting involved comparing everything to 10g Digestive biscuits!).

But as time went by, I picked up on the basic rules: sugary alcohols like beer generally require bolusing for but tail it off as the night goes by so you can be reasonably sure that there is little or no active insulin on board (IOB) by night end, and have something like cheese on toast or cheese on oatcakes or a fish supper or pizza slice, so there will be a slow release of glucose throughout the night to replace the deficit from the liver. It's the one time the dreaded 'pizza effect' is actually useful.

Red wine is preferable to white as it is more or less zero carb, so no bolus needed for it, but it will still inhibit the liver releasing glucose, so an oatcake bump is recommended.

Cocktails involving fruit juice can be very difficult - nothing wrong with fruit juice per se, but figuring out the carbs in it, their rapid uptake into bloodstream and their interaction with alcohol can be murder to figure out.

Spirits with mixers, ask for a bottle for the mixer - busy bar staff can easliy squirt sugary coke instead of diet coke from the gun. I'll generally always test a drink served from a gun with my meter just too rule out the possibility the wrong button was pressed.

I kind of cheat now. After decades on strips, which give very limited insight into bg changes, I've been using cgm for the last three years, so I get 5 min readings, predictions of where I'm going, and an updating estimate of iob. Ask your team about freestyle libre - it's available on prescription if certain conditions are met. It makes a huge difference being able to see and steer bg in more or less real time.

I had done a couple of classes which were medium strength classes and my BG dropped significantly

That's a good lesson for the future - mistakes are useful! Newly dx'd very often get taught to just look at the carb count of the meal then apply x units for that. That's a good starting point, but as time goes by, we also start thinking about things, such as exercise, remaining iob from the last meal or corrections, which may have happened in the last six hours, and what we anticipate doing in the next six, say, exercise, or whether we fancy a biscuit in two hours, and then tweak the bolus call a bit.

Understanding how insulin works over a 5 hour time frame, not just there and then at the time of injection, adds a lot to being able to do creative stuff with it, especially with a cgm which lets you correct any errors before they get messy.

 

[Scott-C]

and still ended up going low constantly and having to adjust my insulin right down to almost nothing.

One trick, which you'll not find in DAFNE, is to keep a bearing on where the local McDonalds is! No, seriously, seriously!

I'm not a regular McDonalds customer, have only had a grand total of three cheeseburgers in the last few years to fill a gap while buying some DIY stuff at out-of-town B&Qs.

But, when abroad, before I got cgm, there's been a few times when I've been getting a bit flaky on the hypo front; a quick trip to McDonalds for a cheeseburger and vanilla milkshake, in an air-conditioned familiar environment has genuinely been a good "pause point" to get my bearings.

The one in Krakow was wonderful: a tree-lined courtyard with people playing violins! So not central London at 3am!

 

[KK123]

One trick, which you'll not find in DAFNE, is to keep a bearing on where the local McDonalds is! No, seriously, seriously!

I'm not a regular McDonalds customer, have only had a grand total of three cheeseburgers in the last few years to fill a gap while buying some DIY stuff at out-of-town B&Qs.

But, when abroad, before I got cgm, there's been a few times when I've been getting a bit flaky on the hypo front; a quick trip to McDonalds for a cheeseburger and vanilla milkshake, in an air-conditioned familiar environment has genuinely been a good "pause point" to get my bearings.

The one in Krakow was wonderful: a tree-lined courtyard with people playing violins! So not central London at 3am!

Thank you for the tip! They're everywhere I know (albeit I'm not sure about Sorrento!).

 

[Deleted Account]

Thanks for the tag @MeiChanski
To be honest, most things I can think of saying have already been said.
I guess the points I would emphasise are
- take at least twice as much of everything than you think you will need. I would probably take even more test strips as a day on holiday is unlike a day at home. And with that in mind, if you meter takes batteries, take spare batteries. And take lots of hypo treatment (Preferably sweets of dextrose because you can’t take drinks through airport security.)
- a letter from your diabetes team is usually free whereas a gp usually charges. I have needed my letter once in 15 years but still take it with me in case I am asked.
- keep everything Diabetes related in your hand luggage. Absolutely, do not check it n your insulin as the hold is too cold and will kill it
- make sure your travel insurance covers your diabetes. It will probably ramp up the cost but you don’t want to give your insurance company any wriggle room if you have a health related problem.
- no need to tell anyone unless you want to. Airlines don’t care. Airport security only care if they see something on the x-ray. The only time I mention it is when I check in and I am asked if I have any sharp items. My evil inner twin always say “yes” and then waits for the panic to show before adding “I have diabetes”.
- have a wonderful time.