Travel and diabetes

A few weeks before your travel, discuss your travel plans with your diabetes healthcare provider. You may find that changes (eg, in diet, activity levels or time zones) affect your glucose management. The most important thing while you travel, is to continue taking your medicines regularly.

Ask your healthcare provider for advice about:

• The timing of your medicines if you're crossing time zones. It's important to be clear about any adjustments you might need to make to your diabetes medicines including insulin injections, insulin pump or tablets.
• If you need to monitor your blood glucose levels while you're away and if your medicines need altering based on your blood glucose. This is mainly if you're taking insulin.
• Having a sick day plan – know what to do if you're unwell with the flu, gastro, or other illnesses and you're not eating and drinking as normal. Also know how to manage low blood glucose levels (hypoglycaemia). See below for more information about being prepared for illness. 

Letter from your doctor

• If you're travelling overseas with medicines or medical devices for diabetes you should get a letter from your GP or diabetes specialist so you can go through security or customs. Here is an example of a letter to complete with your healthcare team(external link).  
• Have your travel letter translated into the language of your destination country.
• Have it available on an electronic device such as a smartphone or smart device and a printed copy in case you have problems accessing it from your device.
• It's also a good idea to have a letter with your medical conditions, the medicines you're taking and a record of any known allergies or sensitivities, including to foods or medicines.
• In some countries you need to keep your medicines in their original containers with labels. Compliance packs (blister packs or plastic pill boxes) may not be accepted. Check the following pages for some information about requirements in different countries.
  • Travelling with medication(external link)
  • Travelling with medical items(external link)
• If you're travelling within Aotearoa New Zealand, carry a full list of your medicines (including the generic names and their dosages) from your pharmacist.

Emergency contact details

• Take clearly written details of emergency contacts such as your next-of-kin or family member with you.
• Take the phone and email details of your diabetes health professionals and of your insulin pump company, if relevant.
• Always carry identification and emergency contacts on you and consider wearing a Medic Alert bracelet or another form of medical identification.

Travel insurance

Take out travel insurance for both your health and belongings. If you use an insulin pump, consider insuring it as well.

Vaccinations

Arrange necessary vaccinations before you travel. It's a good idea to get any vaccinations you need at least 4 weeks before you travel. This gives you time to deal with any possible side effects.

Travel health kit

Wherever you're going, it's a good idea to pack a basic travel kit. In many countries, first aid items and medicines might be hard to find or may be different from what you're used to in Aotearoa New Zealand. Your travel kit could include supplies to manage minor injuries and illnesses such as plasters and antiseptic.

Supply

• Make sure you have a full supply of all your diabetes medicines before you leave. It's a good idea to pack more medicines than you think you'll need. If you're going away for a long period, talk to your healthcare provider about how to access any supplies you may need.
• Check the expiry dates of your medicines so they don't go out of date while you're away.
• Make sure all your medicines are in pharmacy-labelled packaging. If your medicines come in different boxes, each box needs a separate label.

Storage of your medicines

• Carry a supply of your medicines where you can reach them immediately. This way you will have your essential supplies with you if your luggage goes missing. Make you carry more than enough medicines with you in case there are delays. 
• For long-distance air travel, it may be best to keep them in the seat pocket in front of you – not under the seat or in the overhead locker. This is so you can reach them immediately, even if the seatbelt sign is on.
• Don't store insulin in your checked baggage. It could be affected by severe changes in pressure and temperature. 
• Don't let your medicine and supplies get too hot or too cold. Avoid storing your medicines in a hot car, in direct sunlight, or directly on ice. Very high or low temperatures can damage your medicines. Inspect your insulin before injecting each dose.
• Many injectable diabetes medicines are available as pens, eg, insulin, dulaglutide and Victoza. Once you start using a new disposable pen you can keep it out of the fridge at room temperature – usually for 28 days. However, check the storage instructions for the specific medicine you're taking. You can write the date that you took it out of the fridge on the packaging to help you remember.
• If you need to take your insulin or other temperature-sensitive medicines out in hot weather or while traveling without access to a fridge, there are some handy cooling options available, such as FRIO insulin wallets.

Timing and when to take your dose

• It's easy to lose track of time or forget your medicines and meals when you're out of your daily routine. Try setting an alarm on your phone to keep you on track.
• If you're travelling across time zones, find out how to adjust your medicines for different time zones and eating schedules. For medicine that needs to be taken with meals, such as insulin, always wait until your meal is in front of you before taking or injecting it.
• If your medicines are nearby, (eg, in the seat pocket in front of you, you'll be able to reach them quickly and easily. 

Sharps disposal

It's very important that sharps (needles or devices that penetrate the skin) are disposed of safely using a suitable container, immediately after use. Carry a small, travel-size sharps disposal container. Read more about safe disposal of syringes, needles and other sharps.

If you're travelling with devices such as CGMs, insulin pumps, blood glucose or ketone monitors, here are a few things to remember.

• Avoid storing your devices in a hot car, in direct sunlight or directly on ice. Heat can damage your blood glucose meter, insulin pump, and testing strips. Keep these supplies in a cooler with a gel pack.
• For blood glucose and ketone test meters, make sure you have enough test strips to last for your holiday and a few spares just in case.
• For air travel, keep your diabetes supplies where you can reach them immediately, even if the seatbelt sign is on. The best place is in the seat pocket in front of you – not under the seat or in the overhead locker.
• Insulin pumps or continuous glucose monitors (CGMs) could be damaged by X-ray machines at airports and other high-security buildings or events. Instead of disconnecting your devices, you can ask for a hand inspection.
• If you use an insulin pump, you'll need to know how to change the time in the pump to the local time once you arrive at your destination.
• Be aware of internet connectivity and app access. Some insulin pumps have Bluetooth or wireless features, but these are for convenience, not for the main function of delivering insulin. Bluetooth may be used to connect to smartphones, CGMs, or compatible meters. Wi-Fi or mobile data may be used for uploading pump or CGM data to the cloud (eg, for sharing with your care team) or for app notifications or updates.

Use the checklists below for insulin pumps to help you remember things to pack.

• Back-up kit checklist Tandem t:slim X2(external link) Aotearoa Diabetes Collective
• Back-up kit checklist YpsoPump(external link) Aotearoa Diabetes Collective
• Back-up kit checklist(external link) Medtronic Aotearoa Diabetes Collective

Have a sick day plan

Before you travel, talk to your healthcare provider about a sick day plan, in case you get sick while you're travelling or away from home. They can give you advice on:

• what to do if you're not eating and drinking as normal
• other medicines you may need, for example to treat travel sickness, diarrhoea or dehydration
• monitoring your blood glucose levels
• what to do if you have low blood glucose and how to manage hypoglycaemia.

Some people find it handy to have a sick day kit. It can also include medicines for common ailments such as diarrhoea or nausea. Pack it in your
carry-on luggage. Read more sick day plan information for adults with type 1 and type 2 diabetes.

Know what to do if you have low blood glucose (hypoglycaemia)

Delayed meals, unfamiliar foods, different time zones, and changes to activity can all affect your blood glucose.

• If you take insulin or diabetes tablets that can cause hypos, carry some easily absorbed carbs, such as glucose tablets or jellybeans, in case you have a hypo.
• Pack some longer-acting carbs, such as biscuits, crackers, or dried fruit. Note: check if you need to throw this out before going through customs at your destination.
• If you will be extremely active while traveling, you may need to decrease your diabetes medicines. Talk to your diabetes nurse or doctor before you go.
• Here are some handy hypoglycaemia guides for both type 1(external link) and type 2 diabetes(external link),

Hypoglycaemia and driving

• Before driving: If you take insulin or sulphonylurea medicines (glibenclamide, gliclazide, glipizide), always test your blood glucose level before driving. In New Zealand, legally, it must be 4.2 mmol/L or over to drive. “Above 5 to drive” is an easy way to remember.
• If you have mild hypoglycaemia, the law states that you must not drive for 1 hour after that.
• If you have severe hypoglycaemia (when you need someone else's help to treat it) and take insulin, you must not drive for 24 hours. If you take sulphonylureas, you must not drive for 48 hours. After a severe hypo, you're at higher risk of having further hypos because your liver's glucose stores are depleted.
• People who experience severe hypoglycaemia while driving should not drive for at least a month, whether you're involved in a crash or not. Talk to your healthcare provider if this happens to you. It’s likely you’ll need to see a specialist before you can safely return to driving.
• Read more about diabetes and driving NZTA(external link).

Other general travel tips to keep well

• Take care of your feet: Exploring a new place could mean blisters or cuts on your feet. Be sure to check your feet every day, so you can take care of any problems. Avoid walking barefoot, even on the beach. Read more about diabetes foot care. 
• Prevent dehydration: Keep an eye on the temperature if you're traveling somewhere warm and remember to stay well hydrated by drinking plenty of water. Dehydration can impact on your blood glucose and having diabetes can increase your risk of dehydration. High blood glucose levels cause your kidneys to get rid of the excess glucose by flushing it out in your pee. The more you urinate, the more fluids and electrolytes you lose, which can lead to dehydration. 
• Make good food choices: Food can be a big highlight when travelling. You can still enjoy local cuisine but enjoy it in moderation. Buffets on cruises and holiday packages can make it easy to eat too much even when you're not hungry. Take care with your food choices and portion sizes so you don't eat more than you need. Bring healthy foods to have while you travel by car, airplane, or train. If you're driving, bring a cooler with healthy foods and plenty of water. If you're flying, bring options like fruit or nuts to avoid eating unhealthy convenience foods.
• Limit alcohol: Alcohol affects your blood glucose, it increases your risk of low blood glucose and makes it harder to tell when your blood glucose is low. Read more about diabetes and alcohol.