Challenge 1: You're bailed up at airport security or customs about medication/syringes and other equipment in your luggage.
Solution: The advice from Diabetes Australia is to have a typed, signed letter from your doctor, detailing your diabetes management plan, medication and dosage and any equipment you use – including sharps. The letter should stress that you need to keep your supplies with you. Take several copies in case you lose one and, if possible, have the letter translated into the language of your destination. Contact the National Accreditation Authority for Translators and Interpreters (www. naati.com) to find a translator. Pen needles, monitors, lancets and meds should be stored in hand luggage, preferably in a clear, sealable plastic bag that’s available for security inspection. Meds should be in their original packaging, labelled with your name. Carry your National Diabetes Service Scheme (NDSS) card, along with scripts for all medications and make sure they can be easily read. Contact the airline to let them know you have diabetes and check their policy on carrying medical equipment and meds. More information on Australian aviation security is available on the Department of Infrastructure, Transport, Regional Development and Local Government website at www.infrastructure.gov.au

Challenge 2: You’ve ordered diabetic meals for a flight – but when they arrive they’re too low on carbs.
Solution: “This is such a common problem with many airlines, that it’s generally better to stick with regular in-flight meals and take a supply of portable carbohydrate foods with you like dried or fresh fruit and wholegrain crackers in case meals or snacks fall short,” says dietitian Dr Alan Barclay, co-author of the Diabetes and Pre-Diabetes Handbook. You can ask cabin crew for extra food, he says, but it’s wise to have your own supply too.

Challenge 3: You get sick
Solution: “A cold or the flu can push up BGL (Blood Glucose Level) and gastro can send them down,” Dr Barclay explains. His advice: ask your diabetes educator, dietitian or doctor for tips on coping with illness before departure (e.g. nibbling dry crackers or sipping flat lemonade to avoid BG dropping too low if you have gastro and can’t eat much). This is also where being prepared comes in. If you’re heading overseas or off the beaten track in Australia, ask at your Travelvax clinic or your doctor for antibiotics to take with you in case of gastro or whether the cholera vaccine Dukoral, which offers cross-protection against some causes of travellers’ diarrhoea, is suitable. Take along medication for nausea and vomiting and rehydration mixes, and paracetamol to lower fever. Keep your doctor’s contact details with you. Join MedicAlert www.medicalert.com.au which provides you with medical ID that’s linked to emergency medical advice and access to information about your healthcare needs.

Challenge 4 – Changing time zones. How do you work out the timing of medication and eating when you’re changing time zones?
Solution: Take your flight schedule and information about time zone changes to a Travelvax clinic, your doctor or diabetes educator - they can help you plan the timing of injections when you travel. Remember, if you’re on a long distance flight, inactivity may increase BGL.

Challenge 5 – Your diabetes equipment plays up or goes missing.
Solution: BGL monitors can be affected by heat and humidity, insulin pumps can play up, insulin pens can break – or your bag containing your supplies can be stolen. Take spares of everything, along with contact details for a pump supplier at your destination. Always carry back-up pens, syringes and medication if you use a pump. Ask the airline if you can take all your equipment supplies on board the aircraft.

Challenge 6: It's an emergency, but the locals don't understand you
Solution: In non- English speaking countries, it's wise to carry information in the local language about your condition and what to do if you’re unwell. This is where translated information from your doctor can help. Carry translated instructions on what care you need, along with MedicAlert ID. Learn how to say ‘I have diabetes’ in the local language.

Challenge 7: Your medication is damaged or gone missing.
Solution: This shouldn’t be a problem because you wouldn’t dream of leaving home without twice the amount of medication you’ll need carried in your hand luggage, plus spare supplies of equipment. If you’re travelling in Australia, take a spare prescription too. If the worst happens, contact the nearest major hospital for emergency supplies or contact MedicAlert. Again, the letter from your doctor which explains what medication you need will help. Keep receipts for medical costs for insurance claims later. Medicare has reciprocal arrangements with some countries including New Zealand, the UK, Malta, Italy, Finland, Sweden, Norway, the Netherlands, and the Republic of Ireland. This means you’re eligible for the same benefits as a resident of that country – but this doesn’t always mean free treatment, and you may still have to pay something. If you’re going to the US, it’s important not to run out of supplies – diabetes meds are very pricey.

Challenge 8: Staying safe at the wheel.
Solution: Having diabetes means taking special care when you're driving to avoid hypos that can affect concentration. Keep a close eye on BGL, with checks every two hours, and regular stops for food and revival. Keep glucose tablets on hand to avoid low BGL, and make sure your travel companions know what to do if you have problems.

Challenge 9: You're struggling with the change of pace, feeling the effects of temperature, strange food – and maybe more alcohol than usual – and the physical demands of travelling.
Solution: Do more BGL tests to keep a handle on your diabetes control. Set your own pace and don't try to keep up with others who might be more adventurous – or who drink or eat differently to you.

Become a travel ‘germaphobe’, says Tonia Buzzolini
Tonia Buzzolini, a travel health nurse and Travelvax Australia’s National Operations Manager, says it’s important for diabetics to avoid colds, flu and gastro bugs while travelling. Here are her tips:

Tip 1: Before you leave home, know how to head off common infections like colds, coughs and gastric attacks. While they are generally not serious, they’re easy for travellers to pick up – and they can make coping with diabetes more challenging, especially if you’re newly diagnosed. Vaccination against swine flu may be advisable, particularly if you are travelling to the northern hemisphere or to tropical regions.

Tip 2: The microbes that cause ‘gastro’ don’t just lurk in contaminated food and water, but on surfaces too, so it helps to become a ‘germaphobe’ when you travel. With all the human traffic in and out of toilets at airports or aboard long distance flights, there’s potential for picking up bugs from door handles, taps and other surfaces. However, frequent hand washing, or use of alcohol sanitisers, after touching surfaces in public areas or handling money can help you avoid both gastric bugs and respiratory infections like colds and flu. Covering your hand with a tissue when you turn off taps or touch door handles is a good idea.

Tip 3: Given that 50 per cent of travellers come down with travellers’ diarrhoea, consider having a pre-travel vaccination to help prevent it. Dukoral, a vaccine licensed in Australia to protect against cholera will also protect against one of the main causes of travellers’ diarrhoea, a bug called enterotoxogenic E.coli (or ETEC).

Tip 4: And while a cruise might seem less disaster-prone than, say, backpacking in Bolivia, the World Health Organisation’s 2009 Travel Report warns respiratory infections are common on cruise ships. There’s also a risk of being exposed to flu if the passenger list includes people from areas where there’s seasonal flu. Then there’s norovirus – a common gastric bug causing nausea, vomiting, diarrhoea, and sometimes low grade fever, that can be another frequent traveller on cruise ships, according to WHO. Again, it can be picked up from contaminated surfaces as well as contaminated food.

Tip 5: If your holiday could expose you to flu – either on a cruise or because you’re heading into your destination’s flu season, ask your doctor if it’s worth having a flu shot before you go.
The good news is that the air on board a plane may be healthier than you thought. According to WHO, re-circulated air on board jet aircraft passes through HEPA (high-efficiency particulate air) filters like those used in hospital operating theatres and which trap bacteria and viruses. The main risk comes from other passengers’ coughs or sneezes (don’t be afraid to wear a mask), or from contact with contaminated surfaces.

* This edited version of Paula Goodyer’s article is reproduced by courtesy of Diabetic Living and appears in the November/December 2009 issue.