Travel and Diabetes

Travel can be fun, exciting and adventurous and having diabetes shouldn't change that. So, if you have diabetes it's important that you research, plan and prepare for a successful trip.

What to do before you travel and while you're away

Research the following before you go


Plan your trip and medical supplies


During your travel


Travel insurance is vital

Consider the following when choosing a policy:

  • Type of cover – cover health care and belongings
  • Covers you for the whole time you are away
  • Repatriation back to Australia in case of emergency
  • Clauses and exclusions - look closely and read the fine print
  • Fully disclose your status, e.g. type 1 diabetes and other pre-existing conditions
  • You may need to pay a little more excess because of diabetes
  • If the insurance company is reviewing your case make sure they give you a date for response otherwise you may be waiting until the last moment for approval.

Health care in other countries

  • Australia has reciprocal agreements with some countries for emergency medical treatment for Australian citizens and permanent residents. Refer to Medicare Australia's website for details.
  • International Association for Medical Assistance to Travellers (IAMAT) maintains a network of general practitioners and specialists, hospitals and clinics around the world - who have agreed to treat IAMAT members in need of medical care during their journey. Their aim is to make competent care available to travellers anywhere in the world, even in very remote locations, by doctors who speak English and have had medical training in North America or Europe. IAMAT continuously inspects clinics in an attempt to ensure that travellers receive competent medical care.
  • No other country in the world appears to have the equivalent of a subsidised diabetes supplies scheme (NDSS). The cost of diabetes supplies can be very expensive overseas.

 

Climates you expect to encounter

  • This will help you to prepare for appropriate temperature to store your insulin and supplies
  • Even places like North America don't have fridges available to store your insulin (refer to storage of insulin for more information)
  • High blood glucose levels can lead to dehydration especially in hot climates.
  • People with peripheral vascular disease (poor circulation) or peripheral neuropathy (nerve damage) need to take extra care to keep feet and hands warm in cold climates.

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Languages spoken where you are going

  • Learn the phrase "I have diabetes" in the language of countries you are going in case of emergency.

Climates you expect to encounter

  • This will help you to prepare for appropriate temperature to store your insulin and supplies.
  • Even places like North America sometimes don't have fridges available to store your insulin (refer to storage of insulin for more information).

Clean water supplies and uncontaminated food

  • Diarrhoea from eating contaminated food or water is the most frequent health problem encountered by travellers.
  • Gastroenteritis can lead to unstable blood glucose levels and diabetic ketoacidosis.
  • Use bottled or boiled water or water purification tablets if you are travelling to developing countries or camping. Even brushing your teeth with tap water can cause problems.

This list is limitless. The more you research before you go, the less problems you will have when you get to your destination.

Common problems when travelling with diabetes are:

  • Lost supplies/luggage or running out of supplies before the trip has ended
  • Insufficient level of travel insurance
  • No doctor's letter when needed at customs etc
  • Hospitalisation, infection or other illness
  • Hypoglycaemia
  • Blisters to feet or wounds due to poor sensation or circulation
  • Dehydration.

Plan well in advance

Planning well in advance can help you avoid problems and enjoy your trip.

Medical check up

See your general practitioner (GP) or diabetes specialist at least 8 to12 weeks before you travel so that you can review your diabetes and general health.

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Diabetes control

Make sure you are up to date with diabetes checks, tests and scripts for medications before you go and review your diabetes management with your doctor. Avoid and treat hypoglycaemia (low blood glucose), impaired hypo awareness, symptomatic hyperglycaemia, infections, complications of diabetes.

Doctor's letter (make multiple copies)

You may need a doctor's letter for Customs officials regarding your medical supplies and in case you need medical treatment overseas.

The letter should contain the following information:

  • Your full name and address as it is on your passport, medication boxes and prescription
  • The type of diabetes you have
  • Insulin/s and medications that you take (generic not brand names, and dosages. Include insulin type, ie. short, intermediate or long acting)
  • Name of insulin injection device
  • List the accessories you need such as needles, lancets, blood glucose meter, pump and accessories
  • If you need to use an ice pack or gel pack to store your medication.
  • If you have a pump and that it should not be detached from your body.
  • If you are unable to get a letter from your doctor, Medicare Australia's Medicine Export Declaration form may be sufficient to satisfy Customs that the medicine is for your personal use.

 Medication management

  • Take extra prescriptions for your insulin and medications:
    • In case you lose your medication or it is damaged
    • if a doctor needs to write you a new prescription
    • it will reassure Customs officers that the medication is yours.
  • Keep all medication in the original packaging or keep the packaging with you to show to Customs officers if required.
  • The Medicare Australia website provides information about taking and sending PBS medication overseas. The National Prescribing Service has an informative article for people who want to know more.

Insulin dose travel plan

When crossing time zones you may lose or gain time so your insulin dose or medication may need some adjustment. As everyone is different it is impossible to have a 'one rule fits all' approach. Take your itinerary to your doctor or diabetes educator to have an individualised travel plan made for you.

If you use an insulin pump

Find the contact details of your pump company in the countries you are travelling to in case you need assistance whilst overseas. Some pump companies will loan you a spare pump while travelling. Always carry syringes or insulin pen and needles and long acting insulin to cover your basal insulin in case of pump failure.

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Individualised sick day management plan

  • You will need an individualised sick day plan from your doctor or diabetes educator. The Australian Diabetes Educator's Association (ADEA) has examples of guidelines for type 1 and type 2 diabetes. 
  • If you have recurring infections such as bladder infections or thrush, take antibiotics or antifungal creams/tablets with you
  • If you take insulin, prepare a Sick Day Management Kit with the following items:
    • Copy of sick day guidelines/plan
    • Short or rapid acting insulin
    • Insulin syringes or pen
    • Food for sick days and fluids (sweetened and diet drinks or water)
    • Glucose containing food or gel
    • Glucagon and ketone testing strips (for people with type 1 diabetes)
    • Blood glucose meter and strips
    • Thermometer

Anti-embolic stockings

Anti-embolic stockings used for people who are lying in bed are not appropriate for travelling because the compression grading is too high. Flight stockings should be individually measured and fitted to the size of your calves to prevent complications such as pressure ulcers or impaired circulation. People with diabetes should have the circulation checked (Ankle Brachial Index (ABI) in their lower legs before being supplied with compression stockings. Check whether your podiatrist can do an ABI test (not all podiatrists do).

Vaccinations

Most vaccines need to be given at least four weeks before leaving. Check with your doctor or travel agent about the vaccinations you need for the areas you are travelling to. To find out more about the vaccinations you need, go to
http://www.traveldoctor.com.au/default.asp
http://www.immunise.health.gov.au

Packing

The following list is the minimum you should include: (this is only a guide and you may think of others to need to add to this list).

Take double the medication and supplies you need as unexpected events may occur, such as losing luggage, extra testing, or needing to stay overseas longer. Take a spare insulin pen, syringes and needles.

Supplies and Packing List

  • Blood glucose meter
  • Spare batteries for meter
  • Blood glucose test strips
  • Sharps disposal container/needle cutter/SafeClip
  • Emergency Kit (refer to 'emergency kit')
  • Travel alarm clock
  • MedicAlert bracelet
  • Identification stating you have diabetes (NDSS card)
  • Emergency contact number in mobile (store ICE in case of emergency into phone)
  • GP/endocrinologist/diabetes educator's contact details
  • List of medication
  • Copy of prescriptions
  • Doctor's letter
  • All medications
  • Resealable transparent plastic bags
  • Name and address of diabetes services available at your destination
  • If using insulin:
    • Short and long acting insulin
    • Insulin delivery device (pens/pump/lines)
    • Syringes/ spare pen
    • Pen needles
    • Cool pack (Frio) for storage of insulin
    • Hypo kit (refer to 'Hypo kit')
    • Carbohydrate snacks
    • Ketone test strips (type 1 diabetes)
    • Glucagon (type 1 diabetes only).
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Hypo Kit (if you take diabetes medications or insulin)

  • Quick acting carbohydrates (glucose gel, jelly beans or Lucozade)
  • Long acting carbohydrates (muesli bar, crackers, biscuits)
  • Glucagon (type 1 diabetes - your travel companion should carry)

Diabetes Emergency Kit

  • Antiseptic cream or lotion/ betadine
  • Icepack that does not need refrigeration
  • Anti-nausea and anti-diarrhoeal medication
  • Treatment for gastro (gastrolite)
  • Paracetamol or ibuprofen
  • Canesten/antifungal cream if prone to thrush
  • Thermometer
  • Telephone number of your GP and endocrinologist/DNE
  • Ketone strips
  • Glucagon injection kit (for your travelling companion to administer)

Insulin pens

If you use disposable insulin pens such as FlexPen or SoloStar you may find that they take up quite a bit of space in your hand luggage. Non-disposable pens may take up less room (note: not all insulins are available in cartridges). Ask your doctor if your insulin is available in disposable or reusable cartridges.

Storage of insulin

Insulin must be stored at temperatures between 2-8 degrees Celsius. Insulin loses its potency when subjected to extremes in temperature. Insulin must not be frozen, or exposed to direct sunlight or extreme heat. Refrigerated insulin will last until the expiry date on the package.

Once opened, an insulin vial or ampoule must be discarded after 28 days whether it has been refrigerated or not. It is stable at room temperature for up to one month (usually up to 25 degrees - check insulin manufacturer's guidelines).

You will need to provide your own cool pack to regulate the temperature of your medication.  Most airlines have a policy in place that clearly states that they will not store patient medications in their refrigerator throughout the flight.

When travelling, you will need a cool pack to keep your insulin supplies cold.

The Frio pack is an insulin travel wallet that can be used in the absence of refrigeration. There are crystals in the panels that are activated to become a cooling gel when immersed in water. These packs can keep insulin (and other medication) cool for up to 45 hours, after which they can be reactivated. They are reusable and have a life of 18-24 months. You can purchase a Frio pack at DA–Vic.

Another option is an insulated travel bag and ice bricks. However, the insulin must not come into direct contact with the ice otherwise as it may freeze, which will damage it.

Note: Ice packs and gel packs (such as FRIO) are exempt from the liquids, aerosol and gels regulations if they are included on your doctor's letter as being a necessary part of your diabetes supplies and equipment.

Cold or freezing climates

There is no product that can stop insulin from freezing in very cold environments. The safest thing is to keep the insulin close to your body to prevent it from freezing. Similarly, your strips and blood glucose meter can also be protected by your body temperature by keeping it close to you. If you are sleeping in sleeping bags, bring your insulin, meter and strips in the sleeping bag with you.

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Air travel

Arrive early to allow extra time for customs inspections. Advise Customs officers that you have diabetes and that you have supplies with you. Make sure you have the following with you:

  • Doctor's letter (give them a copy only and always keep original)
  • NDSS card

Take all your diabetes supplies and medication in your carry on luggage and share the spare supplies amongst your partner or friends in case one bag is misplaced or stolen. All diabetes supplies and equipment are allowed through Customs.


Should you encounter any problems with Customs ask for the supervisor. The supervisor is employed by DOTAR (Department of Infrastructure, Transport, Regional Development and Local Government) and is aware of laws, rules and regulations. Note that all Australian airports have DOTAR supervisors.

There are restrictions on the amount of PBS medicine that you can take overseas. Staff within the Australian Customs Service advises that generally you are allowed to take a three month supply of medication. For permission to take a longer supply and other PBS medicines information, please visit the Medicare Australia website or call them on 13 20 11.

Airport security and pumps

If you have an insulin pump let the security officer know that you cannot remove it because it is attached to you. You can have it inspected by a security officer in a private room. Metal detectors will not harm your pump or the insulin within it. Read the guidance paper provided by the Department of Infrustructure on the "Carriage of Prohibited Items by People Suffering from Bona Fide Medical Conditions" (PDF).

X-rays and insulin

It is considered safe for your insulin to be exposed to mild x-ray when going through customs and therefore should not produce any change in the quality of your insulin. However, if you are concerned you may have it visually inspected by a security officer in a private room rather than going through x-ray. Security staff members are obliged to respond to such a request.

It is thought that the x-rays for checked-in luggage is much stronger than that used when going through the hand luggage check point and is one of the reasons why insulin should not be stored in checked-in luggage.

Several factors may affect your BGLs during air travel

  • Different foods
  • Long periods of inactivity
  • Altitude
  • Dehydration due to air conditioning
  • Change in time zones
  • Stress/hectic pace of travelling.

During the flight

  • You will need to monitor BGLs more often to assess how your diabetes is travelling.  Different food and sitting for long periods can make your BGLs rise.
  • Drink plenty of sugar-free fluids and avoid alcohol when flying to prevent dehydration.
  • There is little difference between a diabetic meal and ordinary fare, however the diabetic meal will be served first.
  • Perform your leg and foot exercises to stop swelling and clots.
  • Stand up and walk around as often as possible to increase circulation, keep blood glucose levels under control and prevent clots.

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If you take insulin

  • Never stop taking your long acting insulin and take your quick acting insulin when your meal arrives.
  • Do not inject air into an insulin vial when drawing up insulin (air on plane is pressurised).
  • You cannot store insulin in the plane's fridge due to food hygiene regulations and the airline will not take responsibility for insulin storage.
  • Keep your watch on the time at home so you know when your insulin would have been due. Change the time when you arrive at your destination.

If you have a pump

  • You do not need to turn it off, however, a continuous blood glucose monitor must be turned off at take off and on landing just like you would any other electronic device.
  • You do not need to change the rate on your pump until you arrive at your destination. Change your pump's clock when you get to your destination.
  • Take a bolus dose with snacks and meals as usual.

Staying in contact

  • Have an email address to keep in touch with family and friends.
  • Prepare a package of supplies ready for couriering to you in case you lose your supplies.
  • Advise the department of Foreign Affairs and Trade of your itinerary via their website.

Hypoglycaemia

Hypos are a common side effect of insulin therapy and some medications to lower blood glucose levels. However, due to the unpredictability of travelling hypos can occur more frequently. Some reasons may be:

  • Meals may be delayed
  • Foods may have different amounts of carbohydrates
  • Increased activity- sightseeing, walking, hiking
  • Stress/excitement
  • Vomiting and inability to tolerate carbohydrates if unwell.

Have with you at all times:

  • Quick acting carbohydrates (glucose gel, jelly beans or Lucozade)
  • Long acting carbohydrates (muesli bar, crackers, biscuits)
  • Glucagon injection (type 1 only - for your travelling companion to administer).

Sea travel

Sea travel is similar to air travel in terms of customs regulations. You will need your doctor's letter and NDSS card to be allowed to carry supplies and equipment on board with you. All the supplies mentioned for air travel will be the same.

Take motion sickness or anti-nausea medication during sea travel.

Vaccinations are also important even if you are stopping at certain countries only for the day.

We strongly recommend you inform the crew of your diabetes and remember that there is a doctor and nurse on board in case you need help.

Car or driving trips

Do not leave insulin supplies in the car once you've reached your destination as heat and cold will affect your insulin. Your insulin, meter and strips should not be exposed to direct sunlight.

If you take insulin or diabetes medications

  • Check blood glucose levels before leaving and ensure your glucose level is at 5mmol/L or more. A two point test is a good way of knowing whether your blood glucose level is on its way up or down. For example test ½ an hour before you leave and then just before you drive off can give you an indication whether you blood glucose level is dropping. You should test your glucose levels regularly whilst driving to make sure you continue to be safe to drive.
  • Always carry quick acting carbohydrates in the car with you in case you are hypo. If you do become hypo, pull over to the side of the road as soon as you can safely do so. Turn off the ignition and take the keys out of the ignition. Treat your hypo and follow it up with long acting carbohydrates. Ensure that you are safe to drive by re-checking your blood glucose level. Do not drive until your blood glucose level is above 5mmol/L and you feel better.

Camping trips

Camping is often not considered travelling because most people do not go overseas for it.

  • Be cautious about camping alone in case of emergencies.
  • Let someone at home know where you're going and your location.
  • Consider the amount of activity you will be doing as you may need to adjust your insulin accordingly (discuss with your diabetes team).
  • Remember the following:
    • Diabetes Emergency Kit
    • Hypo Kit (including Glucagon if prescribed by doctor)
    • Frio pack/ cooler
    • Protective shoes
    • Supplies of drinking water and water purification tablets
    • Sunscreen, mosquito repellent, hat etc.

Other considerations

Global disease outbreaks

Some areas are endemic for certain infectious disease so it is important to find out about outbreaks in the countries you will visit. Here are some of the websites you can find information.

  • Department of Health and Human Services (USA) Traveller's Health Topics
  • World Health Organistaion Health Topics
  • Travel Doctor is an international provider of travel health services, providing services in specific travel medicine clinics
  • Australian national organisation of GP based travel health clinics - helps you find a clinic near you
  • The Travel Health Advisory Group - an initiative between the travel industry and travel medicine provides information about healthy travel.

Useful travel websites


A great resource is: "The Diabetes Travel Guide - How to Travel with Diabetes Anywhere in the World" by Davida F. Kruger.

If going to the UK read "Moving to London & the UK with type 1 diabetes- a quick guide for Australians" by Kate Gilbert.

Bon Voyage!

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