Living with Diabetis

All destinations are possible when planning a journey, so long as you take into account a series of recommendations. Generally speaking there is no reason why you should limit the frequency or type of journey. However, if you go through a period of unstable diabetes control or have an intercurrent illness, then you should consider delaying the trip. When packing your suitcase, do not forget:

Medicines and equipment used to control your diabetes

• Sufficient insulin and/or oral antidiabetics. It is better to double or triple the amount required. Always carry them in your hand luggage. If travelling with others, share the medication to avoid losing it all at the same time.
• Insulin syringes or pens.
• Glucometer and test strips.
• Test strips for ketones in urine, if you have been advised to use the test.
• Glucagon, if the medication you take has the potential to cause sugar lows (hypoglycaemia).

Food

• Foods to correct episodes of hypoglycaemia: sugar, glucose tablets or gels, fruit juice, etc.
• Non-perishable foods that you can use to improvise a meal that ensures an adequate supply of carbohydrates: Melba toast, juices in cartons, biscuits, etc.

Documentation

• Medical report including the most relevant points of your treatment and clinical progression. It should be written in English, if possible, so that it is more readily understood if you travel to foreign countries.
• Identification card, medical alert jewellery, etc. (optional).

Treatment regimen

• You must follow your usual treatment regimen, although you can incorporate some changes. You will need to perform capillary blood glucose tests more often as many factors can affect your blood sugar levels when travelling, e.g., the excitement of visiting a new country, a change of time zones, increased physical activity and different food.
• If you are on a subcutaneous insulin infuser, it is important to carry the alternative insulin regimen and insulin pens (rapid and slow) with you in case it breaks down during the trip.

Traveller’s diarrhoea is the most common health problem experienced by people who travel to developing countries.

• Increasing the frequency of capillary blood glucose tests will help you modify your insulin regimen, if necessary. The infection causing the diarrhoea can induce hyperglycaemia (high blood sugar levels) but a reduction in food intake and the diarrhoea itself can lead to hypoglycaemia (low blood sugar levels).
• Try to ensure, insofar as possible, your eating plan includes carbohydrate-rich foods and preferably choose the most astringent boiled starchy foods (rice, semolina, etc.) and apple (boiled or uncooked and grated).
• If you have vomited and your ketones in urine test is positive, go to your nearest hospital immediately.

• If you drive, stop to rest every two hours.
• Always measure your capillary glucose level before driving to minimise the risk of suffering an episode of hypoglycaemia while at the wheel, particularly if you have not eaten for hours and it is a long journey.
• If your sugar level is between 75–90 mg/dL, eat some extra food or drink a carbohydrate-rich drink, for example: 1 piece of fruit or 1 fruit juice or 1 glass of a sugary drink.
• If the reading is between 50–75 mg/dL, eat/drink the same amount plus 2 rusks or biscuits and do not start driving until you have confirmed your capillary sugar level is at least 100 mg/dL.
• If the test measures less than 50 mg/dL or you have symptoms of hypoglycaemia (cold sweat, tremors, dizziness, palpitations, disorientation, lack of concentration, etc.), treat the hypoglycaemia with sugar, fruit juice or sweets, etc. and do not start driving until you have confirmed your capillary sugar level is at least 100 mg/dL. Remember that you do not fully recover the ability to react until a few hours after an episode of hypoglycaemia.
• Always carry sugary foods or drinks with you (sugar, fruit juice, sweets, etc.) so you can treat hypoglycaemia wherever you may be.
• Also store biscuits, Melba toast, bread or other similar foods in the car as a substitute for a meal in case of a traffic jam, etc.
• Excessive alcohol reduces reflexes when driving and can also mean the symptoms of hypoglycaemia go unnoticed.
• You should not drive if you have drunk alcohol and maximise precautions if you normally find it hard to recognise the symptoms of hypoglycaemia.
• It can get very hot inside an unattended parked vehicle, especially in summer; the high temperatures reached can damage insulin. Never leave your insulin in a car. Always carry it with you.
• Similarly, if in cold areas during winter, the temperature can fall below 0 °C and insulin can be damaged by freezing. Carry it with you at all times.

• Ensure you take more than one pair of suitable footwear with you and which you have already worn at home for a while. We tend to walk more than usual when travelling, both in the country and in the city.
• Never walk bare foot if you present a high risk of suffering foot injuries due to a loss of sensitivity to pain (neuropathy) or vascular problems (vasculopathy). In such cases maximise your foot care.
• Follow foot hygiene recommendations.
• Check your footwear every day before putting it on. Feel around inside with your hands to ensure there are no foreign objects (loose seams, stones, pins, etc.)
• Remember your footwear should preferably be made of soft, flexible leather, it should be lined, have no internal stitching and adapt to the anatomical shape of your feet. They must have a wide heel, 1–4 cm. Try to avoid shoes that are completely flat, open-toed or lack any support.