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Travel Smarts for the Jetsetting Diabetic

Traveling is just inevitable for humans. For some professionals, traveling to other countries is like hitting two birds with one stone—meeting with clients, and at the same, getting to explore and unearth the secrets of that destination. For the born adventure seeker, traveling may mean getting to know diverse cultures or just getting to see the sights.

All these sound so exciting, but what if diabetes might get in the way of your travel ventures? Read on and find ways on how to make your travel as smooth and enjoyable as possible even with diabetes.

Prepping for the trip
Traveling entails a lot of preparation from flight and hotel accommodations to the clothes and gadgets you need to bring with you. It takes months, sometimes even years to plan these trips. And for those with diabetes, special considerations include paying attention to the amount of medicines they need to bring, as well as having themselves checked by their doctors before getting the green light to travel.

According to Dr. Sjoberg A. Kho, University of Sto. Tomas Hospital endocrinologist, and board director of the Philippine Society of Endocrinology and Metabolism (PSEM), he tells his patients that planning the trip way ahead of time and bringing enough medications are very crucial. “They should count their medicines and pack in extra because they’ll never know if their flight might get cancelled or delayed,” he advises.

Dr. Kho says he also individualizes his patients, from the insulin dependent to the non-insulin dependent. “I’ll tell them on the day before they leave the country what medications they’re supposed to take before hopping on the plane, what medications they’re supposed to take while on the plane, and what medications they’re supposed to stop,” he states.

Packing a snack is also important. “Make sure that they have food with them all the time because when traveling, a lot of times on the plane, bus, or car, oftentimes it’s hard to anticipate what time they’re going to be fed,” he says. “If they take their medication at the wrong time and do not eat, the biggest concern that one can have is hypoglycemia,” he continues. In addition, he says, that a patient with diabetes experiencing a hypoglycemia attack on the plane might just be thought of by the stewardess as a passenger dozing off like the rest. And this could be very dangerous.

On which mode of transportation is best for diabetics, Dr. Kho says that there’s nothing in particular, “you just have to know which one they prefer and then instruct them accordingly.”

Knowing what else to bring
Aside from the basic necessities like clothes and toiletries, it is also very crucial for diabetic patients to bring their medicines and their insulin. Dr. Kho also suggests, “It might be a good idea also to split the medications, meaning some of them are in the carry-on luggage, some of them are checked-in, just in case their checked-in luggage gets lost. For their carry-on, they should bring some of their medicines, even if they have a short flight because they’ll never know if the flight can get cancelled and delayed and they’d run out of medications.”

Dr. Kho also advises to bring extra medications like antibiotics because diabetics are known to be more prone to infections. “It really depends on which part of the world or which part of the country they’re going to. There are certain countries, like the Philippines, that are more prone to acute gastroenteritis and a lot of times they could be bacterial, so they should pack antibiotics. If they have the first sign of diarrhea, especially if there are no physicians available, they can start antibiotic intake,” he shares.

Bringing all sorts of medicines may be a bit of a hassle and may add more clutter to your luggage, so to make things more orderly, Dr. Kho says that a medicine box can help solve the clutter problem. “If they are going to travel for like a week, they can just put their medications in those medicine boxes, if they are going to travel for that long only, so that they don’t have to carry too many things. And it’s easier to remember because medicine boxes would just remind you that if the medicines are still there it… means that you haven’t taken your medications,” he says.

Glucometers are also as important as your medications as they give you an idea of how low or high your blood sugar level is at the moment, and helps you act accordingly. With this Dr. Kho says, “If they have a glucometer they should bring it with them, so they can check their blood sugars more often while traveling. The time difference, meal difference, timing, oftentimes you are at the mercy of when food’s going to be available, so a meter would be good.”

Insulin and medication concerns
For those who are dependent on insulin, knowing when and how much insulin to inject can be very tricky especially when crossing time zones. It is best to remember that traveling east means a shorter day, while going west means a longer day.

Dr. Kho also says that he writes down specific instructions for patients who might get confused because of the time changes. “For example, if they leave here 7am but they will be arriving at their destination also at 7am, the patients really don’t know what to do. Do they take the medications all over again? Do they follow the new time or do they follow the Philippine time? So these are specific instructions that we have to give them,” he says.

However due to the advent of short-acting and long-acting insulin, these insulin shots can now be convenient for the diabetic traveler. “If they’re on once-a-day insulin injection, which is good for 24 hours, sometimes it’s safer to prolong it for more than 24 hours. Allow the sugar to go up a little bit, and then they can give themselves extra quick but short acting insulin, meaning it won’t last many hours. It’s just to correct for that certain high sugar level,” Dr. Kho explains.

Aside from their insulin, their pills could also be a cause of concern. “It really depends on the medication because there are some that no matter how many times you take them, you just don’t get a hypoglycemia attack. But there are medications that if one misses or overdoses on, can bring about hypoglycemia,” Dr. Kho adds.

Safety reminders at your destination
Upon arrival at your destination, it is suggested that you take it easy for a few days, especially after a long flight. This allows your body to adjust, especially if there are major time changes. If you know that you will be more active, like walking around most of the day, it is best that you bring snacks and your medications with you all the time. Your glucometer should also be with you wherever you go.

However, no matter how much you need food with you all the time, it is still smart to watch what you are eating. Dr. Kho suggests that avoiding excessive carbohydrates can help maintain steady blood sugar levels. He explains, “If they’re traveling in a group for example or they’re just visiting a place or visiting relatives, you cannot impose on what kind of food they’re going to serve. So at least at home they know what kind of foods they’re supposed to eat, what kind of food they’re supposed to cook. But when they’re outside they just need to understand what kind of food can potentially make their blood sugar shoot up.”

Other things to remember are to wear comfortable shoes and never go barefoot. It is very important to check your feet especially after a long day of walking around. Check for blisters and cuts, and if you see any signs of inflammation or infection, have yourself checked at a nearby hospital.

Dealing with emergencies
Going to the U.S. or Europe where hospitals are of easy access, can help make emergency situations a lot easier to handle. However, traveling to far-flung areas can cause a major concern. “The scariest part is to go to places in the Philippines where hospitals are two hours away, and there aren’t too many doctors that can be reached. If I know that they’re going to a place where they’re going to have difficulty in terms of medical access, I would give them my telephone number so that they can call me if there’s a problem,” Dr. Kho says.

Other ways on dealing with emergency situations is to learn how to say “I need sugar” or “juice please” in the language or dialect of the place you will be going to.

Trips while traveling alone and other reminders
Dr. Kho shares that most of his patients do travel alone. He says that as long as their diabetes is well-managed and that they are well-educated about their disease, there is really no reason for them not to travel alone. “For our diabetics although we impose some restrictions on them in terms of activity and also some kind of food we don’t want them to feel that they are very different or as diabetics that they are really that sick, we just make them aware of the things they’re supposed to do in excess,” he explains. Adding to that, “But for the great majority of diabetics they are independent, they’re functional, as long as they’re well-educated about their disease there’s no reason for them not to travel by themselves.”

It is also best to know when or when not to travel. Dr. Kho states, “If they’re vomiting, they’re having diarrhea, and if they’re infected, they shouldn’t be traveling as much as possible. If they have mild colds, fine, but if they’re appetite is dramatically affected they shouldn’t be traveling because you don’t know if they’re going to be dehydrated.” People with diabetes, like anyone else, can have the luxury to travel, as Dr. Kho said they would never want to make them feel that they are different from the rest. But it is still best to always see your doctor first before hopping on a plane to Timbuktu. “I think the most important message for diabetics when they’re traveling is to let their doctor know. Oftentimes, diabetics do not just take diabetes medication, maraming kakambal na sakit ang diabetes, so they’ll be taking their cholesterol, their blood pressure medications, so they should let their doctors know that they’re traveling and by what means,” advises Dr. Kho.

One more thing that Dr. Kho suggests is to take their companion or companions during the trip with them during consultation. “It’s always useful to find out who’s going to be traveling with them so that they can come to your clinic and hear you give out instructions. The hardest to give instructions to are the elderly because they tend to forget what you told them. I try to write it down for them, but still they forget where they put the paper. So it’s always good to find out who’s traveling with them and then have that person come to your clinic and hear you give these instructions to the patient,” he says.

On a final note, Dr. Kho shares, “If you take hold of the necessary steps to prevent or reduce the hazards that they might have to face while they’re traveling, that will dramatically take a lot of stress out of the traveling.”

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