Diabetes and Travel

Planning to travel?

This information covers your journey, time zone changes, while you are away, travelling with an insulin pump or a continuous glucose monitoring system and also includes Frequently Asked Questions.

Travel Advice:

• Make sure your travel insurance covers your diabetes and list any medications you may be on.
• Do you need a European Health Insurance Card?
• Find out if vaccinations are recommended for your area of travel 
• If you are on insulin or injectable therapies contact the Diabetes Centre (01904 726510) or your GP for a travel letter prior to your journey. This states that you need to carry needles, insulin and hypo treatment in your hand luggage.
• Take identification in the form of an insulin passport or medi-alert.
• Check the availability of medications, especially insulin, in your country of travel. Some may have different names.
• Take the contact number for the Diabetes Centre (01904 726510
• Take extra supplies of medications, needles, testing strips, lancets etc. and a spare blood glucose meter (if possible). Some countries may measure blood glucose levels differently- mg/dl rather than mmol/l - so be careful.
• Take illness management advice and ketone testing equipment (if appropriate)
• Consider purchasing a cool bag, such as a FRIO bag, for injectable therapy if you are travelling somewhere hot. 
• Seek advice from your GP or the Diabetes Centre, as necessary, prior to travel.

The Journey:

• If you have a travel partner split supplies between your hand luggage in case your bags are lost/stolen.
• Always carry insulin and/or other injectable therapies in your hand luggage as they may freeze in the hold.
• Place pen devices, lancets, test strips and needles in a transparent plastic bag in your hand luggage. Keep your travel letter with this.
• If you are on any treatment that may cause hypoglycaemia carry glucose with you. Jelly babies or glucose tablets are ideal as fluids such as Lucozade and Coke maybe taken off you. Always carry some starchy food such as biscuits as follow up treatment and in case of delays.
• If you are travelling alone consider informing the in-flight team of your diabetes, especially if you are at risk of hypoglycaemia.
• You do not need to order a 'diabetic meal' on the plane.

Time Zone Changes:

• If you are on insulin you may need to adjust the timing of your injections.
• If the time difference is less than 4 hours then just continue your injections at your usual times
• If the difference is greater than 4 hours you will need to adjust the timing of your injections.

Insulin Regime	Traveling West (Longer Day)	Traveling East (Shorter day)
Once daily long acting (e.g Lantus, Humulin I, Degludec)	Keep to UK time during the journey. Once you arrive at your destination move injection to usual time (e.g bedtime)
Twice daily mixed insulin (e.g. Humulin M3, Humalog Mix 25, Humalog Mix 50, NovoMix 30)	Take your normal morning and evening insulin whilst travelling. Take half usual insulin dose with a meal when you arrive.	Take your normal morning and evening insulin whilst travelling.
Once or twice daily long acting insulin (e.g. Lantus, Levemir, Degludec) + rapid acting insulin with meals (e.g. Humalog, Apidra, NovoRapid)	Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time, but if this is greater than 12 hours since your last injection you may need to give a small amount of rapid acting insulin to control blood glucose levels	Take rapid acting insulin with any meal containing carbohydrate. If you take once daily long acting insulin keep to UK time for journey. Once at destination move to a convenient time but if this is shorter than 12 hours since your last injection you may need to give a smaller amount of your rapid acting insulin with your last meal.
If you inject long acting insulin twice daily keep injections roughly 12 hours apart

While you are away:

• Keep monitoring. Blood glucose levels maybe significantly different due to temperature, food and activity levels.
• Be careful of hot sand or hot tiles especially if you have nerve damage.
• Wear sandals or swim shoes- small cuts can easily become infected and cause blood glucose levels to rise.
• If you are on any treatment that may cause hypoglycaemia be aware that alcohol may increase this risk. Have a starchy snack before bed and do not give any extra insulin to cover for alcohol.
• A travel guide can give you an idea of the kinds of food available locally. It is a good idea to have a knowledge of local carbohydrates. 'Carbs and Cals' do an American and Portuguese edition. They also have an app for smart phones.

Pumps and CGMS:

• If you have an insulin pump or continuous glucose monitoring system (CGMS) you should contact your airline a couple of weeks before you travel. Failure to notify the airline of medical devices in advance, can potential result in you being unable to take your pump or CGMS on board.
• There is caution about pumps and CGMS that operate wirelessly. You may need to be prepared to remove these and administer insulin with a pen during the flight.
• There is some difference in advice from manufacturers as to whether insulin pumps can go through x-ray machines and full body scanners. It is best to check with your pump manufacturer prior to travel.
• Take insulin pens with you in case of any problems with your pump.

FAQ:

• Where can I find out if I need travel vaccines?

Websites such as www.fitfortravel.nhs.uk  can help you with this information. Alternatively seek advice from your Practice Nurse.

• Where can I find more information about adjusting my insulin for different time zones?

www.voyagemd.com is a useful resource. You can also see the Diabetes Specialist Nurses or your Practice Nurse for further advice.

• How do FRIO bags work and where can I buy one?

FRIO bags are activated by cold water and keep insulin cool for up to 45 hours. They can be purchased from www.friouk.com and come in a variety of sizes.

• Can people with diabetes wear flight socks?

Often packaging states not suitable for those with diabetes. If you have problems with your circulation or have any ulcers/wounds on your legs or feet please seek advice prior to using them. If you have no circulatory problems and your legs and feet are generally healthy, using flights socks is unlikely to do any harm.

• How can I find out if my brand of insulin is available in my destination?

Contacting the insulin manufacturer is the best way to obtain this information.

• Eli Lilly & Company, tel: 01256 315000
• Novo Nordisk Ltd, tel: 0845 6005055
• Sanofi-Aventis, tel: 01483 505515
• Wockhardt UK Ltd, tel: 01978 661261