Diabetes & going on holiday

It will be necessary to test your blood glucose levels more frequently. They could be raised if you have been sitting still in the car or on a plane or eating food with more carbohydrates than usual. The excitement involved in visiting a new city or country may also increase your blood glucose level.

Remember always to take spare insulin, at least 2-3 times the amount you expect to use. Keep insulin and pens/syringes in your hand luggage but make sure that you have an extra set in another bag in case you lose one bag. Don′t put insulin in the check-in luggage, as there is a risk of it freezing in the airplane luggage hold at high altitudes. Besides, there is always the risk of your luggage being lost or arriving late. The X-ray in security controls will not affect your insulin. It is important to have some kind of ID showing that you have diabetes, as you may have to show it to the customs officer.

Usually, you should not have a problem obtaining insulin from a pharmacy abroad if you can prove that you have diabetes. Take a card on which your doses, concentration and brand of insulin are documented, or bring the original pharmaceutically labeled box. It may be difficult to store your insulin in a refrigerator all the time, but usually it will not be wasted during a short trip, as long as you avoid temperatures above 25-30° C (77-86° F). Remember that it can be extremely hot (up to 50° C, 120° F) in a closed car on a sunny day. Bring a thermos flask or similar with you, containing cold water (cool it with ice before putting insulin into it) during hot days. Remember that insulin is absorbed more quickly from the injection site if you are very warm and that this can result in unexpected hypoglycemia.

Insulin that has been frozen loses its effect. Don′t leave it in the car on a skiing trip, for example. Keep your insulin bottles or pen injector in an inner pocket if it is below freezing outside. Damaged insulin will often turn cloudy or clumpy, sometimes with a brownish colour. Some blood glucose strips can give too high a reading when it is very hot outside and too low a reading when it is very cold. Many glucose meters will give you a warning if the temperature is too high or too low.

Remember that some countries use other concentrations of insulin, mostly 40 U/ml. If you use insulin of 100 U/ml in syringes designed for 40 U/ml or vice versa, you will be in trouble. The insulin concentration appropriate for each syringe is clearly printed on the side of the syringe. If you run out of insulin it is probably better to buy both insulin and syringes for 40 U/ml if 100 U/ml is not available. You can continue taking your usual doses when counting in units. The units are the same and will give just about the same insulin effect with both 40 U/ml and 100 U/ml. The only difference is that insulin of 40 U/ml may give a slightly quicker onset of action.

Blood glucose is measured in mmol/l in some countries and mg/dl in others.

1 mmol/l = 18 mg/dl 100 mg/dl = 5.6 mmol/l

Make sure that you have dextrose and glucagon when traveling, sailing or hiking. With glucagon you can treat a serious hypoglycemia even if you are a long way from emergency care. Make sure that your traveling companions know how and when dextrose and glucagon should be used.

Vaccinations

There are no special restrictions for vaccinations or gamma globulin injections due to diabetes. However, it is particularly important that individuals with diabetes make sure they get the recommended vaccinations, since illness often leads to difficult consequences with problems of diabetes control. Vaccination for hepatitis A, typhoid and other diseases that can result in diarrhoea is a sensible precaution if you travel to areas where these may be a problem. It is a good idea to have the vaccinations well ahead of the trip, as some cause an episode of fever that can affect the blood glucose for a few days after the injection.

Ill while abroad?

Remember to take documents relating to your health insurance so that you make a claim for compensation if you fall ill abroad. Check the small print on your insurance policy to find out whether your health insurance covers acute illness only, or whether it will also cover any deterioration of your diabetes.

If you are a citizen of the UK or another EU country, you will also need a European Health Insurance Card. Ask how to apply at your GP′s surgery or go to www.dh.gov.uk/travellers.

Always say that you have diabetes if you need to see a doctor abroad. If you become ill while in countries other than Western Europe and the US you should, if possible, try to avoid surgical intervention, blood transfusions and injections. If you need medication, ask for tablets instead of injections. If possible, also avoid dental treatment, as there may be an increased risk of acquiring a blood infection.

Diarrhea problems

Prophylactic antibiotic treatment aimed at avoiding diarrhoeal diseases while on holiday is a controversial issue. Since a person with diabetes may have problems with blood glucose levels and insulin adjustments when they are ill, some doctors are more liberal about prescribing treatment for diarrhoea diseases in advance. It can be given during a short trip (3-4 weeks or less) to high-risk areas (Africa, Asia or Latin America) with a 70-90% protective effect. Without this, the risk of catching a diarrhoea infection is 25-35%. On a longer trip, antibiotics should be given only if you actually have diarrhoea. It is best to take the antibiotics with you. Avoid buying them locally as you may not know exactly what you are getting, thereby increasing the risk of side effects. Considering the risks of gastroenteritis, you should avoid drinking water in some countries if you cannot be sure it is entirely clean. Avoid all tap water (even frozen, i.e. ice cubes!). Bottled water and fizzy drinks (cola or similar) are usually safe. Oral rehydration solution is a good alternative if you feel sick or are vomiting.

If you travel in primitive conditions, water should be disinfected by boiling it or by using water-purifying tablets.

If you do not drink enough when outdoors in the heat, you will risk dehydration. This causes the insulin to be absorbed more slowly. Later, when, you drink properly, more insulin will be absorbed and you will risk becoming seriously hypoglycemic. A high blood glucose level above the renal threshold will also cause you to lose extra fluid, as you will be passing more urine.

Passing through time zones

When you travel to other continents there will be a time difference. If you go westwards the day will be longer (as the time will be earlier in the day) and if you go eastwards it will be shorter (as thit will be later in the day). Calculate your total insulin dose for the traveling day by increasing or decreasing it by 2-4% for every hour of time shift. You may need to increase your insulin doses slightly, depending on your regular daily physical activity, as you will be sitting down all day on the plane. If you are flying, don′t order special diabetes food as this is often not very appetizing and the amount of carbohydrates served is often too small. It is better to adjust your insulin doses to the food being served on board.

Due to the pressure differences in the cabin, air bubbles easily accumulate in the pen cartridges. To avoid this, remove the needle immediately after each injection. If air bubbles are present, be sure to get rid of them before taking injections after you have landed. It is common to feel a bit weary before adjusting to the new time zone (called jet-lag) and it will usually take a couple of days before your energy levels are where they should be and your sleeping pattern returns to normal.

Multiple injection and Two-dose treatment

How you administrate your insulin may vary depending on whether you are eastbound or westbound. If you use a multiple injection or a two-dose treatment it may be difficult to adjust to a shorter or longer day. It is therefore wise to discuss your treatment with your clinic team prior to traveling to ensure that your treatment regimen is suitable for traveling.