Diabetes

Incidence

Well over one million Australians have self-reported diabetes, while the condition remains undiagnosed in many others.

Prevention

Pre-flight

Before flying you should:

• Talk to your doctor or travel health provider prior to your trip at least 6-8 weeks before travel
• Ensure you have travel insurance that covers you for your condition and belongings
• Before flying overseas it’s important to check that you comply with the latest Australian Airline security regulations
• 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. Take a spare meter.
• To reduce bulk, use insulin pens over syringes.
• If using an insulin pump, remember to take extra batteries and a manual on how to adjust the settings and try to find out from the manufacturer what resources may be available overseas
• Remember insulin and blood glucose test strips are stable at room temperature under 30 degrees but can be damaged at extreme temperatures (hot or cold)

Consider taking the following medications and first-aid items:

• Adhere to food and water precautions. You may wish to consider water purification devices, iodine or other options to ensure clean safe drinking water. See our tips on safe food and 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 (Norfloxacin or Azithromycin plus Simplotan are a good combination).
• Glucagon, if you use it for ‘hypos’.
• 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.
• Wear comfortable clothing and shoes
• Drink enough water to avoid dehydration
• Move around the cabin as often as you can.

Post-flight

Jetlag

• If you are on oral hypoglycaemic drugs, they can be taken according to local time without regard to time zone changes.
• Patients who inject insulin can also maintain their usual schedule according to local time when travelling across five time zones or fewer.
• When travelling across six time zones or more, patients should consult their doctor for instructions regarding insulin dose adjustments.

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.

Travel to high altitude

Travel to high altitude is safe, although you should be used to exercise and monitor your blood sugars carefully. Be aware that some glucometers may not read accurately at high altitudes.

Ketoacidosis may be triggered by altitude illness and can be more difficult to manage if acetazolamide (Diamox) is taken to assist with altitude sickness.

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."