People travel for various reasons. For diabetic patients, the challenge is to bring all the necessary medicines, take them on time, and still have fun. But for people who need insulin shots, how does one go about it? Here are some tips.

Preparing for travel
Always tell your doctor that you will be traveling. Ideally, your blood glucose levels should be stable before embarking on that plane ride. Your doctor may ask for lab tests to confirm this. Basic tests like FBS, HbA1c, CBC, BUN, and creatinine may be requested. Alert your doctor if you have complications like heart disease or stroke, especially if they are recent events. If your complications are stable, permission is usually granted. A lung problem like COPD may need clearance from a pulmonologist to assess oxygen requirements. Flu or pneumonia vaccine may be recommended.

Bring more than enough worth of medicine’s and insulin. Twice the expected amount needed is a good number, in case you need to extend your trip or if you get stranded. Bring a list of your medicines including generic and trade names, in case you need to buy extra. Carry your medicines with you, because checked-in baggage may get lost.

Don’t forget your glucose meters and strips to check your sugars more often until you settle into a routine. Again, bring double the expected strip usage. Plan also for syringe and lancet disposal, this can be a small plastic cup or you can check out airport restrooms that may have containers for sharp objects.

Diet and exercise
Unfortunately, diabetes doesn’t go on vacation when you are on vacation, so plan your diet and exercise. Ask your airline if they can provide special meals. Ask your doctor if you need extra insulin, especially during long flights or when you take extra food during stopovers. If you will sit for a long time, try to stand every hour to allow blood to circulate well. If you are expecting to walk a lot on your trip, bring the necessary things to keep hydrated. A handy container for fluids, proper clothing, and a good pair of shoes are some of the necessary things.

Insulin handling
Traveling is no reason to stop insulin, but it should be handled properly. Room temperature is usually sufficient. If temperature will vary during travel, a storage container designed to keep insulin at room temperature (about 25°C) is needed. If you are using vials, use them within 28 days after opening whether refrigerated or not. Pre-filled pens do not need to be refrigerated and are used within 28 days after opening. Premixed analogues (like Humalog Mix 25 and Novomix) may need 14 days or less. Check the labels for this.

Adjust insulin dose when traveling east across six or more time zones (usually to the USA). If you are on once daily insulin, inject the usual dose at the usual time on the day of departure. The first morning at the destination, just before breakfast of local time, inject two-thirds of the usual morning dose of NPH (Humulin N or Insulatard). This reduced dose is designed to prevent hypoglycemia during the day. On the evening of the first day, inject the remaining one-third of the usual morning dose only if the blood glucose is elevated (arbitrary value of >240 mg%). If there is regular (Humulin R, Actrapid) or rapid acting analogue (Humalog, Novorapid, Apidra), these are still taken together with meals.

If you are on twice daily injections, follow the same instructions. Inject the usual evening dose on arrival, but if the blood glucose is > 240 mg%, you should add to your evening dose the one-third of the morning dose of NPH that was omitted. If you are taking extra meals, additional regular or rapid analogue may be needed.

If you are taking a basal analogue insulin (Lantus, Levemir) and a rapid acting analogue during meals (called basal-bolus regimen), you might need to add or subtract the basal insulin dose if the time change will add three or more hours to your day, respectively. Some doctors may opt to shift you to a basal-bolus regimen during travel as well, as this is simpler to follow but might require three or more injections.

Preventing hypoglycemia and hyperglycemia
Hypoglycemia remains a problem during travel. Remember that extra activity or delayed meals can precipitate hypoglycemia. Prepare for this by carrying medicines or food to counter hypoglycemia. This can be glucose tablets, 4 ounces of regular soda or fruit juice or three to five pieces of hard candy. If you are traveling with a group, alert the other members in case of emergencies when you need to be brought to an emergency room.

If you are traveling alone, a diabetes bracelet or a card in your wallet should be carried at all times. In case of hyperglycemia, ask your doctor in advance how much regular or rapid acting analogue you should inject. Check your blood glucose hourly until the results fall back into target range. Needless to say, avoid eating too much (especially eat-all-you-can restaurants!) and don’t miss your medication. If you get too sick, keep hydrated and know the area where you can seek professional help. A health insurance is a must if you are traveling abroad.

With these tips in mind, I hope you will be able to make your next trip enjoyable and worth it without sacrificing the good control of your diabetes. Happy trip!

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