Traveling with Diabetes

With proper planning, your time away from home can be a breeze.

Eager to return home from a business trip not long after the 9/11 attacks on NYC, Christa Laszczkowski was first in line to board the plane. In an atmosphere of heightened security, she wasn't alarmed when her luggage was randomly selected for inspection at the gate -- at least not until screeners began to manhandle her diabetes supplies. "Of the four screeners there, only one of them even knew what diabetes was," Laszczkowski told Diabetes Advocate, a newsletter of the American Diabetes Association.

By the time she was finally cleared to board, inspectors had forced her through a tedious and embarrassing explanation of her medical equipment and had handled much of it -- including her syringes -- without gloves. But she really began to lose her temper when they pulled out her glucose monitor and randomly pushed buttons, which could have erased the monitor's memory and made it hard for her to keep track of her blood sugar level.

So many people with diabetes and other conditions experienced similar indignities after 9/11 that the American Diabetes Association urged the Transportation Security Administration (TSA) to take a fresh look at how passengers carrying life-saving medical supplies were treated. As a result, the TSA issued updated guidelines and encourages anyone with diabetes who has questions about screening to call them toll-free before your flight on its TSA CARES helpline at 855-787-2227.

If you have diabetes, there's a lot you can do to smooth your journey when you travel. Long trips will require some advance planning. You can't just toss some clothes in a suitcase and be done with it. No matter where you are in the world, you still need to stick to your diet and exercise routine, and take your medication. Here are some tips from the ADA to help make your next trip a safe one.

Before you go

If you have questions about how to manage your diabetes when you travel, make an appointment with your doctor. You'll want to ensure your diabetes is under control before you leave. Discuss your travel plans, and be sure to mention any expected changes in food or climate.

Ask your doctor for copies of your prescriptions and a letter explaining your condition. The letter should describe your medication regimen and list any devices you use, including syringes. This is not required by the TSA, but it might make things go more smoothly. Carry enough pills or insulin to last the whole trip, but have copies of your prescriptions on hand to save you hassles at the airport, as well as allow you to get more medication on the road if you run out.

Consider buying an identification bracelet or necklace that indicates you have diabetes. These can be purchased at many pharmacies, and you can also order a diabetes ID card (available in several languages) from the ADA.

If possible, get the name of a local doctor where you're traveling. If your own doctor can't give you a referral, contact the International Association for Medical Assistance to Travelers at 716/754-4883 or http://www.iamat.org/. If you're traveling to a country where English is not the primary language, learn how to say, "I have diabetes," "I need help," and "Please get me some sugar or fruit juice" in the native tongue.

Getting there

If you're traveling by air, pack your medical gear in your carry-on luggage. Store extra supplies in your regular luggage as well. Bring at least twice the amount of medications and supplies you anticipate needing, and also pack more than you think you'll need on the plane ride.

Since 2006 the Transportation Security Administration -- with the guidance of the ADA -- has had guidelines for carry-on medical supplies that may keep you from having an unnerving experience like Laszczkowski's:

Notify the baggage inspector that you have diabetes and are carrying supplies. There's no limit to the number of syringes, lancets, test strips, and blood glucose meters that can be carried through security checkpoints when accompanied by insulin or other diabetes medication.

Make sure that your insulin vials, insulin pens, jet injectors, and insulin pump all have pharmaceutical labels. Inconvenient as it may be, the TSA recommends that you keep your insulin in its original box.

It's acceptable to bring lancets for blood testing on board as long as they're capped and are carried with a clearly labeled glucose meter.

Notify screeners if you're wearing an insulin pump and ask that they inspect it visually, rather than have you remove it from your body. This is what the TSA has to say about it: "If a passenger uses an insulin pump, the passenger can be screened without disconnecting from the pump. Passengers who have insulin pumps can be screened using millimeter wave imaging technology, metal detector, or a thorough pat-down." For more information on what the TSA screens for, read its TSA Travel Tips at http://blog.tsa.gov/2014/04/tsa-travel-tips-travelers-with-diabetes.html.

In most cases, airport x-ray machines will not affect blood glucose monitors, insulin pumps, or medication. If you're unsure, request that your carry-on bags be inspected by hand. You can find out more about travel and diabetes at the American Diabetes Association's Guide to Air Travel and Diabetes at http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/public-accommodations/air-travel-and-diabetes/.

If you use insulin, protect it from light and extreme temperatures (both hot and cold). Since baggage compartments of airplanes can sometimes be low enough to freeze insulin, it's probably best to bring all your insulin supplies on board with you. Using a specially designed packet to carry insulin is a good idea. If you're driving, never store insulin in the glove compartment or trunk of your vehicle.

For those who are flying, it's best to bring your own food. Some airlines offer a diabetic meal for a fee, but be aware that many diabetic meals on airplanes are very low in carbohydrates, so you may need to bring extra food or adjust your medication. Always take an extra snack, some candy, or glucose tablets in with you in case of delays. And don't forget water as well. Dehydration is a serious risk for people with diabetes.

If you are crossing several time zones, you may need to adjust your medication. This is particularly true for insulin-dependent diabetics. If you are traveling west to east, you'll have a shorter day and you may need less insulin, particularly if you take intermediate or long-acting insulin. If you are traveling east to west, you may need more insulin and perhaps an extra snack.

Move around during the trip. If you're on a long flight, take frequent walks around the plane, and exercise your feet and legs, even while sitting.

In most countries, customs and immigration officials are used to seeing diabetes medication and supplies, including syringes. But be prepared to show some proof of your condition, like your diabetic identity card or a letter from your doctor.

Make sure any traveling companion knows what to do in an emergency.

Life away from home

Don't assume the small refrigerator in your hotel room is the best place to store insulin. Store insulin at room temperature unless you are in a very warm climate. Insulin should generally be kept at a temperature less than 80 degrees Fahrenheit, but it should not be frozen.

If you need to buy insulin outside the United States, double-check to make sure you are getting the strength you need. All insulin sold in the United States is U-100 strength. In other countries, insulin may be available only in U-40 or U-80 strengths, and you'll also need to buy new syringes to avoid making a mistake in your dose.

The ADA also emphasizes that vacation is not a good time to break in a new pair of shoes. Blisters and infections are the last thing you need to worry about while traveling. Also, try to avoid going barefoot to prevent getting cuts on your feet that could lead to an infection.

If you wear an insulin pump, remember to adjust the clock to the new time zone. And while you're out and about, be careful not to overexert yourself. In a new environment, you may need to be more alert for signs of low blood sugar, and may want to check your glucose a bit more frequently. At least as important as your guidebook are your monitor and a source of sugar, just in case.

References

The American Diabetes Association prints medical identity cards and has several publications on traveling with diabetes. 800/342-2382 or www. diabetes.org

American Diabetes Association's Guide to Air Travel and Diabetes, 2017. http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/public-accommodations/air-travel-and-diabetes/

International Association for Medical Assistance to Travelers: 416/652-0137 or www.iamat.org.

Ruth Lundstrom, Aldo Rossini. The Healing Handbook for Persons with Diabetes, University of Massachusetts, also available at www. http://umassmed.edu/diabeteshandbook/chap14.htm

Traveling with Diabetes, Children with Diabetes, www.childrenwithdiabetes.com

TSA Travel Tips: Travelers with Diabetes or Other Medical Conditions, 2014. http://blog.tsa.gov/2014/04/tsa-travel-tips-travelers-with-diabetes.html

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