Control of diabetes may not always be simple while travelling abroad. Climate change, unaccustomed physical activity, unfamiliar foods, irregular sleeping patterns, inconsistent meal times, high altitude sickness and stress are just some of the variables which may affect the travelling diabetic.
Managing your diabetes is vital when illness occurs, particularly gastrointestinal illness and/or vomiting.
Travelvax advises diabetics that preparation and planning for diabetic control is the most effective means of preventing illness, especially if access to medical care may be restricted.

Incidence
Well over 500,000 Australians have self-reported diabetes, while the condition remains undiagnosed in many others.

Prevention

Pre-flight
Before flying you should:

• Become accustomed to alterations in diet. For example, you may be eating rice in South-east Asia or pasta in Italy. Become aware of how this affects your blood sugar while at home.
• Obtain identification stating that you are a diabetic and a letter* listing your medications (both type and dose). Ensure the letter emphasises that you have medical indications for carrying needles and syringes (important for customs). A diabetic alert card, identification tag or bracelet is highly recommended. (*Travelvax clinics provide a medication authority to clients).
• Have your vaccinations well in advance. Even the possible mild reactions to vaccines may upset diabetic control.
• Take more than sufficient medication for the duration of the trip (2–3 times the amount) and plan to carry this in waterproof packs split amongst your hand luggage and that of your travelling companion, in case of breakage or loss. Ensure you pack plenty of blood/urine testing equipment.
• To reduce bulk, use insulin pens over syringes.

Consider taking the following medications and first-aid items:

• Iodine (2%) to be used as an antiseptic and to purify water.
• A variety of simple dressings (pay meticulous attention to cuts and scratches - even the most trivial - to avoid skin infections in tropical climates).
• Medication to control vomiting, diarrhoea and, if necessary, motion sickness.
• Antibiotics for general use and to treat diarrhoea (Noroxin or Zithromax plus Simplotan are a good combination).
• You may like to consider taking continuous, low dose antibiotics to protect against diarrhoea (e.g. Vibramycin 100mg daily), especially if you are prone to stomach and bowel infections - diarrhoeal illness can make diabetic control difficult.
• Glucagon, if you use it for ‘hypos’.
• Determine in advance where medical assistance is available in the countries to be visited.
• Notify the airline; flight attendants should be advised of your condition. Ensure suitable diabetic meals are available for the flight.
• Teach your travelling companions how to help you if hypoglycaemia occurs. Explain symptoms to them and ask them to give you some form of sugar.

In-flight
Keep medications, insulin and tablets, plus needles and syringes with you at all times in your hand luggage. You may be going to Nepal, but there is no guarantee that your luggage will end up at the same destination! There is no need to worry about refrigerating insulin - it is stable at room temperature for months, and will in fact deteriorate if stored in the un-pressurised baggage compartment of a plane.
Walk up and down the aisles regularly for exercise.

Post-flight
Avoid exposure of insulin to bright light and high temperatures (greater than 33ºC or 90º F) otherwise it can be carried like any other medication. If hiking or camping in hot climates consider carrying some sort of insulator e.g. a polystyrene container or a space blanket.

Even if you are only sightseeing you are likely to use more energy and you may need to increase your carbohydrate intake or decrease your daily insulin dose.

Always carry spare food. Such as some form of sugar in hand luggage, complex carbohydrates such as dried fruit or biscuits, for unexpected delays in flight and simple sugar, e.g. jelly beans, fruit juices to treat ‘hypos’. Consider the availability of food at your next destination and allow for delays in arrival.
Make sure you take old, comfortable shoes or wear in new shoes before departure - blisters are a great place for infection to start.

Be meticulous about any cuts, scratches or broken areas of skin, especially in tropical countries; these must always be washed in clean water and dressed with antiseptic and a clean dry dressing, such as a bandaid. At the first sign of infection, commence using antibiotics, cream or oral medication. Monitor your sugar levels carefully especially if unwell with any illness, but in particular if vomiting or experiencing diarrhoea.

Insulin dose adjustments
Several methods may work to regulate your sugar:

• Some diabetics familiar with managing their condition simply use pre-meal glucose readings and short-acting insulin with each meal. When they reach their destination they can go back to their usual schedule.
• Another method is to ascertain the length of the flight in hours and work out by how much the day will be shortened or lengthened when they arrive at their destination.

Language Barriers Tip

Consult a phrase book and find out appropriate translations for a few simple emergency phrases:

• "I have diabetes."
• "I need sugar."
• "I need a doctor/hospital."

More information on Diabetes is available during your pre-travel consultation with Travelvax. Call 1300 360 164 for the location of the clinic nearest to you.