I’ve always loved to travel, and so when I was diagnosed with Type 1 diabetes at the age of 22, one of my biggest fears was that the disease was going to keep me tethered to home. Thankfully, nearly 14 years later, I’ve learned that diabetes doesn’t have to limit my adventures, as long as I’m thoughtful and prepared – and I’ve been fortunate enough to travel to far-flung places including China, Croatia, Cambodia, Vietnam, Siberia, Mongolia and Tibet. Here are my top 15 tips for how to take your broken pancreas on the road, whether you’re headed someplace exotic, or just relaxing on a beach.
Traveling with Diabetes: How to Stay Safe
- Know how to contact your care team. Talk to your doctor ahead of time about how to get in touch with him or her (or the office) in the case of an emergency, especially if it strikes after hours. It can be helpful, too, to look up local diabetes centers or respected hospitals in the city or countries that you’re traveling to, just in case.
- Carry a card in your wallet saying that you have diabetes . . . in the language of the country that you’re visiting. (Google Translate can usually take care of this for you, even if its grammar is not entirely correct!) If you’re wearing an insulin pump, say that, too.
- Get a note from your doctor on professional letterhead saying that the syringes, insulin vials, and other assorted supplies cluttering up your carry-on are medically necessary for your personal diabetes care, and that you should be allowed to keep them with you at all times. This can be helpful going through airport security.
- Speaking of carry-on bags, never check your diabetes supplies. They have to be in carry-on (if, like, me, you always find yourself in group 5 for boarding, politely explain your situation to the desk attendant and ask if you can board earlier). I once had a bag get lost on the way from Turin, Italy to Vilnius, Lithuania and it took five days before they tracked down my bag in Milan. It was one thing to have to spend a week washing my one pair of underwear in the sink. It would have been another to not have syringes or test strips or insulin.
- Keep a stash of emergency supplies in a separate bag. (I’m talking spare pump infusion sets, an extra vial of insulin, syringes, test strips, etc – whatever you would need for three to five days.) This way if your main bag gets lost or stolen, you will have sufficient supplies to take care of yourself while you sort out what to do next.
- Embrace redundancy. Murphy’s Law and personal experience dictate that the farther you are from home, the more likely it is that your pump will malfunction (or you’ll accidentally drop it in a toilet), or your glucometer will stop working (as once happened to me at the top of Tai Shan mountain in China, where the only available food was large bowls of noodles). Bring an extra glucometer and at least one and a half times the number of test strips you think you’ll need. Bring a few extra vials of short- and long-acting insulin, even if you’re on a pump (and don’t forget pen tip needles or syringes!). No matter what the device, always be prepared for it to fail.
- Consider a loaner pump. If you’re going on a long trip and are a totally devoted pumper, then contact the manufacturer to see if you can get a loaner pump – they’ll often let you borrow a spare one for your trip just in case your normal pump malfunctions. Just be sure to return it when you get home.
- Know your basals! Just in case your pump does malfunction, make sure you’ve got your basal rates (and correction factors and carb ratios) written down someplace so that you can program the new one without having to track down your doctor. Likewise, also talk with your doctor ahead of time about what dose of long-acting basal insulin you should take if your pump were to totally crap out on you and you couldn’t get a replacement.
- Carry glucagon – and make sure your traveling companion knows both where it is and how to use it. Likewise, carry extra glucose tablets or sugar with you at all times. When you’re traveling, you’re likely eating different foods and moving around more than you would at home, and your risk of hypoglycemia can be higher. You may also be prone to dumb mistakes, such as one time, in my pre-pump days, when I was staying in an apartment in a residential neighborhood in Budapest and accidentally took 10 units of short-acting insulin right before bed, thinking it was my long-acting. (I realized this after I’d injected it, but while the syringe was sticking out from my thigh.) Thank god the apartment had a sugar bowl — I drank a cup of syrup so sweet it made me gag, and set an alarm to wake me up every hour. My blood sugar never went above 120 mg/dl. Just thinking about it still gives me the shivers.
- Plan for jet lag: if you’re traveling across multiple time zones, talk to your doctor about how to adjust your basal insulin rates, especially if you’re on a pump. It takes a while for your hormones to catch up to the new time zone, which means you may be resistant to insulin (or particularly sensitive to it) at different times than normal. Sometimes doctors will recommend adjusting your pump settings or the timing of your long-acting dose to the new time zone immediately when you land; sometimes they’ll recommend adjusting them by an hour each day. Talk to your doctor about what would work best for your particular trip.
- Keep your insulin cool. This is not as much of a concern if you’re going on a business trip to Chicago. But if you’re traveling someplace tropical or hot (or, conversely, really, really cold), you’re going to need to keep your insulin at a relatively constant temperature so that it doesn’t denature. When my husband and I did our big trip (we spent several months traveling before moving back east), I used Frio bags to keep my insulin at a decent temperature – all you do is dip them in water and they start to cool, no refrigerator required. (If you’re staying in a hotel with a refrigerator, keep your insulin in it at night. And then put something really noticeable on the floor in front of the refrigerator, so you don’t forget it!)
- Be careful overnight. As noted, any time you switch around your schedule (or have jet lag) you’re prone to have unexpected hypoglycemia. If you’re lucky enough to have a continuous glucose monitor, make sure to turn your alarms on while you’re asleep (or use Kerri Sparling’s trick and put your CGM receiver in an empty glass next to your bed – the glass will amplify the CGM’s vibrations and make it more likely that it’ll wake you up). If you don’t have a CGM, set an alarm for 2 or 3 in the morning for your first few nights in your new location, to make sure your blood sugar’s still in a safe range.
- Use Twitter. If you run into a problem when you’re traveling, send out a tweet using the hashtag #doc (diabetes online community) or #diabetes or #t1d (or #t2d) and include your location. Chances are, somebody knows somebody who might be able to help you. Also check out HelpAround, an app designed to allow you to search for other people with diabetes who are near you and who might be able to help you if say, you need an extra syringe, or are trying to find a local doctor.
- Bring snacks. It can be very difficult to control what you eat while you’re traveling – one day you might find yourself with no lunch options but a bowl of ramen or a breakfast buffet that is entirely carb-based. I like to bring some sort of lightweight food with a long shelf-life – like KIND bars — that I know how to bolus for.
- Don’t let diabetes stop you. Traveling with diabetes definitely makes things more complicated, but as long as you keep these tips in mind, there’s no reason to let it stop you. In fact, I like to think that the challenge of diabetes makes me want to travel even more, to prove to myself that having diabetes doesn’t mean I have to miss out on life.