Travelling with diabetes – unpacking what you need to know when planning your trip

Preparing for travel? Where do you start?

Here is what some of what my checklist included as I prepared to pack my bags:

• Do I have a signed letter on NHS-headed paper from my diabetes consultant saying that I need to carry medication, insulin pens and sharps through the airport and on the plane?
  
  
• Have I got my up-to-date European Health Insurance Card (EHIC)?
  
  
• Have I organised the correct and adequate travel insurance with a company that specialises in cover for people with long-term health conditions?
  
  
• Have I spoken to my GP and explained that I need to put in a prescription for extra supplies of needles, continuous glucose monitors (CGM) and insulin?
  
  
• Have I got enough needles, CGM sensors and supplies of insulin to last me for the duration of my holiday and longer, if for some reason I cannot get home due to delays or other circumstances? Just think of all the air travellers that got stranded for weeks when the Eyjafjallajökull volcano erupted in Iceland. I also know a woman with diabetes whose flights home were disrupted for more than a week after earthquakes in New Zealand. 
  
  
• Do I have a back-up blood glucose meter and some spare batteries, in case my CGM malfunctions, or I cannot get access to spares?  Have I packed enough CGMs to last me for weeks?
  
  
• Have I packed spare pre-filled insulin delivery pens in case the ones I use malfunction, or I need a longer supply of insulin?
  
  
• Have I got a readily available supply of glucose or hypo (hypoglycaemia, or low blood glucose) treatment to carry on the plane with me and to last me the duration of my holiday?
  
  
• Have I got a sharps container with me to dispose of my needles and lancets safely?
• Have I packed medical cool bag kits to keep my insulin pens and spares cool whilst visiting a country that has hot weather? 
  
  
• Is my diabetes awareness jewellery displaying the correct up-to-date information and identification that says I have diabetes and what medication I use and allergies I have etc.?
  
  
• Have I made notes about the language of the country I am visiting and written down some phrases that explains that I have diabetes, what insulins I am using and what my emergency medical needs might be? Have I done some research to see where the nearest doctor’s surgery or hospital is?
  
  
• If you are on oral diabetes medications, like metformin or gliclazide, have you put in a prescription for extra supplies and packed them?
  
  
• If you use an insulin pump, have you packed back-up supplies and peripherals, or will you decide to take a pump break and use multiple daily injections (MDI) while away?

Remember to stay hydrated with lots of water in hot weather and in hot countries, as dehydration can also affect blood glucose levels.

As you can see the list of things to do is very important and potentially lifesaving, especially for people with type 1 diabetes. In addition to making sure you have considered all of the above, there are other extremely vital factors to plan for.

These include:

• How long is your journey going to be? Will you have adequate access to something to eat?
  
  
• What if your flight is delayed and you are stuck at the airport? A few years ago, I got stuck in Detroit airport when major problems arose affecting our connecting flight to Las Vegas. It was the middle of the night, and we were stranded for around 9 hours. None of the eateries or cafes were open and there was not even a vending machine to get a cup of coffee from. The cabin crew gave each of us the meagre offering of a mini packet of dry salted peanuts and a small mixer can of a diet soft drink to survive on. Thankfully, I had a bag of sweets, some cereal bars and my hypo-kit in my hand luggage.
  
  
• How many hours will your flight last? What times zones will you be travelling through? And how will they affect your meal times and how you take your medication, especially your background (basal) insulin?
  
  
• What sort of meals will be served on the plane? Do you need to inform the airline company about your dietary requirements?
  
  
• How will being out of routine affect your blood glucose levels?
  
  
• What is the national cuisine of the country you are visiting? How will the changes in nutrition and food types affect you?
  
  
• Depending on your destination and activities – a safari across the plains of Africa, whale watching in Alaska, shopping in New York or snowboarding down a mountain in France, have you planned for the changes in extreme cold, heat and altitude and how they will affect you, your blood glucose levels and adjustments in insulin doses and testing?

Security clearance

Once you have tackled this brain-swirling overload of diabetes planning, you will also need to consider a few additional things that impacted travel after the events of 11^th September in 2001. Airports and airlines introduced new security measures around certain liquids and food items that could no longer be carried in your hand luggage, so it may be worth asking your diabetes consultant or GP to include hypo treatments, glucose or confectionary in your official letter. Some things are allowed but in limited quantities. I often take a basic amount and then stock up in the departure lounge shops.

On another recent journey from London to Atlanta. I declared to security that I could not go through the full body scanner because I was wearing a CGM. They were polite and escorted me out of line to the side where I was asked to remove my shoes, belt and hand over my backpack and separate all my diabetes supplies and spare CGMs and letter from my consultant. My bag was taken off to X-ray, and I was asked to empty the contents of my diabetes kitbag, dismantle my insulin pens and open my sealed CGM boxes. The kitbag and contents were thoroughly inspected, swabbed and then checked with a hand-held device. I was asked to explain the contents of the CGM boxes. I was patted down and body searched and had a further swab on the CGM I was wearing. If you wear diabetes tech it may be worth preparing for this experience.

·       You can carry a Medical Device Awareness Card which also states you have a medical condition and need to carry medical supplies.

·       You can also wear a Hidden Disabilities Sunflower Lanyard and Card, which security staff will recognise. A whole range are available for different medical conditions including diabetes. A plush Sunny the Sunflower lanyard is also available for children.

Once I had been through this slightly embarrassing show in front of all the other passengers, and airport security were happy that I was not a threat, they let me continue on to the departure lounge where my friends and a welcome cup of coffee and a croissant were waiting, before boarding our plane to jet off and finally enjoy the holiday, safe in the knowledge that all my diabetes needs were well and truly covered.

DRWF Travelling with diabetes resources

Travelling with diabetes means that we have more to think about before embarking on our journey. Being prepared well in advance of travel is key to a safe, healthy and happy experience.

Read our guidance on how to plan for that long-awaited-trip, whether hot or cold, by air, sea, rail or road. We hope this guide will help you as you embark on your next adventure. 

Visit the DRWF information page on Travelling with diabetes