Modern-day travel can be stressful for anyone, and sometimes especially for those with a medical condition such as diabetes. However, with careful preparation, there is no reason why the trip cannot be a pleasurable, rewarding experience. Having diabetes should not limit most people from traveling, taking some simple steps can help prevent diabetes-associated complications.

You can regulate diabetes most effectively by following a healthy life style routine of just the right amo nt of sleep, exercise, caloric intak , and medication dosage. Adjusting to time zones changes, unreg lated meals, and irregular sleep-wake cycles are among the challenges diabetics face due to the unpredictable nature of traveling. Furthermore, since many diabetics have an impeded ability to heal infections, suggestions are offered on the prevention and management of minor, common infections including when to seek medical attention.

Preventing and treating common infections
While traveling, besides controlling blood sugar through proper diet, exercise, and medication, the diabetic should self-monitor for signs of illness or infection. In diabetics, even the most minor scratch, if left untreated, can result in a severe infection. Educated, aware, and healthy diabetics should be able to self-manage minor infections without the guidance of a physician. I advise such travelers to take antibiotic ointments and pills with them to prevent or treat simple bacterial infections. Less self-reliant or less healthy people should seek medical advice and information and, if necessary, a list of antibiotics one can take under normal circumstances.

Here are some of the medical conditions diabetic travelers are at risk of:

Skin and skin structure infections
Diabetics are at particular risk for developing skin and soft tissue infections from even minor cuts and scratches. Many long-term diabetics have developed poor circulation making it difficult to heal even minor wounds. The most notable area of infection is the foot, where nerve damage from long term diabetes, may have eliminated the sensations of heat, cold, and pain. This makes it difficult to detect cuts, sores or even a penetrating nail.

Diabetics should check their feet daily for minor cuts, scrapes or embedded objects. Unnoticed foot trauma from new footwear or hiking shoes may lead to diabetic foot ulcers and bone infection (osteomyelitis). Careful instructions regarding local care of early ulcers, changes of socks to avoid persistent pressure points, and careful wound dressings at night to supplement the use of antibiotics are necessary to prevent skin infections (cellulitis) and infection of the blood vessels (lymphangitis).

Both staphylococcal and group B streptococci are important pathogens under these circumstances. A diabetic who engages in strenuous sports or long arduous treks adds additional risk factors for the development of serious skeletal muscle infection (myositis) with Staphylococcus aureus. This could be a life-threatening condition and diabetics should consult a physician as soon as possible. It is imperative to wear shoes or other protective foot covers at all times, even on the beach. All diabetics should carry a wound care kit on any trip where medical attention might be difficult to attain.

Respiratory tract infections
Most upper respiratory tract infections are viral and do not require medication. However, certain people are at an increased risk of developing bacterial pneumonia and are therefore candidates for preventive antibiotics. People with lung diseases like chronic obstructive pulmonary disease (COPD), heavy smokers, alcoholics or debilitated travelers should take special care.

Community-acquired pneumonia may be more severe in diabetic patients and it may require both hospitalization and broader antibiotic coverage for other organisms which are less common in non-diabetics, such as Staphylococcus aureus, Gram negative organisms or even Mycobacterium tuberculosis (TB). This is more common in diabetic patients who have not received the anti-pneumococcal vaccines. Oral antibiotics may not always prove to be adequate for all infections in diabetics. Nephrotoxic agents (antibiotics that may harm the kidneys) must be avoided; particularly when renal insufficiency is already present, as should the additional burden of ototoxic drugs (antibiotics that may affect the hearing) in patients who already have the potential for impaired vision from diabetes.

Influenza is self-limiting in young non-diabetic patients but not so in patients with diabetes. Most diabetics who did not receive the influenza vaccine and travel to areas with high incidence of influenza will be infected. Single dose vaccination with influenza is given once a year preferably between February to May. The incidence of influenza peaks from July to October. Pneumococcal vaccine should be administered to all diabetic patients especially if there is concomitant co-morbidity like chronic pulmonary or cardiovascular diseases. It is given once in a lifetime although booster doses maybe required.

Immunization should include annual influenza vaccine and pneumococcal vaccine, in addition to purified protein derivative (PPD, which is a form of skin testing to check for TB exposure) before and after any travel that includes added tuberculosis risk, such as medical work in endemic regions. The risk of tuberculosis for diabetics is also several-fold higher than that of the general population.

Urinary tract infection
This is more common in women with diabetes, particularly if fluid intake is decreased. Risk during travel may be associated with increased sexual activity on vacation. Gram negative enteric flora or enterococci are major offenders, unless there has been prior antibiotic use or vaginal candidiasis (fungal infection of the vagina) is present. Upper tract disease (kidney infections) including renal carbuncle, perinephric abscess or papillary necrosis occurs more commonly in diabetic patients. It should be anticipated by utilization of a two-week antibiotic regimen for such infections, rather than short course therapy.

Acute gastrointestinal infections
Watching food and water intake can prevent some gastro-intestinal infections. Those with diabetes are generally not more prone to gastric upsets but the consequences can be more serious. For example, vomiting can lead to hypoglycemia due to reduced calorie intake, while more severe diarrheal illnesses especially if associated with fever may lead to hyperglycemia and ketosis in those dependent on insulin.

If you have diabetes, there’s a lot you can do to smoothen your journey when you travel. Long trips will require some advanced planning. You can’t just toss some clothes in a suitcase and be done with it. If you have questions about how to manage your diabetes when you travel, discuss travel plans with your diabetes specialist or travel medicine doctor. You’ll want to ensure your diabetes is under control before you leave. 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.

Happy travel, party hearty!

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