Diabetes is a disease that is far more prevalent than people think, but contrary to popular belief it is not one that – if managed well – should stop you from travelling or jumping into your own adventures around the world.
As a qualified nurse I get a lot of questions about travelling with diabetes on my travel clinic. I always advise people that it is entirely possible if you manage it well, and with the right preparations and the right amount of knowledge, it is not something that should be a barrier to travelling the world or doing anything you want to do at all. So lets get down to it and take you through this step by step guide to travelling with diabetes.
What is diabetes?
Diabetes is essentially a long term condition where a persons blood sugar levels (glucose) are too high and cannot be used properly by the body. If left untreated or unmanaged it can cause a lot of serious long term side effects and complications. There are 2 basic types of diabetes.
- Type 1: This is a predominantly genetic autoimmune disease where the body doesn’t produce insulin, the thing that is needed to carry glucose from food into your cells to be used for energy. This means that glucose levels in the blood can rise very quickly. This type of diabetes will require regular insulin injections.
- Type 2: This is much more common, making up the absolute majority of all diabetes cases, and is predominantly lifestyle related as opposed to genetic. In type 2 diabetes the body doesn’t produce enough insulin to convert the glucose into energy, or the insulin that it does produce doesn’t work properly. This can be managed with a healthy lifestyle, or in more serious cases tablets or insulin injections.
Diabetes is a major public health problem with a huge number of people diagnosed every year, and millions more expected to be living with undiagnosed diabetes. Given the state of hidden sugar in processed foods and a generally bad lifestyle lived by many people over the last 20 years or more, this is expected to rise dramatically and exponentially in the next 20 years.
Making sure your diabetes is manageable.
Before you even think about setting off on your gap year or backpacking adventure, you want to make sure that you are managing your diabetes well.
This means that your blood sugar levels should be relatively stable, you shouldn’t be getting uncontrollable highs or lows, you should know how to administer any insulin injections or medication and you should be managing with any lifestyle or medication requirements.
This should really go without saying, but uncontrolled diabetes is far more common than you might think, and you don’t want your adventure of a lifetime cut short because you couldn’t resist those extra sticky mango rice puddings.
This is all about ironing out any problems before you go away. If you are newly or recently diagnosed, just make sure that you have settled into a lifestyle and medication regime, you are checking your blood sugars regularly and that you are seeing your diabetes team and GP regularly before you go. You know your own body and you are responsible for it. If it is controlled well at home, you shouldn’t have any problems at all when travelling.
Get yourself checked thoroughly.
It is an unfortunate fact of life that with diabetes comes a lot of regular checks from us friendly health professionals. This is essentially to spot and deal with problems before they become bigger problems, and this is just as true before you travel as well. Make appointments with your diabetic nurse, GP, optician and make sure everything is okay before you go.
Get the right insurance.
I never like giving bad news, but your insurance will probably go up if you are travelling with diabetes. I’m sorry, there’s nothing anyone can do about that.
Most average travel insurance policies will exclude pre existing conditions such as diabetes, and it is absolutely essential that you disclose it on any policy. If you don’t and you need to file a claim, then they will just dismiss it out of hand. This is why you have to make sure that you find a policy that does include pre existing conditions, and make no mistake, travelling without insurance is a very bad idea, no matter how appealing saving that money is!
Before you fly.
It is always a good idea to get some form of diabetes ID, which clearly states you are a diabetic and what to do in an emergency, especially if you are travelling with medication.
Get a letter from your GP stating that you are a diabetic and what medication you need, and will be carrying with you. This is essential not only for getting through security at airports but if you need emergency supplies wherever you go.
Plan ahead and get at least twice as much medication or insulin as you would normally require to carry with you. If you are planning to travel long term then plan your itinerary so that you are hitting major cities or countries with decent health care before you start running out so that you can restock easily and don’t run out.
To help you plan this itinerary contact your insulin manufacturer before you leave and ask them which destinations or clinics will stock and supply their insulin, and also ask them if those countries use a different brand name for the insulin (sometimes the exact same product can have a dozen different names, I know, we get really frustrated with that too!)
Remember that in the UK we measure blood sugar levels with the standard millimoles per litre (mmol/l), but not every country uses the same measurements so just to avoid any confusion (and any wrong doses) make sure you make a note of this conversion chart for when you restock.
Also remember that insulin comes in different strengths and doses. In the UK we generally use U 100, but this may not be the case in the destination you are travelling to so it is always a good idea to check.
Packing supplies and airport security.
Always split your diabetes supplies and medications into separate packs, and keep them in their own container if possible to help with organisation and safe storage. There are a huge range of protective cases to choose from, some which help keep your insulin temperature regulated as well. If you are travelling with someone, then have them carry some for you too. That way you always have an immediate supply if something happens to one of your packs.
The normal (and ridiculous) 100 ml liquid security restriction doesn’t apply for medical supplies or medication, which technically are counted as ‘essential medical supplies for the period of your trip’, which means you can take on as many tablets or as much insulin as you need, and does include all lancets, needles, monitors and batteries.
It is also quite often mandatory to contact the airline beforehand and inform them of any medical supplies or equipment you may be taking on board, and if you are travelling with a pump or other equipment then you may be required to fill in extra paperwork. Even if this isn’t a requirement on your airline it is always a good idea to do it anyway just to be sure.
This is where the letter from your GP will be essential, and the Civil Aviation Authority’s own guidance states that this is important to verify the medication and equipment you need to carry with you. It is also a good idea to get your GP to state that you do have to carry your medical supplies with you on the flight and not store them in the hold. I’m not saying airline security staff are clueless, but …
If you are also travelling with an insulin pump or continuous glucose monitoring device (cgm) then you can also opt for a pat down search or other screening options as their is conflicting advice on the affect of x ray machines on the devices. All EU airports will be aware of this, but you may need to explain it if you are travelling elsewhere. Again this is where that letter will come in handy.
If the airline requires you to remove your pump or cgm device, which some do, then you need to be prepared for that and have a blood glucose monitor and manual insulin pen ready for the flight.
Considerations when flying.
Flying in and of itself doesn’t pose any significant problems to travellers with well controlled diabetes. Most potential problems come from the logistics of travelling with equipment and medication and these can be managed with a bit of preparation.
Assume that there will be delays when flying and pack extra snacks and drinks so you can manage your blood sugars more effectively.
Glucose tablets or high sugary drinks (Lucozade is the go to drink but any fizzy sugary drink will do in a pinch) are a good idea in case of a blood sugar drop or hypo, alongside longer acting carbs like a sandwich, biscuits or fruit.
Speak to the airline crew when you board, they will be able to tell you the times of the meals and make sure you are served on time so that you can plan your insulin doses accordingly.
Maintaining a healthy diet and lifestyle when travelling.
The good news is that a healthy diet is a healthy diet, and the diet recommendations for people with diabetes are the same as anyone eating a healthy, balanced diet. There are no real restrictions provided that you check your blood sugars regularly, maintain any medication regime and keep your levels balanced. So don’t be afraid of trying out that awesome looking street food stall or having that desert if you want to. Food is one of the absolute best things about travelling the world and you shouldn’t miss out on that just because you have diabetes! Just be sensible with it and keep everything balanced and in moderation.
It is also a very good idea to maintain a healthy lifestyle and a good fitness and exercise regime when travelling too. This is of course good advice for anyone, but the basic fact of the matter is the healthier and fitter you are, the easier your diabetes will be to manage.
If you do all of this and manage your diabetes well, then there is absolutely no reason at all why it should stop you from doing anything that you want to do, whether that is taking a gap year, a snap year, climbing mountains or diving in the red sea! Don’t let your condition control or determine your life and get out there!
Did you enjoy this article or find it useful? Remember you can always make an appointment at my online travel clinic if you need any further advice on a one to one basis or have any questions at all.
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