Traveling Inside Your Comfort Zone
By Alan Uphold
Traveling provides very specific challenges for people with diabetes. Alan Uphold shares his experiences traveling, what tools and tricks he uses, and his checklist when planning a vacation.
I’m sure that at one point or another you’ve heard the admonition that sometimes you need to throw caution to the wind and get outside your comfort zone.
I do like to follow this advice and take some risks from time to time. But as a person with diabetes, traveling is definitely not one of those times.
When I’m traveling, I would much rather travel inside my comfort zone.
I just returned from spending a month in France, and it was an amazing trip. But after basically being confined to the house for 18 months of COVID-19 lockdown, and as a person with type 1, I had to pull out my checklist to remind myself of the things I need to remember when traveling.
Of course, during this time of COVID-19, there are certain precautions that we all need to consider, but this article is not intended to address COVID-related travel considerations for diabetes. Instead, this article is meant to remind us all of the things that people with diabetes need to consider anytime we travel.
With the holiday travel season almost here, what better time than now to review some quick reminders that will allow both people with type 1 and type 2 diabetes (as well as their families and caregivers) to travel inside their comfort zone.
Traveling with diabetes
Before you go anywhere, it’s usually a good idea to check with your healthcare team and do a little research. Some destinations may require specific vaccinations. In other cases, if you’re traveling abroad, the US State Department may have health-related travel alerts.
It’s also a good idea to have your healthcare team give you a note or medical record or something indicating that you have diabetes and that your medications and devices are a necessity. Also, in the event that you don’t already keep your proof of insurance in your wallet or purse, you should definitely take your insurance card with you when traveling. Depending on the length and cost of your trip, you might also consider purchasing travel insurance before you go.
To protect yourself in the case of an emergency, always wear some kind of medical identification bracelet or necklace that indicates that you have diabetes. An EMT friend of mine stressed the importance of this by telling me that whenever he arrives on scene in which someone is unconscious, one of the first things he does is check the person’s wrist or neck for medical ID indicating what might be wrong.
In addition, be sure you have enough of everything before you leave for your trip – often this means you may need to get prescriptions in advance. Even after you have what you need for the trip, be sure to bring extra supplies in case of an emergency in which you may not be able to get access to the medications or tools you need.
Diabetes travel kit
Depending on how you treat your diabetes, these supplies might include, but are not limited to, things like:
All of your oral medications – including those not diabetes related. If you are going out of the country, consider also bring common medicines for cold, fever, and stomach (diarrhea or vomiting) symptoms as well.
Insulin – and extra bottles or pens of all the different insulins you take, If you use a pump, consider bringing basal insulin in case your pump breaks or malfunctions.
Blood glucose meter – including an extra meter if you have one.
Lancets and test strips – bring more test strips than you think you might need.
Blood ketone meter and test strips – if you don’t have a meter for testing ketones, consider bringing urine testing strips (especially if you become sick, you will need to check your ketones).
Glucose tablets, gels, or glucagon – to treat hypoglycemia.
Always be sure to take a little more than you anticipate needing for your trip. I got snowed in during the Christmas holidays one year and couldn’t get a flight home until three days after my originally scheduled flight. Fortunately, I had extra supplies with me, but if I hadn’t, it would have been a challenge to find a local pharmacy where I could get insulin and needles during the holidays.
Planes, Trains, and Automobiles
If you’re traveling by plane, there are a few things to keep in mind. Most TSA agents are aware of medical equipment such as pumps and CGMs; however, it’s best not to assume that all of them do. In addition to the above mentioned note from your doctor or pharmacist, you might also consider printing out and carrying with you a TSA Disability Notification Card.
If you use a pump or CGM, it’s a good idea to check with the manufacturer regarding how your device interacts with airport security machinery. Most manufacturers recommend that you do not send your medical devices through the x-ray machine. Also, while most devices are fine to go through airport metal detectors, many manufacturers recommend that you do not pass through airport body scanners while wearing your insulin pump or CGM. The x-ray and scanning machines can affect the accuracy of your device. Instead you should declare your medical device and either remove it or ask for a pat down.
The TSA exempts people with diabetes from the maximum 3.4 oz. of liquid and will allow you to take juices, gels or other liquids that treat your hypoglycemia. These liquids should be removed from your bags and should be separated from your other liquids and declared to a TSA agent. Personally, I have found that it’s easier to just buy some juice once I pass through security rather than explaining my situation every time I travel. That said, you have every right to take these liquids and gels through security in accordance with the Air Carriers Access Act.
You might also consider avoiding this issue altogether by always carrying with you fast-acting glucose tablets, since the TSA has no issue with you taking solids through security checkpoints.
Make sure that you place any of the supplies you might need in your carry on bag – not in your checked luggage. In fact, when I say “carry on,” it’s a good idea to make sure these items are in a small purse or backpack that can fit under your seat – not in your roller suitcase. Even though the roller suitcase is technically a carry on, not all flights allow you to take them onto your flight in the main cabin.
I learned this the hard way the first time I flew on a regional plane. On small regional airliners, roller bags don’t fit in the overhead compartment, so they make you check your roller bags at the end of the jetway. I like to travel light, and I used to carry my diabetes supplies in my small roller suitcase. On my first regional flight, I didn’t have a small bag, so I had to grab insulin, a couple of needles and a protein bar out of my roller bag and shove them in my pockets before I boarded the flight. Now I always keep those supplies in a small backpack, no matter how far I’m going or how big I think the plane will be.
For many of these reasons, including the fact that sometimes checked baggage can get lost, or not make it to the destination with you, the American Diabetes Association recommends that it’s best to just carry your insulin and devices with you in the main cabin.
If you’re on a flight with meal service, every major airline allows you to order a diabetes-specific meal in advance. You can do this up to 24 hours prior to departure. If I’m traveling alone, I usually introduce myself to the person next to me at the start of the flight and ask them to wake me if I’m asleep when the meal is served. If you’ve ordered a special meal, the flight attendant will usually wake you, but they already have enough to worry about so it’s good to have a backup plan.
If you’re traveling by car, always be sure to take a cooler with you so you can safely store your insulin and other supplies. Never leave any of your supplies – from insulin to test strips to devices – in a hot car. Extreme heat is not good for any of your diabetes supplies.
Traveling across time zones or traveling abroad can present a few other unique challenges for those with diabetes. You may be visiting a country where it’s not just the language that’s different. Often the medications, and even the weights and measures, can be different. For example, many common medications may have different names depending on the country; it can be helpful to look up what your medications are called in the places where you are traveling or be prepared for some slight confusion if you ask for a specific medication at the pharmacy and they don’t recognize the name.
In addition, adjusting to a new time zone can be difficult. As I mentioned, my husband and I spent the month of September in France. We live in California, so the time difference is nine hours. That meant that I was often eating when I would normally be sleeping and sleeping when I would normally be eating. As a result my CGM was frequently alerting me to early morning lows (around the time when I would have been eating dinner in California). It took my body a while to adjust to the time difference.
I’m not a doctor, so I will not presume to give you any advice on this particular issue. I will simply say that this is one of those areas where you should definitely check with your healthcare team regarding how to adjust your insulin regimen and doses when traveling across time zones.
If you’re traveling to a country where you don’t speak the language, in addition to learning how to say, “please” and “thank you,” it’s not a bad idea to learn how to say a few other key phrases such as, “I have diabetes,” “I need some juice,” or “I have an emergency.”
Alternatively, you might consider calling up a translator on your phone. There are several free internet translator options, such as translate.google.com.
I’m pretty good at speaking French, so I was able to speak to pharmacists and get everything I needed on our recent visit. But a few years ago, we were in Thailand, and I didn’t speak a word of Thai. We were in a small village, and I was in desperate need of Imodium. I typed into my phone what the issue was and what I needed then handed the phone to the pharmacist. She immediately understood and was able to give me exactly what I needed. The translation programs are not always 100% accurate, but in a pinch it usually gets the job done. It certainly worked for me. Speaking of pharmacies, once you arrive at your destination, it’s a good idea to find out where the nearest pharmacy is located and its opening hours.
Don’t forget that most other countries around the world use the metric system for foods and liquids. This is important to keep in mind if you need to treat a hypoglycemic event. For example, you will need to look for a bottle of juice with 120 milliliters, rather than 4 oz. Other weights and measures will apply across the board, and here again, your phone can be a very helpful tool. Simply type in “convert” in your search bar and you can convert almost any weight or measure to its American equivalent. (You can also convert currency in the same manner.)
The last thing I’ll mention about traveling abroad is to give careful consideration to your food and beverage intake. If you’re like me, one of the best parts about traveling is getting to try the local cuisine. But counting carbs can be challenging when you may not know exactly what’s in the foods you’re eating. We had some amazing fondue in the French Alps that was probably not my healthiest choice. But as my endocrinologist would say, “Don’t deprive yourself, but everything in moderation.”
This may seem like an awful lot to consider before heading out on your next road trip or trip abroad, but you can put together a checklist with all of these things and call it up on your phone or computer each time before you travel.
Keep these things in mind, and you’ll feel a lot more at ease as you plan your next adventure – inside your comfort zone.