As any travel agent or stranded tourist will tell you, planning ahead is the key to a successful trip. And this is particularly true for people with diabetes - a little forethought will take you a long way and help keep you healthy once you are there. Whether you want to hike in the Canadian Rockies or lie in the Florida sunshine, you can turn to the Canadian Diabetes Association for travel tips to help you to make your journey safer and more successful.
PLANNING AHEAD
Diabetes shouldn't stop you from doing the things you want to do. If you want to travel, and you have diabetes, you must plan ahead carefully. There are many disaster stories such as lost luggage or encountering a hurricane. Travelling can be stressful sometimes - and stress can raise blood glucose levels. Although you can't avoid the odd surprise, preparation before you leave can help you avoid undue stress.
Consider telling your travel agent that you have diabetes and explain some of the particular needs that travelling with diabetes entails. That way, a suitable itinerary can be planned to meet your needs. A missed connection or illness can ruin the best-laid holiday plans.
Visit your doctor or diabetes educator
It is a good idea to visit your doctor for a checkup several weeks before you leave. Show your itinerary to your health care team and work out plans for your meals and medication, especially if you are travelling through different time zones. Be sure to get any required vaccinations at least four weeks before you travel so you have time to deal with any possible side effects.
Ask for a list of your medications (including the generic names and their dosages) from your pharmacist -- particularly oral agents for diabetes and insulin. If you take insulin, record the types of insulin and whether the insulin is short, intermediate or long-acting. Photocopy the list and carry one copy with you at all times. Some countries require you to have written documents from your doctor, stating that you are allowed to carry medicines or supplies. Syringes and needles in particular can present a problem when entering some countries.
Illness Management Tips
Ask your doctor or diabetes educator what to do if you get sick on your holiday. Generally, if you experience motion sickness while travelling, take carbohydrate in the form of fluids. If you are not sure how to convert carbohydrate to fluids, ask your diabetes educator. Here are some basic illness management tips:
- Test your blood glucose levels every two to four hours around the clock.
- If you have type 1 diabetes, test your urine for ketones every four hours around the clock. If your blood glucose is high and you have ketones in your urine, you will need to take more short-acting insulin.
- Never stop your insulin or oral agents when you are ill, even if you are unable to eat. If your blood glucose levels are low you may need to reduce the dose.
- Drink lots of fluids as illness can cause dehydration.
- If you are able to eat follow your regular meal plan and drink one cup of sugar-free fluid per hour (e.g. water or diet pop).
- If you are unable to eat drink sugar containing (e.g. regular pop or tea with sugar) fluids. Try to take one carbohydrate choice per hour. See the Canadian Diabetes Associations'Good Health Eating Guide for a list of choices. In addition, drink sugar-free fluids. Try to drink one cup of fluid per hour.
- Rest.
- Seek medical attention if you vomit more than twice.
If you use insulin to manage your diabetes, you should also ask your doctor or diabetes educator about Glucagon. Glucagon is an injection that is used to treat severe low blood glucose, a condition that can cause seizures or a loss of consciousness. If you are travelling to a remote spot that does not have ambulance service, it is important that your travel companion learn how to give Glucagon. See your doctor or diabetes educator if you are unfamiliar with its use.
Identification
Take identification with you that explains your condition in case you are unable to give instructions yourself. Consider getting a MedicAlertTM bracelet or necklace that states you have diabetes or obtain an information card from the Canadian Diabetes Association detailing your type of diabetes and the treatment you require. (For more information on how to contact the Canadian Diabetes Association or the MedicAlert Foundation, see the Resources section at the end of this pamphlet).
Travel Insurance
Some insurance plans do not cover pre-existing medical conditions, which includes diabetes.
The Canadian Diabetes Association offers its members medical travel insurance that includes worldwide 24-hour protection. Costs vary according to age, type of diabetes and the length of your stay. Coverage is for health care only and does not include theft or other concerns.
(For more information on the Canadian Diabetes Association travel insurance program, call 1-800-BANTING).
PackingDivide your medications and diabetes supplies and pack them in more than one place, in case you lose one of your bags. Most importantly, make sure that you have a portion of medications and supplies in your carry-on luggage. Take extra supplies and medication in case of loss, theft or accidental destruction. Also consider some of the other supplies you may need including treatment for hypoglycemia, food supplies, drinking water, walking shoes, sunblock and medication for nausea and diarrhea.
By Air
Most airlines are more than happy to help with the special needs of their passengers. Airlines usually offer special meals for people with diabetes, but most often the regular airline meals can fit into your meal plan with some careful planning. Always have some appropriate snacks with you in case your flight or in-flight meal is delayed or the meal provided does not have enough carbohydrate. Be aware of time zone changes and schedule your meals and medication accordingly. If you choose to sleep while on board, use a travel alarm clock or ask the flight attendant to wake you at meal or medication time.
Most airlines are more than happy to help with the special needs of their passengers. Airlines usually offer special meals for people with diabetes, but most often the regular airline meals can fit into your meal plan with some careful planning. Always have some appropriate snacks with you in case your flight or in-flight meal is delayed or the meal provided does not have enough carbohydrate. Be aware of time zone changes and schedule your meals and medication accordingly. If you choose to sleep while on board, use a travel alarm clock or ask the flight attendant to wake you at meal or medication time.
If you take insulin, be sure to carry it with you at all times. Manufacturers indicate that, ideally, insulin should not be exposed to x-rays during travel and that it be inspected manually whenever possible. However, the security scanners used at check-in will not normally damage your insulin or blood glucose meter. If baggage remains in the path of the x-ray for longer than normal, or if the baggage is repeatedly x-rayed, the insulin may lose potency. Insulin is affected by extreme temperatures and should never be stored in the unpressurized baggage area of the aircraft. As always, it is important to inspect your insulin before injecting each dose. If you notice anything unusual about the appearance of your insulin, or notice that your insulin needs are changing, contact your doctor.
Try to do some activity during your journey. Walk around in the terminal before boarding. Consider doing simple stretching exercises in your seat. Move your ankles in circles and raise your legs occasionally.
By Car
Whether you are a driver or a passenger, checking your blood glucose regularly is very important. Check your blood glucose before you leave home and then again every four hours during your journey.
Stop every few hours to stretch your legs and do some physical activity. This will help improve blood circulation.
At the first sign of low blood glucose or hypoglycemia, pull over to the side of the road and take a form of fast-acting sugar such as three glucose tablets or 175 mL of fruit juice. Follow this with a longer-acting carbohydrate such as a sandwich. Do not start driving again until the symptoms have disappeared and glucose values are above 6 mmol/L. If you take insulin, avoid driving in the time between your injection and your next meal. Limit your driving to a maximum of 12 hours per day, or six hours between any two meals.
Keep your medication, meal, and snack times as regular as possible. You may not always be able to get to a restaurant on time, so bring supplies with you to treat low blood glucose (e.g. three glucose tablets, four to six Lifesavers� or 125 mL of fruit juice or regular pop) in case of traffic jams, car trouble, or wrong directions.
By Sea
Cruise holidays are known for all-you-can-eat buffets. With a wide array of mouth-watering foods available, it's easy to overindulge. Talk to your diabetes educator before you leave about how to fit some of these foods into your meal plan. When possible, obtain a sample menu from the cruise line so you can get an idea of the types of foods served and you can then plan your meals accordingly.
Keep active to compensate for extra food eaten. Cruise ships offer some great activities; try an aerobics class, go for a swim, or stroll the deck at sunset.
It's a good idea to make the cruise staff aware of your diabetes in case any problems arise. Have all of your medications well documented.
By Foot
A vacation in the great outdoors can make for an excellent retreat from the pressures of everyday life, but there are a few things to consider before you go. Most importantly, there is safety in numbers - avoid going camping or hiking alone. Tell someone where you will be and when you expect to return, so you can be found in case of an emergency. Bring along a first aid kit and if you use insulin, a Glucagon1 Emergency Kit. Teach your travel companion when and how to use Glucagon. For more information about the Glucagon Emergency Kit, talk to your diabetes educator.
A vacation in the great outdoors can make for an excellent retreat from the pressures of everyday life, but there are a few things to consider before you go. Most importantly, there is safety in numbers - avoid going camping or hiking alone. Tell someone where you will be and when you expect to return, so you can be found in case of an emergency. Bring along a first aid kit and if you use insulin, a Glucagon1 Emergency Kit. Teach your travel companion when and how to use Glucagon. For more information about the Glucagon Emergency Kit, talk to your diabetes educator.
The key to enjoying a camping trip is to avoid things that severely alter blood glucose levels. Avoid cuts, bruises, sunburns, blisters, insect bites and contaminated food or water. Of course, make sure you eat and drink enough to meet your needs - bring extra food, water, medication and sugar. Store your food where animals and bears cannot reach it. If you are extremely active you may need to decrease your diabetes medication, so be sure to discuss this with your diabetes educator or physician.
1 Glucagon is used when a person has severe hypoglycemia and is unconscious.
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