Traveling with Diabetes
Traveling with Diabetes
- Take extra oral medications and/or insulin as well as extra supplies for your glucose meter. Double the normal amount of supplies for short trips. For long trips, have enough supplies to last for two weeks longer than the length of your trip.
- Take prescriptions for your medications with you, in case you run out or lose your supplies.
- Test your blood sugars in your usual routine or more frequently; remember travel will make your blood sugar less predictable. Test more often if there is a concern about hypoglycemia.
- Don't forget your medical identification.
- Keep some food and drinks with you in a cooler in case of unexpected delays.
- Do not leave your glucose meter in a hot or cold car or directly in the sun.
- Do not leave insulin in a hot or cold car. Insulin will spoil if it freezes or gets much warmer than 75 degrees Fahrenheit. Insulin does not need to be refrigerated, but it may be easiest to keep it in a cooler in the summer, a little away from the ice. Or there are available commercial pocket "coolers" for insulin - we like the Frio Wallet.
- If your blood sugar is low, stop immediately and treat. Check your blood sugar levels and do not drive until your levels are within the normal range.
- If you are using an insulin pump, you may want to increase your basal rate 20 - 40% (using a temporary basal rate) for longer trips to compensate for inactivity.
- If you are using injections, this is a little harder to do, but in general, add a few units to your boluses for this same reason.
- Ask us for a letter outlining your diabetes treatment plan and supplies you will be carrying; this will help you get through customs, onto airplanes, etc.
- Pack your diabetes supplies in your carry-on and not in your suitcase. Luggage can get lost and extreme temperatures in the baggage area can damage supplies.
- Consider carrying your opened and in-use insulin, oral medications, and meter in a fanny pack that stays attached to your person. Instant accessibility makes an enourmous difference in emergencies.
- Since September 11, 2001, you may carry insulin and supplies on board provided you have a pharmacy label on the insulin with proper identification.
- Make arrangements with the airline in advance if you require a special meal(s) during the flight.
- Carry some snacks with you on the plane.
- Check with us about changing your insulin dose or schedule if you are traveling across three or more time zones, or check out the suggestions below.
- If you need insulin while you are flying, put only half the air into your insulin vial to adjust for altitude pressure changes.
- Find out which immunizations are needed for your trip. Get immunized at least three - four weeks prior to your departure.
- Pack a translation book and learn key phrases of the country you are visiting to express your diabetes needs.
- Pack a small disposable container to hold used lancets and needles - empty film canisters or empty glucose meter strip canisters work really well and zip lock bags are good for syringes without the needles.
- Also pack a supply of non-prescription medicines to treat minor illnesses.
- Check out the International Association for Medical Assistance to Travelers for information on English speaking doctors in foreign countries.
Changing Insulin Doses for Crossing Time Zones
This only applies to flying, because you change time zones quickly and only if you cross at least four time zones. If you drive or travel by ship, just follow the local times and if you cross only three time zones or less while flying, just follow the local times.
Rapid acting insulins (regular insulin, Novolog or Humalog)
- Rapid acting insulin given with meals does not need to be changed. Take it when you eat, as you would any other time.
Long acting insulins (UL or Lantus)
- UL or Lantus insulins also don't need much adjustment. If you take one of these only in the evening, keep taking it once a day, but "shift" the insulin time by up to four hours with each dose to get to a convenient dosing time locally (you may want to keep one watch set to your local American time to help). Examples:
- You are flying from Boston to San Francisco. The time difference between the two is four hours. Just keep taking your Lantus or UL "in the evening" based on local time, as you would normally, the four hour time shift will not affect the insulin much. Since the continental US only has four time zones, you can always just keep taking your long acting insulin "at your usual time" based on local time.
- You are flying from Boston to Munich. Munich is six hours ahead of Boston. On the day of departure, take your Lantus or UL about three hours earlier than usual, which will move you "half way" to Munich time. The next day in Munich you can take it at the "usual time" based on the local clock, which will complete the six hour shift to Munich time.
- If you take UL or Lantus twice a day, you can get away with even bigger shifts in the doses in time.
Crossing time zones with an insulin pump
- When you get to your destination, reset your pump clock.
- If your basal rates are very different throughout the day to account for different activities throughout your usual day, you may want to reset to a single basal rate chosen as your best estimate of need while traveling.
- Your boluses for food and correction will not change.
Intermediate Insulins (NPH, Lente)
- These are more difficult to adjust.
- You may want to talk to us about your particular circumstances before you go.
- If you take your NPH or Lente just at bedtime, then in general keep taking it at bedtime.
- If you take NPH or Lente twice each day and you are traveling EAST, then you'll want to take only 2/3 of the first dose at your new destination. If you are traveling WEST, you'll want to add a 1/3 of the latest dose you took at home about 4 - 6 hours later.