Traveling with Diabetes
Prepare with Care
Diabetes is a condition that requires management, such as monitoring blood glucose (blood sugar) levels. This management can become a challenge when traveling, either by air or by car. People with diabetes should be at least as diligent about their practices when traveling as when at home.
There are a few tips to consider whether traveling by air or in the car. “As a general rule before starting a trip, a person who has diabetes should first see their physician to discuss if their health is good enough and they’re fit for travel,” said endocrinologist Dan Mihailescu, associate professor of medicine at the University of Illinois College of Medicine in Chicago. “Patients who are taking insulin should share their plans and discuss how to plan activities that could affect their blood glucose levels. For example, how to adjust their insulin doses if traveling over different time zones or if the anticipated level of activity is higher than their normal.”
Dr. Dan Mihailescu
While meeting with the doctor, get a back-up prescription for your medication. This is helpful if you run out of medication or it gets lost. “I also recommend getting a letter describing your condition and treatment, as well as any other factor that the physician considers important,” Mihailescu said.
A medical ID bracelet or necklace is a good precaution, particularly if you use insulin and are subject to hypoglycemia. A medical ID should list diabetes and other critical medical information as space allows. Mihailescu also recommends travel insurance. It provides some coverage if the trip is delayed or canceled for medical reasons.
“In general, for flying or driving, I think it’s a good idea to have a special meal packed that is consistent with the patient’s meal plan,” Mihailescu said.
For diabetes educator (and diabetes patient) Toby Smithson, planning is key. “Planning ahead helps to reduce stress,” she said.
Plan #1 — food. “I recommend traveling with snacks and meal replacements because you can’t predict flight delays or traffic jams,” Smithson said. She recommends three types of snacks. It’s also a good idea to have a water bottle to stay hydrated.
First, fast-acting carbohydrates for moments of low blood sugar. “A lot of people know about half a cup of juice, but if you’re traveling, you’re not necessarily going to have liquids with you,” Smithson said. “Five Life Savers® or other hard candy is a serving to treat a low blood sugar. Three or four glucose tablets, which you can buy at the pharmacy, will also do the trick. Those are easy to carry, and then you’re prepared for treating low blood sugar if you tend to have that.”
Second is a healthy, in-between snack, such as fresh fruit or unsalted whole grain crackers, to carry someone over to the next meal.
Third is a meal replacement, something like a peanut butter sandwich or peanut butter on a graham cracker. “Those don’t need refrigeration, and they’re fine to go through TSA, and it’s a good source of protein,” Smithson said.
“Also, I recommend checking your blood sugar before having a snack or meal to help decide if you need a snack or meal,” Smithson said. The National Institute of Health’s National Institute of Diabetes and Digestive and Kidney Diseases recommends a blood sugar target range of: 80-130 mg/dl before meals and less than 180 mg/dl two hours after the meal starts. Talk with your health care team about the best target range for you.
Smithson points out that sometimes blood sugar rises, and at those times you don’t need to eat a snack. “It may be that you need to get up from your seat and walk around a little bit and drink some water,” she said.
“In general, I think it’s a good idea to have all diabetes supplies — medications, testing — in one bag that is easily accessible,” Mihailescu said. “If flying, that should be a carry-on bag. I actually recommend to my patients to have a smaller bag or a purse held at their seat because sometimes it’s impossible to reach in the overhead for the carry-on luggage. That bag should include insulin, testing supplies, any pills they are taking, as well as glucose tablets and a few snacks. It is important not to store the insulin in the checked luggage as it could be affected by the changes in temperature.”
Changing time zones can be a concern, especially for those who need insulin. “If there’s a big-time difference, like traveling overseas, then as soon as you arrive, get into that time zone,” Smithson said. “Do your eating and medication and all of that based on the new time zone as soon as you land. If it’s one or two hours, like Eastern to Central or to Pacific, it won’t make that much of a difference.”
Make sure that your medication does not get left in a hot car. Mihailescu recommends keeping medicine in a cooler, “and never leave your medicine or glucose monitor in the car where the temperature can get very high quickly,” he said.
Mihailescu notes that for those who need to keep medication cool, there are new cool packs that don’t require refrigeration. “They can just be put in cold water for 5 to 10 minutes and then they can maintain a lower temperature for many hours,” he said.
At the other extreme, Smithson warns not to leave medication in the car if you are traveling in cold weather, like a skiing trip.
Smithson says that although insulin is refrigerated, opened vial, disposable pen or pen cartridge insulin can stay out of the fridge for up to 28 days at room temperature (below 86 degrees Fahrenheit). Review the product storage instructions on the manufacturer’s package insert, as storage instructions may vary based on the type of insulin and administration system.
“For Type 2 diabetes, there are some injectable medications that aren’t insulin that should not stay out of the refrigerator for more than 14 days,” she said.
Take special care when you will be driving for a long time, particularly if you use insulin: “It’s very important to test their sugar before they start driving and periodically thereafter,” Mihailescu said. “Also, take some breaks to walk around after a few hours of driving to prevent blood clots in your legs.”
“Try to incorporate exercise whenever possible,” Smithson added. “I suggest making some intentional stops to get out of the car and do a little bit of walking, like at a rest stop.”
Stay Within Targets
Staying within your target blood glucose range can be a challenge since travel often means changes to one’s typical meals and activity level. “Patients should test their [blood] sugar level more often and discuss with their physicians some possible adjustments in the [medication] doses in terms of anticipated activity,” Mihailescu said. “If they are planning to be more active, definitely test the sugar before starting an activity and periodically during the activity and at the end.” Essentially, make the same good eating choices you do at home. Be mindful of how your level of activity while you travel is different from your typical level of activity at home and make adjustments as needed.
“It is so important to check your levels often,” Smithson said. “That will give you information on where you’re at, how you’re dealing with the differences and changes with traveling.”
Eating out can be a minefield for a person with diabetes. Traveling by car may be simpler because there are more eating options. “However, the airlines are serving food less and less,” Smithson said. “On many flights, there is no meal service, so it really is important to plan ahead and bring some snacks and meal replacements. It’s really hard if you’re not bringing your own food and depending on airport restaurants. I recommend going online and checking to see what eating establishments are available at the airport that you’re flying into or out of. Then you can plan ahead and make the wisest choices.”
“Indeed, it’s so important to watch the diet and look for healthier food options,” Mihailescu said. “Even at the airport, or on the road, you can find different options that don’t have such a negative impact on the blood glucose levels. For example, yogurt, fruits, nuts, salads, eggs, omelets. And it’s good to avoid the buffet-type of meals where people often tend to overeat.” Make sure that dairy products are fat- and sugar-free, fruit is unsweetened, nuts are unsalted and omelets are made with healthy ingredients.
Stay away from sugary soft drinks and be mindful of limiting any alcohol intake. “And stay well hydrated,” Mihailescu said.
“People should know that TSA’s 3.4-oz liquid rule does not apply to insulin and the fast-acting carbs like juices or the gel packs that are required to keep medications cold,” Mihailescu said. “It’s allowable and they can pass through the security without any problems. It’s always a good idea to pack those together with other medications in a separate clear plastic bag so you can show it right away to the TSA agent.”
When traveling by air, be mindful of insulin pumps or glucose sensors — “Those devices cannot be exposed to the x-rays or to the scanners at the airport and should be inspected by hand,” he said. Check with the manufacturer about whether any other equipment can go through x-ray scanner.