Travelling with diabetes Voyage Tips and guide

Diabetes is a disease related to the blood sugar level of the body and the hormone insulin which regulates it. People with diabetes need to take some things into account when they travel and in their daily life in general, including keeping a suitable diet and carrying medication and equipment for measuring their blood sugar level.

The number of people with diabetes has risen over the years, as of 2013 the estimate is 8.8% of the global adult population. It is partially a hereditary, a lifestyle, and environment related disease, and there are two main variants called type 1 and type 2.

Both too low (hypoglycemia) and too high (hyperglycemia) blood sugar levels can be potentially deadly.

As a diabetic, depending on the seriousness of your disease you may have to monitor your blood sugar level continuously using a sensor attached to your body, and have an insulin pump likewise attached to your body, or have to carry an injector and testing device for fingerprick testing. You will almost certainly have received advice from medical professionals for how to manage your diabetes at home, though like with any medical condition, it means you need to take certain things into consideration when you travel.

Plan ahead both for yourself and for your medical equipment. Consult your doctor before you travel. As a diabetic you may need to keep a regular meal schedule. Will you be able to get something to eat when you need to, and can you bring your own snacks - e.g. flight security limits liquids and gels you can take onboard and customs control in the destination country may not allow certain food products from abroad into the country? Also, if you travel long distances east or west, the time difference may affect your meal schedule.

The weather conditions, more specifically the temperature is also something to consider. If you carry insulin pens, they should be stored at room temperature, roughly speaking. Freezing cold or extreme heat will ruin the insulin - carry them in an insulated bag or keep them indoors or in a vehicle. Especially for long-term stays, check how to get replacement insulin at your destination (you will need a prescription valid for pharmacies in the destination country). Extreme temperatures can also upset your blood sugar level.

While you should obviously obtain travel insurance for your trip, also research into the healthcare services that are actually available at the destination, particularly if going to remote areas or developing countries.

Make sure to tell people you travel with that you have this condition; that you (especially with diabetes type 1) will regularly have to monitor your blood sugar level, inject insulin when needed and that in the case of hypoglycemia they need to give you something with high sugar content (though only in the case you can swallow, otherwise they may need to call the emergency number).

In addition to what you normally pack - from travel documents to clothing - diabetics also need to pack not only their medication and equipment but also different documents for travel abroad. You need prescriptions for your medication to show the customs and if you need to fill up yout supply at your destination. The medical equipment such as insulin pumps, sensors and meters might need to be declared to bring onboard an airplane.

Already when going through airport security you need to know if said equipment is X-ray sensitive and if this is the case, have documentation on hand to show the security staff that you need to carry the equipment past the X-ray machine to keep it safe. Here you also need to mention if you have some medical equipment on you body like a glucose sensor or insulin pump.

Another thing when flying, never pack all of your medicines or medical equipment in one checked bag because bags can get lost. Spread out your stuff between hand and checked luggage, or between individual pieces of checked luggage.

Travel does not always go to plans. Planes and trains may get delayed or even cancelled, drives may take longer than you think, and places to eat may be closed - not a big deal in larger cities but a different matter in remote areas. Therefore, you should bring snacks in the case your blood sugar level drops. For air travel, you need to consider what you can take into your hand luggage and in your pocket - bringing fluids and gels through the security screening is generally limited. In some cases you need to go through security again at your transfer airport meaning you may have to discard fluids bought after security at your departure airport or onboard. Also if you travel internationally, inform yourself about customs regulations (for countries like Australia it's in practice easiest to avoid bringing any food, or just bring glucose tablets and packaged confectionary).

Especially if you travel to destinations different from home, the food available will to various extents be different from what you're used to back home. Just as if you have food allergies, it can be a good idea to familiarize yourself with the carbohydrate content of the local food. Food and drink brands may have different ingredients to home, so check the nutritional label if possible.

If you plan on drinking alcohol, remember that alcohol intake lowers the blood sugar level.

Hypoglycemia means low glucose levels (below 5 mmol/L), is a dangerous condition and in this case you need to consume something with sugar content, e.g. candy, sooner rather than later. This can kick in quickly, particularly if you have had strenuous exercise. Hypoglycemia can be deadly.

Hyperglycemia, the other extreme, is also a dangerous condition. It will of course go down with time but you may need to add insulin to get the level down or prevent it from rising higher.

Other diseases and conditions like fever or diarrhea likewise affect the blood sugar level, for example if the body doesn't have time to digest and take up carbohydrates from food before it comes out.

Having an extensive travel insurance that covers medical costs is important for travelers, but especially for people who have a higher than average risk of getting into a situation where they need medical care. You are often required to declare pre-existing medical conditions including diabetes when purchasing travel insurance.

• Travelling on a low-carbohydrate diet
• Dealing with emergencies