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Do your research. Find travel books or search the internet to learn more about your travel destination. Consider the climate, accommodation, culture and food that you�ll be exposed to once you arrive. Research where you�ll be able to buy diabetes supplies or seek healthcare services while away. Talk to others who have traveled there before and ask friends with diabetes what worked well for them when traveling. Your travel agent can also give you information on your destination, help you plan an itinerary and find accommodation that suits your needs.

See your doctor or healthcare provider at least 4-6 weeks before your trip. This gives them enough time to ensure you have all the information, documentation and supplies you need. This is a good time to:

� Have a physical exam

� Review how well you�re managing your diabetes

� Ensure you have enough medication for the duration of your trip

� Discuss any necessary adjustments to the doses or timing of your medication, especially when crossing different time zones

� Learn how to properly transport your medications

� Discuss healthy eating strategies including timing of meals and snacks,

� Get any necessary vaccinations

� Ask your doctor for a letter explaining your medical history, current medications and why you�re carrying syringes or insulin pens

� Make a plan for managing your blood sugar when you�re ill

� Provide important contact details in case of an emergency, both locally and during your trip.

Ensure that you have travel health insurance and carry some form of identification to alert others that you have diabetes such as a medic alert bracelet.

Packing for the journey

Make sure you pack a copy of your health insurance, contact information, and letter from your doctor with your other travel documents. Pack travel-friendly snacks such as almonds, dried cereal, crackers, dried or fresh fruit, granola bars or sandwiches, and some fast-acting �sugar� such as glucose tablets, hard sweets or a juice box. These snacks can help when your blood glucose drops or you�re unable to eat your next scheduled meal on time.

When packing your medication and diabetes supplies, decide what you need and then take extra. It�s important to keep some of your medications and supplies in your hand luggage. You may also want to divide the rest of your medication and diabetes supplies, packing them in more than one place, in case of a lost bag, theft or accidental destruction.

Insulin can be kept at room temperature for up to 30 days, but it must be stored and transported properly, as it will spoil if left in temperatures that are too hot or cold. So don�t leave it in the car or sun. Consider using a cooler bag to transport it. Many hotels and boats have mini fridges, which can be used to store your extra insulin.

Traveling for long hours and doing lots of walking while away are good reasons to pack and wear comfortable, well-fitting shoes and clothes. It�s always a good idea to take sunscreen and you may want to have moisturizers, insect repellent and lots of water on hand.

Tips for the journey

� Drink plenty of water throughout

� Use the airport waiting time to walk around, instead of just sitting

� Stretch regularly during long flights

� Use moisturizers more frequently

� Avoid drinking too much alcohol

� On adventurous trips, travel with a companion who can recognize hypoglycemia and help if you�re ill

� If you use insulin: if flying west, increase the gap between doses by 2-3 hours twice daily. If flying east, reduce the time between doses by 2-3 hours each time, but watch for hypoglycemia. It may also be wise to decrease your doses of insulin by six units. Monitor the situation carefully.

Be alert for:

� Travel sickness, vomiting and diarrhea. Vomiting can lead to loss of diabetes control. and your sugar control and metabolism are extra vulnerable when you�re ill. Seek medical advice early.

� Dehydration Be careful to avoid dehydration especially if it�s hot or you are very active.

� Sunburn. Look after your skin as a burn can stress the body and destabilize diabetes.

� Foot care problems. Hot, sticky climates can lead to fungal infections; hot sand and stones can burn your feet; dry and cracking skin should be kept moist.

� Any illness as it can raise insulin requirements. Never stop your insulin if you fall ill and consider increasing it as per your doctor�s instructions.

� Hypoglycemia (low blood glucose). When possible, test your blood sugar at the first symptoms of hypoglycemia. If in doubt, treat your low blood glucose symptoms. It�s better for your blood sugar to be too high for a few days than to have a hypoglycemic incident.

Dealing with hypoglycemia

What causes hypoglycemia?

� Delayed or missed meals, or a meal with too little carbohydrate.

� Extra strenuous or unplanned physical activity (hypoglycemia may be delayed up to 12 hours).

� Alcohol � especially on an empty stomach.

� Too much insulin or medication for diabetes.

� Vomiting or being unable to tolerate food.

To treat hypoglycemia

Consume some fast-acting carbohydrate such as:

� 15g of glucose in the form of glucose tablets � read the insert to get the right dose.

� 15ml or 3 teaspoons of sugar or honey

� � can of a regular soft drink (not diet).

� � cup of juice.

� 5-7 hard sweets or jelly beans.

Other considerations

� It�s vital to treat low blood glucose quickly. Otherwise it can lead to loss of coordination, confusion, slurred speech, loss of consciousness, or seizures.

� If you�re driving and develop signs of hypoglycemia, pull over to the side of the road and treat it.

� Always carry fast-acting carbohydrates with you if you�re taking insulin or other diabetes medication.

� If you�re doing strenuous exercise take extra carbohydrates before and during the activity.

� If you�re experiencing hypoglycemia more than once a week, talk to your doctor.

Fatma Almarashi M.D., F.A.C.E.
American Board Certified Internal Medicine
American Board Certified Endocrinology, Diabetes & Metabolism