May 30 , 2017Blood sugar management Diabetes Diabetes Tips type 1 diabetes Type 1 Diabetes Management
It’s finally here: vacation season.
You’ve bought the guidebooks. You’ve written out an itinerary. Pretty soon you’ll be dipping your toes in the ocean or sightseeing a far-off city.
But before you hightail it out of town, make sure you’ve considered your diabetes. "The evidence … shows that about 10 percent of people with diabetes experience problems with diabetes control when traveling," says David Kerr, MD, FRCPE, a diabetes expert with the Bournemouth (England) Diabetes and Endocrine Centre and developer of the diabetes travel website VoyageMD.com. A little extra homework will keep diabetes from putting any kinks in your trip.
Whether you’re hitting the road or flying halfway around the world, these tips can help you have a healthy and hassle-free trip.
Plan for meals.
People with diabetes aren't alone in their desperation for a healthy midflight meal. The fact is, the food available on long flights is notoriously unhealthy, and sometimes it runs out. When booking your flight, many airlines will give you the option of picking a meal suited to your health concerns, but if you don't have that option, call the airline. Request a diabetes-friendly or vegetarian meal. Many airlines will offer heart-healthy or low-sodium options, too.
If the thought of eating airline food turns your stomach, buy snacks in the airport. Find nuts, seeds, fruit, yogurt, veggies and dip, sandwiches with lean meat, and salads at various vendors. If you didn't bring glucose to treat lows, this is also a good time to stock up on Transcend Glucose Gels.
Carry a doctor's letter.
Your trip through airport security will go smoother if you plan ahead: Ask your doctor to write a letter alerting the Transportation Security Administration (TSA) to your diabetes and your need to carry insulin, syringes, test strips, and other supplies. Also carry with you pharmacy-labeled pill bottles and insulin vials. You'll spend a lot less time explaining that the thingamabobs attached to your abdomen are what we in the diabetes world like to call insulin pumps and continuous glucose monitors.
Crossing time zones is tricky for people with diabetes because it requires adjustments to insulin injections and is highly individual. That's why you should mention your trip to your doctor at least a month before you leave. Along with the rest of your health care team, he or she can help you plan for the changes you'll need to make to your insulin regimen.
For a general idea of how traveling may affect your insulin needs, go to VoyageMD.com, which has a flight calculator, developed by Kerr, that can help you determine what changes to make to your insulin regimen. Still, it's important to discuss the suggestions with your doctor.
You and your health care provider can also discuss other travel-related changes you may need to make to your insulin plan. You might need to dose more or less insulin depending on your itinerary: "If [you're] walking all the time, you may need to adjust insulin," says Kruger.
Pack a carry-on.
As heavy as the bag on your back might be, avoid the temptation to store all of your diabetes supplies in your checked luggage. The cargo hold can get pretty chilly at 30,000 feet (not such a pleasant atmosphere for insulin). An even bigger worry is lost luggage. The safest way to ensure your supplies make it to your destination is to keep them on you while flying. If you plan to stuff your carry-on in the bin above your seat, keep a smaller bag beneath the seat in front of you so you have easy access to your meter, test strips, syringes and insulin, snacks, and fast-acting glucose. After all, meals may be delayed because of turbulence. To deal with eating uncertainties, consider dosing rapid-acting insulin after your meal arrives.
Mention your diabetes.
If you're traveling alone, it's important that someone on the flight know about your diabetes in case of an emergency. Alert a flight attendant when you board. You don't have to go into details, but let him or her know that you may need glucose gels if you become hypoglycemic.
Disconnect your pump.
You may want to consider briefly disconnecting from your pump during takeoff and landing. "Some studies have shown that the change in pressure on a flight can make the pump deliver more insulin," says Sheth. Once the plane has reached its cruising altitude, it's safe to reconnect. Before reconnecting your pump after takeoff and landing, check for air bubbles caused by altitude changes. Reprime the pump if necessary. Bubbles can cause you to get less of the medication than you intend.
Prepare for emergencies.
Federal regulations require U.S. airlines to have a medical kit on board, and the law specifies which necessities must be included. But that's not the case for international travel. "I've seen medical kits that you could run an entire ER with, and I've seen some medical kits with hardly anything in them," says Mark Gendreau, MD, assistant professor of emergency medicine at Tufts University School of Medicine and an expert in travel health. Regulations abroad often aren't as stringent as those in the United States, and certain budget airlines may not even have a medical kit. Call the airline ahead of time and find out what you can expect on your flight.
Being stuck in the middle of the ocean might not sound like the ideal vacation for many people with medical conditions, but today's cruise ships are essentially floating metropolises. The following steps will help you stay healthy and safe at sea.
Anyone who's ever faced a cruise ship buffet knows how easy it is to go overboard—nutritionally speaking, that is. Just as with any other buffet, moderation is the name of the game. Forget about seconds and stick with one plate of healthy food, such as fresh fruit and vegetables, low-fat dairy, whole grains, lean protein, nuts, and beans. If you're going to indulge—and, let's be honest, once you see that dessert spread, you'll have a hard time resisting—mind your portions.
Ask about emergencies.
When you book your trip, talk to the cruise line about its medical offerings, says Kruger. There are no regulations regarding cruise ship medical facilities, but industry guidelines say ships should be able to provide care to passengers.
It's also important to determine how the cruise line will handle emergencies. Is the medical facility equipped to give you an IV if you develop diabetic ketoacidosis? (It's a condition in which an insulin-deprived body breaks down fat instead of glucose, leading to a toxic buildup of ketones in the blood that can be fatal.) If an emergency occurs, can you be airlifted off the ship or will you have to wait until you reach the next port?
Be aware of alcohol.
Booze flows easily at sea (and in port), but you will need to pace yourself. Too much high-carb alcohol, such as beer or sugary cocktails, can make your blood glucose spike. If you're trying to lose weight, opt for water or diet soda instead. Alcoholic drinks are loaded with calories, so if you must imbibe, pick wine or light beer—and avoid anything garnished with a paper umbrella.
The flip side to the alcohol problem is that it can also lower your blood glucose. That effect can last up to 24 hours. Scarier still: "Even a small amount of alcohol can blunt the warning symptoms of hypoglycemia," says Kerr. If you're going to drink, don't do it on an empty stomach, and test your blood glucose often.
Laid-back beach life may zap your work-related stress, but it takes some planning to be on your way to a carefree day.
Keep meds and supplies cool.
If it's warm enough for you to sit out in a swimsuit, it's probably too hot for your insulin, which should be kept at room temperature. Bring along cool packs for storing your insulin. Cool, not frozen—freezing kills insulin. Keep your diabetes devices out of the sun in a cool place, too. "Even blood glucose meters don't like extreme temperatures," says Kruger.
Consider injections instead of a pump.
Many pumps are waterproof enough to swim with, though check your user's manual before you jump in. Certain pumps require you to disconnect before going in the water (it's usually OK to suspend your pump for an hour). But even if your pump can handle being dunked, do you want to risk it? If your day consists of lying out on the sand, the sun can heat the insulin in your tubing, Kruger says. Injections, on the other hand, will use insulin that's been kept cool.
Don't go barefoot.
Debris on the beach—sharp shells, bottle caps, and other trash—can cut the skin on your foot. If you can't feel the cut because of neuropathy, you may not notice a problem until it's too late and infection has set in. Always wear sandals or water shoes when walking the beach or stepping on the bottom of a lake or ocean. Do foot checks when you return from the beach.
The Big City
With pharmacies, hospitals, health clinics, and grocery stores all within walking distance, major metropolitan areas ease some of the stress that comes with traveling with diabetes. Still, taking a few precautions before you set off to sightsee can mean the difference between spending your day touring the Smithsonian or the inside of an emergency room.
Never assume you'll easily be able to find the diabetes supplies you need—even if you're visiting a city such as New York or Chicago. Carry everything you need (insulin, a blood glucose meter, test strips, syringes, backup infusion sets, and glucose tablets or gels) in a bag you'll have on you at all times. If your blood glucose dips after a long walk on Fifth Avenue, you'll want to treat immediately with a glucose source you're carrying.
Into the Wild
People with diabetes go on wilderness trips all the time. (Some have gone so far as to climb Mount Everest, weather Antarctic terrain, and cross the Sahara Desert.) The following tips will get you going.
Store insulin properly.
Keeping insulin cool when you're miles from the nearest refrigerator or ice machine isn't as impossible as it may sound. Instead of packing a cooler with traditional ice packs, which need to be refrozen when they get warm, pick a cool pack, such as those made by Frio, that doesn't require freezing or refrigeration. Just run it under cold water for five to 10 minutes, and crystals in the pouch will keep insulin cool for hours.
Deal with dirty hands.
If you spend any time away from running water, you may run into a problem: You need to test your blood glucose, but you have no way to clean your hands. Prevent this scenario by bringing small packets of alcohol wipes or wet wipes with you when camping, hiking, or otherwise spending time in an isolated area. Use them to clean dirt and food residue off your finger before pricking. If you forgot to bring wipes, use this diabetes educator–approved trick: Lance your finger, squeeze a drop of blood, then wipe it away. Do this again once or twice more before taking a reading to ensure you're using blood untainted by whatever dirt was on your finger.
Overseas vacations require more preparation than U.S. trips. There are passports to procure, language barriers to consider, and currency to exchange. With diabetes, vacation planning involves a bit more homework.
Whether you're headed across the globe or making a cross-border day trip, always pack more supplies than you think you'll need. It's even more crucial if you're headed to a country where you don't speak the language and where you may have a hard time finding medications and supplies.
Do your homework.
For foreign travel, you can never be too prepared. Start the minute you book your trip: Go to cdc.gov/travel for a list of destinations with information on safety concerns, medications you might need, tips for staying healthy in the country, whether tap water is safe to drink, and recommended vaccinations. For trips to less-developed countries, start with your primary care physician. Gendreau also suggests visiting a travel clinic, which can be found in many hospitals, to get all vaccinations, medications, and tips for minimizing health risks.
You may also want to study up on the local cuisine and get a feel for the types of food you may encounter on foreign menus. Sheth suggests eating at restaurants rather than street vendors because there's a greater chance someone will speak English and can answer any questions you may have. Sanitation and food hygiene may be better in restaurants, too.
Visit the doctor.
About six to eight weeks before your trip, visit your endocrinologist and ask for prescription refills, a doctor's note that may ease your route through airport security, and any advice on adjusting your medication while traveling across time zones. It's also a good idea to ask your doctor for the chemical name of each medication you take because many countries will carry foreign versions of the brand names you're used to. Keep in mind that your body may react unusually to the same medication obtained at a pharmacy in another country because the drug may have been mixed differently or might use varying additives, says Sheth.
Learn the language.
You don't have to be fluent in a country's native tongue in order to safely travel there, but you should prepare a few key phrases ahead of time, such as "I have diabetes" and "Where is the hospital?" Write them down on your phone or on note cards that you can keep on you at all times. That way, you can flash the phrase at a person in an emergency.
Talk to your insurance provider.
You're unlikely to be the poor traveler who's sick enough to require thousands of dollars' worth of medical treatments, but if it happens to you, you'll want to be covered. Start by calling your insurance company and asking what medical expenses it will pay for, what you need permission for, and what you'll have to cover on your own. "A lot of insurance companies won't do full evacuations," says Gendreau. Instead, they may cover only a fraction of the total cost.
Buy travel insurance.
The primary reason many people buy travel insurance is to cover the steep cost of medical evacuations, which can run higher than $100,000. Gendreau recommends WorldClinic (worldclinic.com) because it offers travel insurance with perks: The company can send a Learjet and medical team to evacuate you and can airlift you to an American hospital instead of what many medevac companies consider the "most reasonable medical facility."
Note local hospitals and pharmacies.
Digging around for local medical care options is a smart idea. Find out what pharmacies and hospitals are closest to your hotel before you leave for your trip. If you skip this step and are in a bind, ask the hotel for recommendations. Staff there may even be able to help you track down a doctor if needed.
Get to know the embassy.
When traveling abroad, it's important to know where to turn during a medical emergency. "Become familiar with the [U.S.] embassy in the country that you're traveling to, and make sure it has a health branch," says Gendreau. The embassy will have a list of physicians whose credentials have been evaluated and approved and who speak English. Embassy staff can also help you with medical evacuations if needed.