Diabetes and Travel – time to refresh your knowledge?

Education on diabetes and travel – key considerations

 The topics to cover when providing education around diabetes and travel will depend on the person and their circumstances, including the type of diabetes they have, how it is managed, whether they are using any diabetes technology including a blood glucose monitor, continuous glucose monitor (CGM), flash glucose monitor or an insulin pump, the duration of their travels and the places they will be visiting.

However, key topics include:

• Ensuring they have adequate diabetes supplies including medications, blood test strips, ketone strips, CGM or flash GM sensors/transmitters, pump consumables and spare batteries for pumps and blood glucose meters. If they are planning a short trip, they could take double the amount they expect to need. For longer trips encourage clients to take enough for at least a few extra weeks in case of travel delays or misplaced supplies.

• Diabetes medication storage, for example using insulated cases for transporting insulin and injectable medications. These are usually available through the Diabetes Australia state and territory organisation online stores (https://diabetesshop.com/collections/cooling-cases) or can be purchased online directly  from manufacturers/suppliers.  Common brands include Glucology (IBD Medical), FRIO and Medactive.  The type of case someone chooses needs to take into consideration whether they will have regular access to a fridge/freezer throughout their trip. It is important to remind people with diabetes to carry their medications and diabetes supplies  with them at all times.  For air travel, this means keeping diabetes supplies with them in the aircraft cabin, not in checked luggage.  Insulin stored in checked luggage in the aircraft’s hold could become frozen, or luggage may be ‘lost’ and be delayed reaching the passenger.

• Managing time zone changes. Anyone taking insulin or medication that needs to be taken at a particular time of the day will need advice on adjusting their insulin/medication timing as they change time zones.

• During long haul flights, keeping hydrated with water is important. Encourage clients to wear comfortable shoes and try to exercise to reduce foot swelling and risk of deep vein thrombosis.

• Medical identification. This can be a good idea, particularly for individuals at risk of hypoglycaemia.  There are many options available but MedicAlert is recognised internationally.  https://www.medicalert.org.au/

• Sick day management. Ensure clients understand how to manage their diabetes during sick days and that they have an up-to-date sick day plan and a travel-friendly sick day kit. A travel sick day kit should include antiemetics, antidiarrhoeal agents, paracetamol, broad spectrum antibiotics, oral rehydration solution, antiseptic cream/lotion, and basic wound dressing products.

• Pump back-up plan. For anyone using an insulin pump, ensure that they have a current back-up plan in case of pump failure and spare basal and rapid-acting insulin as well as pen needles or syringes as appropriate.  Some companies will also loan a spare pump for travel but an application usually needs to be submitted a few months ahead.

• Low blood glucose treatments. For those at risk of hypoglycaemia, ensure they pack plenty of hypo treatments and spare snacks.  Good options which don’t take up too much space or weight include glucose tablets and gels and muesli bars or trail mix.

• Travel insurance. Make sure that clients check that their travel insurance covers pre-existing conditions. Australia has reciprocal arrangements for emergency medical treatment in Europe and several European countries (for those who have access to Medicare), however this is not a substitute for travel insurance.  More information can be found at gov.au/individuals/services/medicare/reciprocal-health-care-agreements . If using a pump they might also want to consider insuring the pump.

• Encourage clients to ensure they are up to date with vaccinations including measles, tetanus, hepatitis B (hepatitis A may also be required in some cases), influenza, pneumococcus  and of course COVID-19. Anti-malarial medications may also be recommenced in some countries.

Travel letters – what to include

Providing a letter stating that the person has diabetes and outlining the supplies they will be carrying and any requirements around diabetes technology and x-rays, can help to prevent hold-ups at airport security. If travelling to a non-English speaking country, recommend that they get the letter translated to the language of the country/countries they are visiting.

Include:

• The client’s name and DOB
• The type of diabetes they have and how it is managed (e.g with insulin injections or a pump)
• What they will be carrying during the flight (e.g. insulin pens, pen needles, blood glucose meter and test strips, CGM sensors and transmitters, pump consumables, hypo treatments etc)
• If they are using CGM or an insulin pump explain that these devices should not be exposed to X-ray screening, including whole-body imaging scanners and baggage X-ray machines. If needed, an alternate means of screening. (e.g. pat down or hand inspection of the device) can be used. 

Resources

NDSS Diabetes and Travel fact sheet This includes a useful “what to pack” check list. https://www.ndss.com.au/about-diabetes/resources/find-a-resource/travel-fact-sheet/

NDSS Travel and Type 1 Diabetes booklet (for young people) https://www.ndss.com.au/living-with-diabetes/about-you/young-people/resources/

ADEA sick day fact sheets and sick day plan templates: https://www.adea.com.au/resources/standards-position-statements-and-other-resources/adea-clinical-guidelines/