Medical check up
See your general practitioner (GP) or diabetes specialist at least 8 to12 weeks before you travel to review your diabetes and general health. If seeing your GP make a double appointment to allow sufficient time. Make sure you discuss:
- Current diabetes managment
- Sick-day managment plan
- Presciptions up to date
- Complication screening-up to-date
- Discuss any hypoglycaemia, impaired awareness of hypoglycaemia, hyperglycaemia, infections and/or complications you are experiencing.
You may need a doctor's letter for customs officials regarding your medical supplies and in case you need medical treatment overseas. Make sure you make extra copies. The letter should contain the following information:
Individualised sick day management plan
- 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)
- 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.
You will need an individualised sick day management plan from your doctor or diabetes educator. The NDSS has general information on sick days for both 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
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 out the contact details of your pump company in the countries you are travelling to in case you need assistance while overseas.
- Some pump companies will loan you a spare pump while travelling.
- Always carry syringes or insulin pen and needles and insulin as a back-up.
- Take a written copy of your pump settings.
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).
Some health problems associated with international travel are vaccine preventable. Travellers should consult a travel medical centre, or their local doctor, at least 6–12 weeks before departure, for a check-up and to discuss required and recommended vaccinations for specific regions. The websites below provide information about vaccinations and tips for staying healthy while overseas:
The following list is the minimum you should include (this is a guide only)
- All medication
- If using insulin:
Short and long acting insulin
Insulin delivery device (pens/pump/lines)
Syringes/ spare pen
Cool pack (Frio) for storage of insulin
Hypo kit (refer to 'hypo kit' information below)
Ketone test strips (type 1 diabetes)
Glucagon (type 1 diabetes only)
If using other injectable medications
Cool pack (Frio) for storage
- Blood glucose meter
- Spare batteries for meter
- Blood glucose monitoring strips. Take double what you need.
- Sharps disposal container/needle cutter/SafeClip
- Emergency Kit (refer to 'emergency kit' information below)
- 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 including their email address
- 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
Take double the medication and supplies you need as unexpected events may occur such as losing luggage, delays and needing to stay overseas longer than expected.
Hypo kit (if you take diabetes medications or insulin)
Diabetes emergency kit
- 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)
Antiseptic cream or lotion/ betadine
Icepack that does not need refrigeration
Storage of insulin
- Anti-nausea and anti-diarrhoeal medication
- Treatment for gastro (gastrolite)
- Paracetamol or ibuprofen
- Canesten/antifungal cream if prone to thrush
- Telephone number of your GP and endocrinologist/DNE
- Ketone strips
- Glucagon injection kit (for your travelling companion to administer)
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
Unopened insulin should be stored in the fridge, between 2–8 degrees Celsius. Once opened, insulin may be kept at room temperature (below 25–30 degrees Celsius) for one month and then discarded. Insulin can be damaged by extreme temperatures. It must not be left where temperatures reach over 30 degrees, eg. in the car or in direct sunlight. Insulin should not be allowed to freeze (such as the cargo hold area of a plane) as it will lose its potency, and must be discarded.
When travelling, you will need a cool pack to keep your insulin supplies cold. 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.
The Frio pac
k 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 either online or at the retail shop.
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 to do is keep your 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 them close to you. If you are sleeping in sleeping bags, bring your insulin, meter and strips in the sleeping bag with you.