Any time of the year is a good time to make a trip without the right circumstances. Summer, Christmas, Easter,… Many times this implies trips to other countries, with different habits and time zones. The weather can also be a factor to take into account in the control of diabetes.
This makes it important to follow a number of recommendations for people travelling with diabetes.
What do we do about diabetes medication?
If you are travelling abroad, it is important, before travelling, to find out if the destination you are going to has health care agreements with your country
It is very useful to be in possession of the European Health Card, which guarantees reciprocity in the treatment between the traveller and the nationals of the country you are travelling to, although not all countries have the same benefits as ours.
In any case, if it is a short stay, typical of a summer holiday, it is advisable to take the medication from your country. There are refrigerators and “cold wallets” to keep insulin at the right temperature.
If you travel by plane is essential a brief medical report, in English if not to a Spanish-speaking country, which would also serve to inform the doctor of the country of destination in case of emergency. (We attach here a sample medical report that may be useful).
Insulin pumps may or may not sound when passing an airport or train control arch, depending on its sensitivity, so some people prefer to warn the officer in charge in advance that they are carrying an insulin pump (with the corresponding report).
For air travel it is essential to specify that insulin, along with glucagon, test strips, lancets, needles, disposable insulin pump material,… and any other medication must travel in the cabin and not in the baggage department, to avoid both the deterioration of medication by temperatures in the baggage department and to avoid losses.
To minimise this risk, if you are travelling with someone you trust, it is advisable to distribute the medication so that the other person(s) also carry medication in their hand luggage.
We must not forget to take food to overcome hypoglycaemia, which includes both fast absorbing carbohydrates (sugar, glucose gels, juices -preferably industrial juices that go up faster than natural ones- that are not “light”), and slow (cookies, toast,…).
If for any reason we have to buy insulin abroad, we have to look at the concentration of it.If we are given an insulin pen and supplies the corresponding insulin dose that is marked on the device, the danger would be if we are given vials of, for example, 40 units/ml and we use our 100 ui/ml syringes. In this case, we would be administering 2.5 times less insulin than we intend, so if they give us vials of a different concentration we must also buy syringes that are marked for that concentration.
On trips within Europe there are usually no problems with the medication, but they can be produced with test strips to measure blood glucose, so it is advisable to take them from the place of origin.
Is it necessary to adjust the dosage?
Sometimes it is necessary, especially in people who administer insulin, since among the factors that influence absorption are temperature and humidity. Logically, the lifestyle can also be very different, so it would be necessary to adapt the guideline to that lifestyle.
When travelling from east to west or vice versa, time zones are changed, which can make it difficult to adapt the therapeutic regimen. Travelling to the west earns hours, the opposite of what happens when going east. With bolus/basal insulin guidelines and, even more so, with insulin pumps, it is easier to adapt the therapy. Logically, the doctor in charge of taking the case is the one who should recommend how we adjust the medication.
On travel days it is advisable to measure capillary blood glucose more frequently, in order to have more information to make the changes. Obviously, in a person with type 2 diabetes controlled with only oral antidiabetics these adjustments are much simpler, but even so, especially if in addition to oral antidiabetics is also being treated with insulin, it is advisable to discuss it with your doctor.
Adaptation to lifestyle change
In summer, and even more so during the holidays, the lifestyle is usually different from the usual one. In many cases the greater availability of free time favours more physical activity.
Tourism can also be associated with visiting museums, monuments, touring cities or walking along the countryside or the beach with the result that it will be necessary to reduce the dose of medication or compensate with carbohydrate intake to prevent hypoglycaemia.
Another danger associated with exercise, especially at very high temperatures, is dehydration. Therefore, it is essential to hydrate well with water or isotonic drinks.
Diet, along with medication and exercise, is one of the fundamental components of diabetes treatment. In summer it is also common to consume foods other than those of winter. If, in addition, you travel abroad, you may find foods that are very different from the usual ones.
However, in others they do it worse or, simply, they do not do it. When the food you have chosen has more or less hydrates than expected we can always use bread or fruit as jokers to adjust the rations.
With regard to drinks, in addition to the aforementioned recommendation to stay well hydrated, it is worth remembering that we consider water, coffee (normal or decaffeinated), infusions, malt and siphon to be free. Light” drinks are also allowed, but it is advisable to read the label to guarantee the absence of carbohydrates.
Alcohol consumption should be moderate, as should people without diabetes, taking the precaution of taking it together with food to avoid hypoglycaemia. The most recommendable would be wine or beer. In case of drinking a drink of more graduation (gin, vodka,) should be done in small quantities and combined with soft drinks other than “light” to minimize the risk of hypoglycemia.
In countries that do not have sanitary guarantees, especially if they are tropical, the water consumed should be bottled. Ice added to drinks should also be made sure that it does not come from tap water.
Special precautions for travellers
In tropical and subtropical countries it may be necessary to be vaccinated against diseases such as malaria.
Often there are areas within the same country in which it is necessary to be vaccinated and not in others, so before contacting you must be well informed about the specific geographical location to which you are going to travel.
One of the most typical problems when travelling is “traveller’s diarrhoea”. What for many people can be simply annoying for a person with diabetes can be dangerous. It is a good idea to bring some medication to combat it, such as loparamide.
If you travel by boat or airplane and are prone to dizziness, you should also bring drugs to combat them.
Among the typical complications of diabetes is the diabetic foot. Remember that you should not walk barefoot on the beach if you have neuropathy or vasculopathy. On holidays you often walk more than usual. Footwear should be adequate, should not be worn for the first time during the trip, it is preferable to have a wide heel with a height of between 1 and 5 cm to facilitate foot play, flexible and without interior seams.
15 tips to keep in mind if you travel outside
Find out if the destination we are going to has health care agreements with your country. If the destination country is in the European Union it is very useful to obtain the European Health Card. Find out here how you can do it.
If you have a travel insurance, or medical insurance (company or similar) is necessary before leaving the trip, find out what steps to take to be served in the country of destination if necessary.
Take a report from your doctor with you to prove that you have diabetes and that you should carry your medication and some devices (glucose meter, lancets, insulin pens, insulin pump, continuous monitor, glucose monitor, etc.). If you are going to a non-Spanish speaking country, the report should also be written in English. (Attached here is a sample medical report that may be useful.)
If your stay away from your usual residence is not going to be very long, take with you all the necessary treatment material for your holidays: lancets, test strips, insulin, glucose meter, tablets, extra refills for the infusion set and batteries if you are on insulin pump treatment, and in the latter case, insulin in pen or vials to be used if you have technical problems with the infuser.
When travelling, you should always carry a glucagon kit.
If you go to a place where it is hot, there are refrigerators on the market to keep the material at the right temperature.
If the trip is made by plane, it is essential to specify that insulin, along with glucagon, test strips, lancets, needles, disposable material from an insulin pump and any other medication must travel in the cabin and not in the luggage department (to avoid both the deterioration of the medication due to temperatures in the luggage department and to avoid losses). If travelling with fellow travellers, it is advisable to distribute the medication so that the other person(s) also carry medicines in their hand luggage.
It is advisable to double – or triple – the medicines you will need during the holidays, in case of losses, deteriorations, delays in the trip, etc.
Do not forget to bring food to overcome hypoglycaemia, which includes both fast absorbing carbohydrates (sugar, juices, etc.) and slow carbohydrates (biscuits, toast, etc.).
On travel days, it is advisable to measure capillary blood glucose more frequently, in order to have more information and make the necessary adjustments due to different time zones or lifestyle changes (diet, exercise, etc.).
In warmer areas it will be necessary to pay more attention to hydration and always drink bottled beverages. It will be necessary to take into account the labeling of drinks to check the carbohydrates that are ingested.
It is important to pay attention to the food as these may be different from those you usually eat, try to follow a diet as close to yours.
It is advisable to bring medication to treat travel complications such as diarrhea or vomiting.
If your destination is the beach or the river, remember not to walk barefoot if you have neuropathy or diabetic foot.
Always, before a trip, consult your doctor to adjust the treatment well.
If you want to treat you diabetes permanently, I would highly recommend to read our Halki Diabetes Remedy Review.