The Healing Handbook for Persons with Diabetes

Diabetes and TravelChapter 14: Traveling

 For All People with Diabetes 
For People with Insulin Dependent Diabetes 
For People with Insulin Dependent Diabetes Traveling Across Time Zones 

Whether you travel for business or pleasure, diabetes travels with you. You can't ignore your diet, exercise, and insulin regimen just because you're away from home. But there is no need to feel trapped by your diabetesÑyou can go anywhere a person without diabetes can. Just remember these simple tips to make getting there a lot easier. And, happy traveling!

For All People with Diabetes 

Before you leave:

  • Have a medical checkup. If you are going to an area where diarrhea might be a problem, ask your doctor to prescribe an anti-diarrhea medication. You may also want to take along something to prevent or treat nausea.
  • Have required vaccinations weeks ahead of your departure time to avoid reactions that might disturb your blood sugar balance while away from home.
  • When planning a trip to areas where English is not the principal language, try to learn how to say: "I have diabetes; please get me to a doctor." and "Sugar or juice, please." in the language of each country you plan to visit.
  • Choose hotels carefully. Know what facilities are offered what services are available.
  • Always wear or carry some form of medical identification. A tag, bracelet, or necklace with the medical emblem is best.
  • If you take oral medications for diabetes, carry enough for the entire trip. You may have trouble getting your prescription filled in a foreign country.
  • Take along familiar blood glucose and urine monitoring equipment. Remember, many changes take place during travel, and the only way to assess your control is by monitoring frequently.

While traveling:

  • If you are traveling by plane, notify the airline 24 hours in advance for a special diet order. Tell the flight attendant that you have diabetes. CARRY ALL MEDICATIONS WITH YOU ON THE PLANE.
  • Keep active while in transit. If you are traveling by car, stop every so often and take a walk for at least five minutes. On a train, walk through the cars now and then. On a bus, take advantage of stopovers by getting out and walking around to stretch cramped muscles.
  • On car trips, carry food in case of an emergency. A flat tire or mechanical failure may leave you stranded far from a restaurant at your scheduled meal time.

When you get there:

  • Keep copies of the address and telephone number of your doctor near your hotel-room phone and in your wallet or purse. That way, if you need medical attention you won't have to waste time searching for this information.
  • You can eat anywhere, but full-service restaurants are usually more compatible with your need for a balanced diet. Don't wait until the last minute to order from room service. Order at least 30 minutes before your scheduled meal time.
  • In South or Central America, Asia, and Africa, avoid the following foods: raw meats, milk, ice cream, cream sauces, soft cheese, water or ice cubes, peeled fruits, and lettuce and other leafy vegetables.
  • Always carry small cans of juice, dried fruit, peanut butter, crackers, or packaged cheese and crackers. These snacks can be a substitute meal if necessary.
  • Don't overexpose your skin the first few days you spend in the sun. Apply #15 sun screen to protect against burning.
  • Remember your basic rules of foot care (see Chapter 11). Don't wear new shoes on vacation. Check your feet daily. If you get blisters from walking, apply a mild antiseptic and a small gauze pad held in place with non-allergic tape. Don't break blisters!
  • Don't walk barefoot on hot beach sand or in areas where sea shells may cut your skin. Always wear beach or swim slippers, sandals, or some other foot covering.
  • If you are ill during a trip, remember your rules for sick day management (see Chapter 10). Check blood sugar frequently and test urine for ketones. Ice chips or sips of regular (not diet) cola or ginger ale are good for nausea. Try to take some every hour. You may also try cereal, milk, ice cream, tea, toast, broth, and soups to replace full meals. If you take oral medications for diabetes and you are too sick to eat, try to drink plenty of liquids. If your urine tests are all positive for sugar, or your blood sugars remain high, call for help.

For People with Insulin Dependent Diabetes 

  • Carry insulin with you, along with your syringes. U-100 insulin is now available in most countries, but you can never be sure. Insulin need not be refrigerated, but you must protect it from extreme heat or cold. Do not leave your insulin on the dashboard of a hot car. If traveling by plane, have insulin in your carry-on luggage.
  • Carry a letter stating you have diabetes and must carry with your insulin syringes and monitoring equipment. This will protect you in case of any questions about your syringes, or in case you lose them and need replacements.
  • Always carry fast-acting sugar. 
  • You may need to adjust insulin or food according to your activity level. Bike riding, hiking, and walking tours burn up a lot of calories. To be safe, check your blood sugar frequently.
  • Make sure that traveling companions know the signs of an insulin reaction and how to help your with fast-acting sugars.

For People with Insulin Dependent Diabetes Traveling Across Time Zones 

  • When planning a trip that will take you across time zones, consult your doctor or diabetes educator about adjusting your meal and insulin schedules. On a long plane trip across time zones, keep your watch at point-of-departure (POD) time and take snacks and meals accordingly. Resume normal doses the next day at point-of-arrival (POA) time.

Guidelines for Crossing Time Zones

Heading East (Shorter Day)

West ----------- > ----------- > ----------- > East 
8 a.m.   6-8 p.m. Point of Departure time
2/3 dose intermediate or long-acting insulin   2/3 dose intermediate or long-acting insulin

Maintain usual doses of Regular Insulin before meals.

Heading West (Longer Day)

East ----------- > ----------- > ----------- > ----------- > West 
8 a.m. 6-8 p.m. Point of Departure time 6-8 p.m. Point of Departure time
Usual dose intermediate or long-acting insulin plus usual dose of regular insulin Extra dose of regular _____ units if indicated by blood sugar of _____ mg Usual dose intermediate or long-acting insulin

REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort. 

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical School. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management. 

Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention! 

Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
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 Dr. Aldo Rossini