For people with diabetes, the summer months with travel, hot weather, gatherings and perhaps more intense physical activity can be challenging. But with careful planning and preparation, the condition shouldn’t stop you from doing anything you want to do, say experts at the Diabetes Education Centre of St. Joseph’s Health Care London. St. Joseph’s diabetes nurses, educators and dietitians have the following tips for a safe, fun-filled summer for those with diabetes.
Before you go
- Planning your itinerary: Consider telling your travel agent that you have diabetes and explain the requirements that travelling with diabetes entails. That way, a suitable itinerary can be planned to meet your needs. A missed connection or illness can ruin the best-laid holiday plans.
- Pre-trip check-up: It is a good idea to visit your doctor for a check-up several weeks before you leave for a holiday. Discuss your itinerary with your health care team and work out plans for your meals and medication, especially if you are travelling through different time zones. Be sure to get any required vaccinations at least four weeks before you travel so you have time to deal with any possible side effects.
- Medication list: Ask for a list of your medications (including the generic names and their dosages) from your pharmacist. If you take insulin, record the types of insulin and whether the insulin is rapid-acting, short-acting, intermediate or long-acting. Be sure to carry a copy with you at all times.
- Language challenges: Sign up for IAMAT (www.iamat.org), an organization that provides access to English speaking medical assistance in other countries. Know a few phrases in the language of the country you are going to: "I have diabetes that requires insulin injections"..."I need sugar"..."I need juice"..."I need medical attention/hospital/doctor"..."Blood sugar too high/too low.
On the road, in the air or at sea
- Airlines and medications: Airlines and some countries require you to have written documents from your doctor stating that you are allowed to carry medicines or supplies. Syringes and needles in particular can present a problem when flying and when entering some countries.
- Identification: Take identification with you that explains your condition in case you are unable to give instructions yourself. Consider getting a MedicAlert® bracelet or necklace that indicates you have diabetes.
- Travel insurance: Some insurance plans do not cover pre-existing medical conditions, which includes diabetes. The Canadian Diabetes Association partners with Ingle Insurance to offer travel insurance.
- Packing: Divide your medications and diabetes supplies and pack them in more than one place in case you lose one of your bags. Most importantly, make sure you have a portion of medications and supplies in your carry-on luggage. If you take insulin, be sure to carry it with you at all times. Insulin is affected by extreme temperatures and should never be stored in the unpressurized baggage area of the aircraft. If you are on an insulin pump, bring a copy of your pump settings and carry them with you. You may also want to contact your pump company and inquire about the loaner pump program. Take extra supplies and medication in case of loss, theft or accidental destruction. Also consider other supplies you may need, including treatment for hypoglycemia, food, drinking water, walking shoes, sunblock and medication for nausea and diarrhea.
- Insulin and baggage X-rays: Ideally, insulin should not be exposed to x-rays during travel. It should be inspected manually whenever possible. However, the security scanners used at check-in will not normally damage your insulin or blood glucose meter. If baggage remains in the path of the x-ray for longer than normal, or if the baggage is repeatedly x-rayed, the insulin may lose potency.
- Metal detectors, x-rays and pumps: Walk-through metal detectors and the wand are safe for those with pumps. However, the pump cannot be exposed to X-rays.
- Regular blood glucose checks: Checking your blood glucose regularly is very important. Check it before you leave home and then again every four hours during your journey.
- Don’t overindulge: Cruises and resorts are known for their delectable all-you-can-eat buffets, making it easy to overindulge. Talk to your diabetes educator before you leave about how to fit some of these foods into your meal plan. When possible, obtain a sample menu from the cruise line to give you an idea of the types of foods served, which can help you can plan your meals accordingly.
Insulin storage and use
- Maintaining insulin potency: To ensure your insulin remains effective, avoid storing it in hot or cold temperatures. Insulin retains its potency at room temperature for thirty days. If you are travelling in hot temperatures, store your insulin in an insulated bag or cooled thermos. In extremely hot conditions, you can freeze water in plastic bottles and keep these in your insulated bag along with your insulin and food supplies.
- Disposing of needles: If your trip is short, you may want to keep your needles and sharps and dispose of them on your return home. For longer trips, you can purchase small containers that store or disintegrate needles and syringes.
- Extras: If you use insulin pens, take a spare one with you. Also, pack some syringes as they can be used in an emergency to withdraw insulin from an insulin cartridge.
Keeping blood glucose levels under control
- Regular checks: While on vacation, check your blood glucose regularly. Regular checks are the only way you’ll know whether your blood glucose levels are in their target range. It is also a good idea to bring the instruction manual for your meter as well as extra batteries and test strips.
- Clean fingers: Carry alcohol swabs or moist towelettes to wipe your fingers prior to testing when necessary.
- Daily record: Keep a daily record of injections, medications and test results. If you have trouble with your blood glucose levels, follow the adjustment guidelines as discussed with your doctor or diabetes educator, or contact your doctor or diabetes educator or a hospital in the area for advice.
- International travel – insulin, supplies and measurements:
- If you have to go to the hospital, take your documents with you. Insulins have different names and are supplied in different strengths in some countries. Make sure the insulin and syringe concentrations are the same as those you use at home. Consider using your own supplies of medications and syringes in Third World countries.
- If you are in another country and have to switch to U40 insulin (we use U100 in Canada), you will need to get U40 syringes.
- Remember that glucose levels may be measured differently in other countries. For example, in the USA 1 mmol/L equals 18 mg/dl. So a blood glucose of 10 is 180 in the US.
Dealing with time zone changes
Long journeys often cross several time zones so a regular 24-hour day can be extended or shortened. You will have to adjust your insulin and/or medication schedule accordingly. Blood glucose control can be upset by a change in time, altered activity, or disturbance of body rhythm and sleep patterns:
- When travelling east, your travel day will be shorter. If you lose more than two hours, you may need to take fewer units of intermediate or long-acting insulin.
- When travelling west, your travel day will be longer. If you gain more than two hours, you may need to take extra units of short-acting insulin and more food.
- You can change the time of your injections and meals by up to two hours in a day without adjusting your insulin dose or your meal plan.
- If you are crossing more than two time zones, you will need to prepare a meal and insulin schedule with your doctor or diabetes educator.
- For those taking oral medication, if the time difference is less than three hours, you can move the time you take your oral agents by one to one-and-a-half hours. If the time difference is more than three hours, ask your doctor or diabetes educator for advice.
- For those with pumps, when arriving at your destination set the pump clock to local time. If there is a wide variation in basal rates it is safer to adjust the clock by 1 to 1.5 hours each day. Keep doing this until you get to local time. Do lots of glucose testing and check during the night until your glucose levels are stable.
The great outdoors:
- Hiking: Avoid going camping or hiking alone. Tell someone where you will be and when you expect to return so you can be found in case of an emergency.
- First aid: Bring along a first aid kit and, if you use insulin, a Glucagon* Emergency Kit. Teach your travel companion when and how to use Glucagon.
- More intense activity: If you will be more active on your trip, especially for walking tours, carry a carbohydrate containing snack with you as well as extra fluid, preferably water. Some people may need to adjust their insulin if they will be more active. Speak to your diabetes doctor or educator for more information.
- Cuts, bruises, bites: Try to avoid getting cuts, bruises, sunburns, blisters, or insect bites. Where comfortable walking shoes that you have worn before.
- Amusement parks and pumps: If you’re heading to an amusement this summer, precautions are needed for those with pumps. Very powerful electromagnets are sometimes used on "free-fall" amusement park rides. Insulin pumps should be removed and not taken on these "free-fall" types of rides. For roller coasters, high gravity forces can be experienced. It is recommended that you disconnect (NOT suspend) the pump while on roller-coaster rides.
Activity in hot weather:
- Check frequently: In any weather, it’s important to check your blood sugars frequently– before starting the activity, every 30 minutes during long periods of activity, after the activity and whenever you have symptoms of a low blood sugar. Medications such as glyburide, diamicron or insulin can cause hypoglycemia and a higher activity level can increase this risk.
- Make sure to keep well hydrated: Your fluid needs will be higher if you’re active in the hot weather to replace sweat losses. It’s a good idea to drink 1 cup of water before the activity, 1 cup for every 20-30 minutes of activity as well as afterwards.
- Don’t forget to snack: If you are taking a medication that can cause hypoglycemia and your blood sugar is less than 5mmol/L, it’s recommended to have a carbohydrate snack prior or during the activity. Remember to carry quick sugar like juice, candy or Dex tabs with you as well as a carbohydrate snack in case you experience hypoglycemia.
Eating away from home
- Moderation is key: People with diabetes can fit virtually anything into their meal plan, in moderation. Managing your food intake away from home involves estimating appropriate amounts of these foods. It is a good idea to visit a registered dietitian to learn how to estimate serving sizes.
- Talk to your dietitian: It’s also important to eat a balanced diet while you’re away from home. Try to keep your calorie intake close to your typical level unless you are more active than usual. With the help of a dietitian, you can vary the types of food you eat.
- Another snack reminder: Always have some snacks with you in case your blood glucose level drops or you’re unable to eat your next scheduled meal on time.
Fasting during Ramadan
- The Primary Care Diabetes Support Program located at St. Joseph’s Family Medical and Dental Centre on Platts Lane in London offers a special service to people with diabetes who observe Ramadan. Individuals can receive the guidance and support they need with no referral necessary. Those interested can call 519 646-6100 ext. 67268.
For much more information on living with diabetes, printable handouts on a wide variety of topics are available on the Diabetes Education Centre website at www.sjhc.london.on.ca/diabetes-education-centre/patient-handouts