It's not a problem travelling the globe when you have diabetes - all that is required is a little caution.
Flying, for example, can present a challenge for people with type 1 diabetes as a doctor's note is often required for people to be allowed to take sharps with them.
When travelling, you should consider how time zones and time differences could affect your management. If you are unsure as to how to manage your medication then you should discuss a plan with your diabetic team.
Purchasing travel insurance
Diabetes is generally not automatically covered on a travel insurance policy, unless explicitly stated. Regardless of how well controlled your diabetes is, you should state your diabetes to an insurer and confirm that cover is included.
Once you have travelled, you won’t be able to get cover so getting travel insurance beforehand is essential in case your holiday is interrupted by a medical emergency.
Travel insurance will also ensure you are covered in the event of your holiday being cancelled or the loss of any personal belongings. Booking your travel insurance early will give you enough time for the hard copies of policy documentation to arrive.
Doctor's letter or proof
People with diabetes can take their insulin, injections, needles and other medications abroad, although you may be asked about the materials by border security.
Diabetics should collect a doctor’s letter prior to arriving at the airport to explain the need to carry syringes, injections and insulin.
The doctor’s letter should be presented to the airline staff if requested, while if any problems are encountered then you should ask to speak to a senior member of staff.
If you are in any doubt about which documentation will be required, contact the airport you are travelling from or the relevant border security to see what you will need to bring with you.
Stock up on supplies
It is recommended to take twice as much medication and supplies as you think you will need. Taking backup supplies, such as a second blood testing kit and additional amounts of insulin, will ensure that should you lose or end up using an unforeseen amount of medication, you will still have enough leftover.
It is also advised to keep separate stashes of your medication in different places. Should your luggage be delayed in reaching you following your arrival in your destination, you will be naturally concerned if a large portion of your medication was lost.
Ensuring you have a suitable amount of medication in your hand luggage will provide you with at least some temporary cover while you await the return of your baggage.
Ensuring access to medication
UK citizens with diabetes will not be entitled to any free medication services when visiting most countries outside of Europe. Some countries, though, will have a reciprocal healthcare agreement with the UK.
Additionally, it is useful to be aware of emergency service telephone numbers (e.g. 911 in America) and the diabetic associations for the country you're visiting, especially if English is not the native language.
It you are travelling for an extended period of time, it is worth checking with the manufacturer of your medications that the particular equipment and/or medication you require is available beforehand and if it is sold under any different names.
Keep your supplies close at hand
It is essential that passengers with diabetes carry all necessary equipment and medication in their hand baggage, including insulin, injection pens, urine ketone testing strips, blood testing kits and testing strips.
Any gels will be required to be packed in a separate clear, sealable bag, but all liquid containers over 100m can be taken through if they are essential medical items.
Should you choose to pack the rest of your non-liquid medication in bags, they will need to be removed from your carry-on luggage and separated from your other belongings for screening.
Airport staff might need to open the containers to screen the liquids at the security point. However, sugary drinks such as Lucozade may be confiscated so it is worth bringing alternative means of sugar to the airport, such as sweets or glucose tablets. Any drinks can be then purchased from shops once you are through customs.
Insulin absorption may be greater after injection in warm climates, requiring additional checking of your blood glucose levels. This is especially the case if you are planning any periods of exercise immediately following an injection.
Colder climates, on the other hand, can make obtaining blood from fingertips more difficult. A way of preventing this from happening can be wearing gloves to keep your hands warm.
Testing strips should be kept out of direct sunlight, but in colder climates they should also be kept warm enough to prevent them from freezing.
When arriving at your destination, it's worth remembering that hot weather and dehydration can affect insulin absorption. This can lead to decreasing blood sugar levels.
Carrying sugar (i.e. a hypo treatment) on you at all times of the day is also imperative in case you or a member of your party is susceptible to hypoglycemia.
It is advised to consider the length of the trip you are taking and work out how the journey may affect your diabetes.
If your journey will require alterations to your diabetes management, these should be discussed with your diabetes team prior to departure.
Carrying medical identification and contact information on you at all times is essential. If you were to have a hypo in a public place then this ID will provide emergency services with the details they require on how to treat you.
It is important to make anybody else you are travelling with aware that you have diabetes and what they should do in case of an emergency. Ensuring your travelling party are aware of your medical identification will enable them to pass your information on to emergency services much quicker.
Insulin pumps and airport security
Insulin pumps and continuous glucose monitors (CGMs) should not be put through the X-ray machines that are used to scan luggage.
Insulin pumps and CGMs can safely go through the airport metal detectors (the ones passengers walk through).
Eating on the plane
Some airlines will provide the option of a “diabetic meal”, however, these are not recommended by experts and they can still raise blood glucose levels.
You can ring up the airline in advance to check, however, what glucose would be in a “diabetic meal” so you can plan what food to eat on the plane beforehand.
Storing insulin when flying
Insulin and other injectable medication could be damaged by temperatures that are too cold if put into the luggage hold of a plane. They should instead be taken in your hand luggage to prevent damage occurring.
Storing insulin when you land
You should store your insulin in a hotel fridge or cool bag when you arrive, which is especially important if you are travelling to very hot climates.
Blood glucose meters when at altitude
When testing your blood on board a plane, be aware that some glucometers have a tendency to under-read at altitude, particularly those dependent on a glucose oxidase reaction. The altitude at which the deviation seems to become significant is between 1500 and 2000 metres.
There is also a possibility of blood thickening at high altitude due to dehydration. It is therefore important to keep your meter and test sticks warm – this could be achieved by using insulated pouches worn under clothing and near to the skin.
Taking readings in the shade will deliver a much more accurate set of results, while using a large drop of blood will prevent rapid drying on the test strip.
Time zones and medication
If crossing time zones or travelling for many hours, specific advice regarding adjustments to medication can be obtained from your healthcare team.
If your time zone change is less than four hours, you may not need to make major changes whether you take insulin, tablets or other medication.
Be aware that in notably warmer or colder climates, the possibilities of different food being available and whether you are more or less physically active than usual may affect your medication doses.
If you are unsure of how to, or whether you may need to adjust your doses, arrange an appointment to discuss this with a member of your diabetes team before travelling.
You should make a note of the diabetes associations in the country, or countries you are travelling to in case of an emergency.