Travelling with diabetes: challenges and tips

Covid-19 has disrupted international travel for many and, at the time of writing, looks like it may continue to do so into the foreseeable future. However, as some countries loosen restrictions and allow international travel to resume across their borders, it is worth reminding ourselves of the precautions people with diabetes should take when they travel.

Travelling is a passion shared by many people and a diagnosis of diabetes should not be an obstacle to exploring the world. However, before travelling, it is important for people with diabetes to ensure their condition is under control and they are prepared for any potential emergency situations.

As someone living with diabetes and fortunate enough to get opportunities to travel, both for personal reasons and professionally, I have learnt to take extra precautions and be meticulous when I prepare for my trips. Travelling can disrupt blood glucose levels and, when there are changes to my regular routine, it takes extra effort and care to keep on top of my condition. My experiences when travelling have not been smooth sailing, as I have often and continue to encounter challenges. However, I have found that with proper planning, I can leave home with peace of mind and make the most of the time that I am away.

When I prepare for a trip, I always ensure that I pack more than enough of my required medication and supplies. I pack all these, including insulin, in my hand luggage so that I can readily access them and avoid any issues related to lost or delayed checked-in baggage. This is particularly important when travelling by air, since checked-in baggage can be subject to temperature extremes – very cold in the cargo, very hot in the holding area. These can result in insulin losing its efficacy. It is also important for me to have some snacks with fast-acting carbohydrates in my hand luggage, to prevent and manage episodes of low blood glucose during the trip. Other essentials are a refillable bottle of water and enough money to allow me to buy food and drink, in case of delays or my supplies running out.

A doctor’s note outlining my condition and treatment has also always proven useful. This helps to navigate through checkpoints and as a source of information in case I need medical assistance during my trip.

When travelling by air, I find it convenient to have an aisle seat. This facilitates getting up to exercise or just stretch and go to the toilet when I need to, which can be more often than usual when blood glucose levels are high. I make sure that I exercise by walking up and down the aisle after meals. On road trips, I take advantage of stops along the way to get out of the vehicle and walk around. Sitting down for too long can lead to problems with blood clots, which can be more common in people with diabetes.

Travelling with friends, family members or colleagues who do not have a sufficient understanding of diabetes has proven problematic at times. Other people may not understand the need for frequent stops and requests for “special foods” that can be different from what everyone else is having. Some hotels do not have provisions for special diets and many people with diabetes I have spoken to tell me that airlines often do not fulfill requests for “diabetes-friendly” meals, despite people having indicated clearly that they have diabetes when reserving their flight.

People with diabetes must pay attention to their diets and eat meals at regular intervals. When travelling, the frequency and amount of food you consume should be similar to when at home. This is easier said than done. I have often found it difficult to follow my regular diet plan when my normal routine is disrupted, but I try to do so as much as possible. Another challenge is that, when you are in another city or country, it can be difficult to access the foods or cooking methods to which you are accustomed. I find this particularly difficult when I am away from home for long periods.

Here are some tips to make travelling with diabetes as safe and enjoyable as possible:

• Before any long trip, visit your health professional for a check-up well in advance and schedule any vaccine shots if required.
• Get all your necessary prescriptions and a letter that authorises you to travel with your diabetes medication and supplies.
• Wear a medical ID bracelet that indicates you have diabetes or carry notification in an obvious place, just in case someone needs to find out whether or not you have a medical condition.
• Pack all your diabetes supplies, including extras. Make sure insulin is packed appropriately. Take three to four times more than needed if you’re traveling to remote locations where medical supplies are not readily available.
• Pack at least one set of medicines and supplies in your hand luggage. Make sure to have this with you at all times.
• Pack some snacks to deal with possible episodes of low blood glucose (hypoglycemia).
• If flying, request a “diabetes-friendly” meal and, if possible, alert the airline in advance that you have diabetes.
• If you change time zone(s), you may need to adjust your medication schedules. This is particularly relevant when the time difference is greater than three hours. It is recommended to start gradually adjusting your insulin schedule a few days prior to travel.
• Check your blood glucose levels frequently during the trip.
• When travelling by plane or long-haul bus, alert a member of staff that you have diabetes so that they are prepared in case you need medical assistance.

Checklist of travel essentials for people with diabetes on insulin and/or oral therapy:

• Blood glucose monitoring equipment and relevant supplies such as strips, lancets and lancing device and sensors (if you use a CGM).
• Insulin vials or pens.
• Oral and/or injectable diabetes medications.
• Syringes or needles.
• An insulated bag.
• Sources of fast-acting carbohydrates (e.g. glucose tablets, sugar packets, sweetened drinks*)
• A pair of comfortable shoes

*If you need to go through airport security, please remember that, in many places, any liquids and gels will be taken off you if they exceed 100ml.