Navigating travel with diabetes
ABSTRACT
As the number of people who travel continues to increase, so too will the number of travelers with diabetes. This increase will come with new and more frequent requests for medical travel advice. This article equips clinicians with the tools to address patient concerns about travel and to empower patients to be prepared for emergency situations both abroad and at home. This includes encouraging patients to obtain a travel letter, bring enough supplies for the trip, and have a plan to manage time-zone changes.
KEY POINTS
- Patients should pack all diabetes medications and supplies in a carry-on bag and keep it in their possession at all times.
- A travel letter will facilitate easy transfer through security and customs.
- Patients should always take more supplies than needed to accommodate changes in travel plans.
- If patients will cross multiple time zones during their travel, they will likely need to adjust their medication and food schedules.
WHAT TO EXPECT WHILE ON LAND
Insulin 101
Storing insulin at the appropriate temperature may be a concern. Insulin should be kept between 40°F and 86°F (4°C–30°C).4 Remind patients to carry their insulin with them at all times and to not store it in a car glove compartment or backpack where it can be exposed to excessive sun. The Frio cold pack (ReadyCare, Walnut Creek, CA) is a helpful alternative to refrigeration and can be used to cool insulin when hiking or participating in activities where insulin can overheat. These cooling gel packs are activated when exposed to cold water for 5 to 7 minutes5 and are reusable.
Alert patients that insulin names and concentrations may vary among countries. Most insulins are U-100 concentration, which means that for every 1 mL of liquid there are 100 units of insulin. This is the standard insulin concentration used in the United States. There are U-200, U-300, and U-500 insulins as well. In Europe, the standard concentration is U-40 insulin. Syringe sizes are designed to accommodate either U-100 or U-40 insulin. Review these differences with patients and explain the consequences of mixing insulin concentration with syringes of different sizes. Figure 2 shows how to calculate equivalent doses.
Resort tips: Food, drinks, and excursions
A large component of travel is indulging in local cuisine. Patients with diabetes need to be aware of how different foods can affect their diabetes control. Encourage them to research the foods common to the local cuisine. Websites such as Calorie King, MyFitnessPal, Lose it!, and Nutrition Data can help identify the caloric and nutritional makeup of foods.9
Advise patients to actively monitor how their blood glucose is affected by new foods by checking blood glucose levels before and after each meal.9 Opting for vegetables and protein sources minimizes glucose fluctuations. Remind patients that drinks at resorts may contain more sugar than advertised. Patients should continue to manage their blood glucose by checking levels and by making appropriate insulin adjustments based on the readings. We often advise patients to pack a jar of peanut butter when traveling to ensure a ready source of protein.
Patients who plan to participate in physically challenging activities while travelling should inform all relevant members of the activity staff of their condition. In case of an emergency, hotel staff and guides will be better equipped to help with situations such as hypoglycemia. As noted above, patients should always carry snacks and supplies to treat hypoglycemia in case no alternative food options are available during an excursion. Also, warn patients to avoid walking barefoot. Water shoes are a good alternative to protect feet from cuts and sores.
Patients should inquire about the safety of high-elevation activities. With many glucose meters, every 1,000 feet of elevation results in a 1% to 2% underestimation of blood glucose,10 which could result in an inaccurate reading. If high-altitude activities are planned, advise patients to bring multiple meters to cross-check glucose readings in cases where inaccuracies (due to elevation) are possible.
