Summary

For persons with  diabetes, travel brings a lot of challenges, both during and after the journey, at the new destination. Especially if the journey is a long one, which spans different time-zones, and is one is arriving in a foreign country. Over time, various doctors and thousands of travellers have compiled a set of instructions, tips, tricks and hacks that make this experience less challenging or stressing, and more fun and rewarding, which is how travel is meant to be! In this article, we will examine some of them.

Introduction

Ever since India liberalized its economy, Indians have been traveling abroad for studies, work, and off-course vacationing. In 2022, in-spite of the second wave of the pandemic, 1.5 crore Indians travelled abroad. In FY 2023-24, in just the first half, Indians spent USD 5.5 billion in overseas travel. Indians are exploring new and less-travelled destinations across different continents and countries. The travel bug has bit everybody and spared nobody, irrespective of their age or minor health-challenges such as diabetes.

Persons with Type-1 diabetes need to take insulin for the rest of their lives, and there is little choice in this matter. This simplifies the travel experience; however, they too need to exercise care and caution as explained below. With type-2 diabetes, the situation is complex. They may need to take a combination of medications which may include Insulin.. They may also need to manage other associated concerns such as obesity, urinary incontinence, etc.

But nothing needs deter people with diabetes from traveling across time-zones today. It just requires good planning, adequate awareness, the right resources and plenty of care and caution at every step. For those who are determined to have a great holiday, all these expectations appear small and manageable. To make it easy for them, there is a wealth of knowledge available today, on how to go about this journey (pun intended).

Persons with diabetes may have a family doctor, or diabetologist who they consult from time to time. Once the travel date is finalized, the person must meet his doctor and discuss the travel. The doctor would  give  a ton of advice, suggestions and tips that must be followed by the person, in his/her own interest. This should be the first step that the person must do, after booking the mode of travel – be it flight, cruise-ship, or motor-vehicle (in case of a cross-country road-trip).

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Also Read: Essential Knowledge – A to Z of Diabetes

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A few weeks before the Travel

• Before the trip, meet your doctor, and get a thorough medical checkup. While it rarely happens that a person may have to cancel the trip because of what the reports show, it is good to be aware of any new condition that may have   Also, take vaccines and shots for infectious or communicable diseases.
• Get your doctor to give you an authorization letter. This letter will state that you have diabetes and need to carry the medicines found in your hand-baggage. Make multiple copies of this letter and keep them in your check-in baggage, hand-baggage and shirt/pant pocket. Keep all your necessary prescriptions for diabetes and other conditions, along with the letter, and the stock of medicines.
• When it comes to stock of medicines, both for diabetes and other conditions, carry more than what you may require for the specific duration (three to four times more). This may be required in case of emergencies or if an equivalent drug may not be available in the destination. Keep some of them in the hand-baggage while the rest can go into the check-in baggage.
• When it comes to insulin, make sure that it is packed appropriately in an insulated bag. While the bag must be reasonably cool, please ensure the insulin vials or pens do not come in contact with the ice-packs used for cooling. This can freeze and hence damage the insulin.
• You must wear a medical ID-bracelet that indicates you have diabetes along with carrying notifications to the effect in obvious places (shirt-pocket, wallet etc). This will be critical in case of a medical emergency and can make a lot of difference to you.
• Pack some snacks to deal with the possibility of low blood-glucose levels or hypoglycaemia. These could be unsweetened snacks like nuts, dried fruits, protein bars, chips, crackers, chakli, chiwda etc. This will also be required when you are on sight-seeing trips at the destination. Eateries along the route, or at tourist spots, may not have the kind of healthy or diabetes-friendly meals that you require.
• In case of a flight or cruise, ask for a “diabetes-friendly” meal. Also, alert the airline/cruise-liner staff in advance that you have diabetes.

Checklist of essentials to be carried

All these items will go into your hand-baggage and not check-in baggage.

• Blood glucose monitoring equipment: These could be standard glucometers, which require pin-pricks to obtain a blood sample. This is only used for persons who don’t require frequent testing or insulin injections. The other type is a Continuous Glucose Monitor that does not require pin-pricks to obtain a sample of blood. The blood-glucose level is estimated by placing a sensor on the skin. This type is recommended for any person who requires tight and constant monitoring of blood-sugar levels. You need to carry the type of monitor that is relevant for you, along with associated accessories such as lancets, strips, lancing devices, batteries, chargers and sensors.
• Insulin vials and/or insulin pens (both long-acting and rapid-acting insulin)
• Diabetes medications in the form of pills or injections
• Syringes and needles
• An insulated bag for heat-control. This is required because insulin should neither get frozen, nor heated up. For this reason, insulin pens or vials should never be stored in the check-in baggage and should always be placed in your hand-baggage.
• Sources of quick-acting carbohydrates such as biscuits, glucose tablets, sugar sachets and sweetened drinks. When it comes to drinks, please note, in many countries or airlines, liquids and gels that exceed 100ml in quantity will be taken off the flight. But the good news is that several airlines have relaxed this restriction for persons with diabetes, as long as there is a doctor’s letter or prescription accompanied.
• A pair of comfortable shoes. This ensures you don’t get shoe-bite and other minor foot-injuries while walking, climbing or sitting for long periods of time. Such a shoe should be worn for your journey.
• Wet-wipes: These will be required to clean your hands before taking a glucose test. Especially, while out on sight-seeing trips, as running water may not be available then.

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Also Read: The Importance of an Individual Meal Plan for Diabetes

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Before boarding the flight/cruise-ship/motor-vehicle

• When travelling by plane or long bus-journey you may consider informing a member of staff that you have diabetes. This way, they will be prepared in case you need medical assistance.
• Staying hydrated during the journey is important. Towards this, one must consume soups, plain water, juices and hot beverages as much as possible. Given that some persons with diabetes tend to urinate often, please factor in the same. Choose an aisle seat as against middle or window, to make the frequent trips to the washroom easy and hassle-free.
• CGMs and Insulin pumps get damaged during X-ray screening. Mention this, and clearly ask for a manual inspection. Towards this, you will be expected to carry the manufacturer’s manual and invoice for purchase, and preferably the same packaging that these devices came in.

During the flight/cruise/road-trip

• If you travel across time zone(s), you will need to adjust your medication schedules. This is especially required when the time-difference is greater than three hours. If you are traveling West, you gain a day, so you will require an additional meal and additional dose of diabetes medication. If you are traveling East, you lose a day, so you may skip one or 2 doses of medication, or meals, as per the doctor’s advice. So, it is good to start gradually adjusting your insulin schedule, a few days prior to travel.
• Check your blood glucose levels frequently during the trip, at-least once every 4-6 hours.
• Get up and walk around the aircraft or cruise-ship, as often as possible. This ensures you don’t get stiff in the limbs. At the same time, the little activity is very good for your blood-sugar levels.
• If you are on a cross-country road-trip, carry plenty of drinking water, to meet your hydration needs.
• Avoid alcoholic drinks and caffeinated beverages completely.

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Also Read: Diabetes & Fruits Consumption – Should You, or Shouldn’t You?

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At the destination

• Heat can damage CGMs and insulin pumps. Never leave them in a car/bus/van that is out in the hot-sun, or close to any source of heat. Keep these cool and dry all the time. The same rule will apply for all your medication.
• Heat is also bad for the health of the person with diabetes. This can increase blood-sugar levels. So, avoid sunbathing for long duration of time, or jogging/walking/swimming in hot weather. Stay in the shade as much as possible. If the ambient temperature is high, use fans, coolers and AC, as much as possible.
• Some flights and cruise-ships offer fancy meals with a large spread of food. Avoid consuming them as these will spike your blood-sugar and create unwanted complications.
• Have glucagon kits, to overcome episodes of severe hypoglycaemia. A friend/relative who is frequently with you must be trained on how to use the glucagon kit.
• Avoid purchasing ready-to-eat snacks unless the label has clear information on how much of added sugar is present. For the same reason, do not experiment with new dishes, or unfamiliar cuisines, as they may contain more than necessary added-sugar. Eat familiar foods/dishes only. Experimenting with food is not a luxury for diabetics.
• Be aware of service centres for insulin pumps and CGMs, at the local destination, in case they breakdown and need repair.
• Be aware of English-speaking doctors, at the local destination, if you cannot speak the local language.
• Avoid walking barefoot anywhere, either on the sand in beaches, grass in parks, rocky pools of water, hard concrete ground, etc. This is especially important if you suffer from diabetic neuropathy. Always have your feet covered in sandals or shoes.
• Cold climates can cause hypoglycaemia. So, if you are going to a destination that is cold now, or will get cold soon, carry enough warm-clothing to wear.
• Carry medication for diarrhoea, in case you catch the tummy bug. To avoid such instances, do not eat street-food as much as possible and only eat at clean and hygienic eateries. The stress induced by minor conditions like diarrhoea can also affect your blood-sugar levels.

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