Guidelines For Diabetes

Before Travelling

Start accustoming yourself to alterations in diet eg you may be eating rice in S.E. Asia, pasta in Italy. Become aware of how this affects your blood sugar whilst at home where you have easy access to blood sugar monitoring devices and to medical care.

Consult your doctor

Obtain identification stating that you are a diabetic, and a letter listing your medications (both type and dose), emphasising that you have medical indications for carrying needles and syringes (important for customs). A diabetic alert card, identification tag or bracelet is highly recommended. Have vaccinations well in advance. They can make people feel unwell for a day or so, and may upset Diabetic control.

Take more than sufficient medication for the duration of the trip, and plan to carry this split amongst your hand luggage and that of your travelling companion, in case of breakage or loss. Ensure you pack plenty of blood/urine testing equipment.

Seek your doctors' advice for a small medical kit, appropriate to your needs.

Consider the following:

  • Iodine (2%) to be used as an antiseptic and to purify water.
  • A variety of simple dressings (you will need to pay meticulous attention to cuts and scratches, even the
  • most trivial to avoid skin infections in tropical climates).
  • Medication to control vomiting, diarrhoea and motion sickness if necessary.
  • Antibiotics for general use and to treat diarrhoea (Noroxin and Simplotan are a good combination to take).
  • You may like to consider taking continuous, low dose antibiotics to protect against diarrhoea (eg
  • Vibramycin 100mg daily), especially if you are prone to stomach and bowel infections - diarrhoeal illness
  • can make diabetic control very difficult.
  • Glucagon, if you use it for "hypos".

Time Zone

variations can be confusing in terms of timing insulin injections. Find out from your travel agent the duration of the flight and expected time of arrival at you destination. Consult your doctor re adjustment of the insulin dose. Some general guidelines are as shown overleaf.

Have adequate medical insurance.

Find out in advance where you can obtain medical assistance in the countries that you plan to visit.

Notify the airline, so they can make your flight attendants aware. Order diabetic diet for the flight.

Consult a phrase book and find out appropriate translations for a few simple emergency phrases

eg "I have diabetes" "I need sugar" "I need a doctor/hospital"Teach travelling companions how to help you if hypoglycaemia occurs – explain symptoms to them and that they should remember to give you some form of sugar.

In flight

Keep medications, insulin and tablets, plus needles and syringes with you at all times in your hand luggage - you may be going to Nepal, but there is no guarantee that your luggage will end up at the same destination! There is no need to worry about refrigerating insulin - it is stable at room temperature for months, and will in fact deteriorate if stored in the un-pressurised baggage compartment of a plane.

Walk up and down the aisles for exercise.

Whilst Away

Avoid exposure of insulin to bright light and high temperatures (greater than 33o or 90o F) otherwise it can be carried like any other medication. If hiking or camping in hot climates consider carrying some sort of insulator eg a polystyrene container or a space blanket.

Even if you are only sightseeing you are likely to use more energy and you may need to increase your carbohydrate intake or decrease your daily insulin dose.

Always carry spare food. Such as some form of sugar in hand luggage, complex carbohydrates such as dried fruit or biscuits, for unexpected delays in flight and simple sugar, eg jelly beans, fruit juices to treat "hypos". Consider the availability of food at your next destination. Allow for delays in arrival.

Make sure you take old, comfortable shoes, or wear in new shoes before departure -blisters are a great place for infection to start!Check feet daily for preasure sores ,cuts.

Be meticulous about any cuts, scratches or broken areas of skin, especially in tropical countries - these must always be washed in clean water, and dressed with antiseptic and a clean dry dressing, e.g. bandaid. At the first sign of infection, commence using antibiotics, cream or oral medication. Monitor your sugar levels carefully especially if unwell with any illness, but in particular if vomiting or having diarrhoea.

Dress appropriately for the climate.

Insulin Dose Adjustments

Several methods may work to regulate your sugar. Some diabetics familiar with managing their condition simply use pre-meal glucose readings and use short acting insulin with eating each meal. When they reach their destination they can go back to their usual schedule. Another method is to ascertain the length of the flight in hours and work out by how much the day will be shortened or lengthened for the traveller when they arrive at their destination.

Difference In Day Length

Dosage Alteration

Day shortened by less than 4 hours

No action required.

by more than 4 hours

Decrease insulin by 20%.

NB: If a twice daily dosage, reduce second dose only.
Day lengthened by less than 4 hours

Take an extra 2 carbohydrate portions at 24 hour point.

by more than 4 hours

Have normal dose on day of departure. Have a small additional dose (10% of total usual daily dose) taken before extra meal served at end of flight.

Please discuss any adjustments to your insulin dose with your Doctor.
© 2014, Travel Medicine Centre Perth