Diabetes shouldn't be a barrier to going on holiday. But as coronavirus restrictions vary across the world, there are more things to think about before you plan a trip – especially if you're going abroad
Coronavirus has meant huge changes to the way we live, including when and where we travel.
The Foreign and Commonwealth Office currently advises British nationals against all but essential international travel. But there are some countries that this doesn’t apply to, because they’re not seen as high risk anymore. Check the UK government site for all the latest updates on where and when you can travel. You could also check the TravelHealthPro website for the latest travel health guidance.
If you are still hoping to travel, you may need to do a bit more planning ahead than you’re used to. As well as your usual list of what to pack, you will need to check and follow the current guidance in the place that you live as well as the place you’re travelling to. For example, in some areas of the UK you’ll need to wear mask on the flight and at the airport.
Find out about any entry restrictions, screening or quarantine requirements for the country you’re travelling to. It’s a good idea to find out where the local UK embassy is too, in case you need help in an emergency.
And if you’re thinking of booking a cruise, the advice is to hold off for the moment.
If you're looking at holidays within the UK, you'll need to check your national government sites for the latest updates on areas with local lockdown restrictions.
Travel insurance
The UK has now left the EU so there will some changes from 1 January 2021.Buy travel insurance that covers your healthcare fully. European Health Insurance Cards (EHIC) will only be valid until 31 December 2021 so even if you have one, we still advise that you get travel insurance. This is because the card doesn't cover certain things like emergency repatriation (if you need to come home) and not all countries give the same level of cover as the NHS.
Check that your insurance provider covers pre-existing medical conditions like diabetes, because many do not. It’s really important you ask if they cover coronavirus in case you need treatment while away.
Packing checklist
- Face masks or coverings – can be disposable or reusable. Remember, you need to wash reusable face masks after each use.
- Hand sanitiser – 100ml for hand luggage.
- Diabetes supplies, ID and meds – keep these in your hand luggage if you’re flying, along with a letter from your doctor, in case your hold luggage gets lost. Split them between separate bags if you can.
- Extra snacks in case of delays.
At the airport
Heightened airport security means that it's really important that you plan ahead if you have diabetes. This means you'll avoid running into any last-minute problems.Airport restrictions are subject to change, so contact your airline directly or call the Department for Transport’s enquiry line on 0300 330 3000 to find out about any changes. Or, you can go to gov.uk to find out more.
Security regulations
Current security regulations state that liquid items are only allowed in your hand luggage if they are in containers 100ml or less.There are a few exceptions including essential medicines for your trip, which may be allowed in larger quantities above the current 100ml limit. This will be subject to authentication, so always check before you go.
Passengers are also permitted to carry essential medical equipment through airport security in hand luggage, though all medication and equipment must be supported by documentation from a relevantly qualified medical professional. The doctor's letter should be shown to the airline staff, and if you do encounter any problems you should request to speak to a manager or senior member of staff.
Tablets
There is no restriction on the number of tablets you take through airport security, but you would still need to take documentation from a medical professional or your prescription for authentication.Travelling with a pump or CGM
If you treat your diabetes with a pump or use a continuous glucose monitor (CGM), make sure you contact your airline before you travel, if possible do this a few weeks before you fly.The Civil Aviation Authority’s Advisory Health Unit recommends that people with diabetes should always contact their airline before travelling to discuss medical devices they need to take on board an aircraft.
Some airlines will require you to notify them of your medical equipment before the flight and fill in additional paperwork. If you don't do this, you might, in some cases, not being allowed to board the aircraft with your pump or CGM.
You should also speak to your diabetes team before you go. Should you need to remove your pump for any reason, they can provide you with any extra equipment such as insulin pens and help plan your doses throughout your journey.
Caution around insulin pumps and CGM on board aircraft is because of wireless functionality. This might interfere with aircraft communication and navigation systems. If your pump or CGM cannot function without a wireless signal, then you may need to be prepared to remove your CGM and pump and treat your diabetes with an insulin pen while you're in the air. You'll also need to test your blood glucose levels manually with a standard blood glucose meter.
Is it safe to go through the X-ray machines or full-body scanners?
If you use an insulin pump or a CGM you shouldn't put them through whole-body scanners or any X-ray machine. It's important to know that airports also use X-ray machines on any luggage you check in to the aeroplane hold as well as hand luggage. This is because X-ray waves can cause your pump or CGM to stop working properly. Contact the manufacturer of your devices if you have any questions about going through X-ray machines and whole-body scanners.If you have diabetes and you're carrying any medical equipment, you can download a Medical Device Awareness Card.
This card has information for airport security about diabetes and the equipment you're carrying to stop any confusion.
Organise medication
Take a letter from your doctor or clinic that explains that you have diabetes, the medication you use and all the equipment you need to treat diabetes. This should include insulin, insulin delivery devices, needles, blood glucose monitors, glucose tablets or liquid and ketone test strips.It would be helpful if the letter explains the need to carry all medications and equipment with you in your hand luggage and to avoid storing it in your luggage in the hold. This is because problems will arise if luggage goes missing or your medication is spoiled. It would also be useful to take a recent prescription with you. Cabin crew may request medication be handed over for storage during the flight.
Take twice the quantity of medical supplies you would normally use for your diabetes. If you need to quarantine or self-isolate in the country you’re visiting, you may have to stay longer than planned.
And if you test positive for coronavirus, you are likely to need treatment locally and stay there until you are better. Follow your sick day rules if you become ill.
Before travelling, find out where you can get supplies of insulin at your destination in case of emergency. Contact your insulin manufacturer before the trip to see if your insulin is supplied in the country you are travelling to. If you need a prescription whilst on holiday, and your usual medication isn’t available, you may be given an alternative that does the same thing.
Managing medication when crossing time zones
Journeys across time zones may mean that you need to adjust your insulin. All international flights eastwards or westwards involve crossing time zones and days will be shortened or lengthened. There is no need to be alarmed about this. Many people across time zones regularly, without any serious problem. Remember that “running a bit high" for up to 24 hours is unlikely to cause you any harm.Time zones and insulin
When travelling east to west, the day is lengthened and some clinics will advise you to take an extra meal and to cover it with extra insulin. When travelling west to east, the day is shortened and the amount of insulin and carbohydrate may need to be reduced.In general, if your time zone change is less than four hours, you will not need to make major changes to your injections. If you are on two injections of insulin a day, a greatly lengthened day may mean that you need a small amount of insulin with a meal between two main injections. This will usually be short-acting insulin, but you will need to discuss the details with your diabetes doctor or nurse.
A shortened day may mean that you need to reduce your pre-flight insulin. Again, it is important to discuss this beforehand with your diabetes care team. When discussing this, make sure that you have your flight details to hand, including your departure time, the length of the flight, and the local time of arrival.
Many people now have three short-acting injections during the day, followed by a medium or long-acting injection in the evening. Because this regime gives a great deal of flexibility over the timing of injections and meal times, it can be easily adapted to time zone travel. Many people who regularly travel by air switch to this system.
Some people may have a problem with this system because the normal sleep cycle is broken by time zone travel. As a result, the medium or long-acting insulin is being taken more than once in every 24 hours. It may then build up in the body and cause a hypo.
Many diabetes doctors and nurses now recommend a variation on the above; you leave out the medium or long-acting injection entirely and rely on short-acting injections before meals until you are safely back on a 24-hour clock in your country of arrival. Many travellers find this very helpful because it allows them the flexibility they need.
Both systems allow you to adjust your dosage and timing of insulin injections as the day becomes shorter or longer.
Time zones and tablets
If you take diabetes tablets, you are unlikely to have any particular problems. Very occasionally, it may be necessary to take extra tablets to cover a longer day. Do discuss this with your diabetes care team beforehand.You may, on occasions, need to leave out one dose of tablets on a short day, when you are travelling on a long west to east journey. Again, speak to your diabetes care team about this well in advance of the trip.
Food and travelling
Eating on a plane
Airlines can provide information on the times of most meals so you can plan your insulin.It is best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. Cabin crew are usually able to provide fruit, crackers or rolls.
Glucose tablets and drinks used to treat hypos can be carried on board along with longer-acting carbohydrates such as biscuits. If you have any problems buying glucose tablets after going through customs, remember that any sugary non-diet drink, sugary sweets, fruit juice are all effective if you need to treat a hypo. To prevent blood glucose from dropping again eat a longer-acting carbohydrate, such as a sandwich, some fruit or biscuits.
On long flights, you may need snacks in between meals and at bedtime to prevent blood sugar levels going too low. Try to carry extra starchy carbohydrate foods, such as biscuits, cereal bars or fruit buns, on board the aircraft. If you use insulin, monitor your blood sugar levels frequently and be prepared to make changes to your dosage.
Eating abroad
The diet for people with diabetes is the same healthy diet recommended for everyone so you should be able to choose items from the regular menus. If you are travelling alone, you may like to let the staff know when you check-in just in case you become unwell during your stay.There’s normally loads of opportunities to try different foods when you're abroad. And there’s no reason not to just because you have diabetes, but if you keep in mind the basics of healthy eating.
Since starchy carbohydrates are an important part of a healthy, balanced diet, it’s worth knowing what carbohydrates will be available locally. A good travel guide will give you an idea of the local cuisine, or you could carry a pocket dictionary or learn the words for a few basic foods.
There’s also the Carbs & Cals Pocket Counter or the Carbs & Cals app for Android or iPhone. These will help you to compare the food on your plate to the photos in the book or app, to quickly see the nutrients in your meal.
Get more about eating out when you have diabetes and healthy eating tips when you're abroad.
Allergies and intolerances
If you have food allergies or intolerances, try to find out the phrases for asking if foods are suitable for you. Allergy UK sells laminated translation cards in various languages.Gluten-free products may not be commonly available in some countries. If you have coeliac disease, take plenty of gluten-free staples with you like bread, biscuits and crackers. For more on coeliac disease and travelling, go to Coeliac UK's website.
Whatever food allergies or intolerances you have, if you’re staying in a hotel ask when you're booking if they can cater for you. If you’re eating out and in any doubt whether food is okay, stick to plain foods where you can clearly see what you’re getting like boiled potatoes, salads, meat, fish or plain rice.
Food poisoning
Hot climates increase the risk of food poisoning, especially in countries where levels of sanitation are not as high as you’re used to.Food cooked hot to order is the safest option and be wary of anything that may have been left standing or reheated. Watching where local people eat, or asking for recommendations, is a good way of finding the best eating places.
If you’re concerned about the safety of the local tap water, stick to bottled or sterilised water.
Remember to also avoid ice in drinks, salads that may have been washed in tap water and fruit that you can’t peel. Bottled water and sugar-free drinks are available in most places.
Hot climates
In hot countries, the biggest health threat is the sun, so keep covered.Wear clothes that cover and protect your skin and make sure you wear high factor sunscreen. People often miss the backs of their hands and necks, so make sure you keep these covered and protected with sunscreen.
Sunglasses should also have a UV400 label to make sure they protect your eyes.
Take particular care of your feet if you have neuropathy which is the numbness in your feet. This can mean you’re not aware skin is burning so protect them from the sun with socks or sunscreen. Make sure you wear well-fitting sandals on the beach, so they don’t burn on the hot sand.
Sunbathing
Sunbathing on the beach can make your blood sugar levels higher than normal, because you're not being very active.Your insulin will be absorbed more quickly from the injection site in hot weather too, and this increases the risk of hypos. You’ll need to monitor your levels more often and be ready to adjust your diet or insulin dose.
Be careful of misleading test results because the extremes of temperature may affect the accuracy of your meter.
Also keep in mind that if your levels are higher, this could be because of the weather. Heat can damage your insulin and stop it from working properly.
To keep your insulin cool when travelling, it is best to store it in a hotel fridge (if there is one in your room) or in a cool bag (providing it does not freeze). A variety of cool bags and storage containers are available. If using a cool bag that uses plastic ice blocks, make sure that the insulin does not come into contact with the frozen plastic containers.
Cold climates
In cold weather, your insulin is absorbed more slowly at first, but can then be absorbed suddenly when you warm up later in the day. This can cause you to have a hypo. If your body also uses up more energy staying warm, for example shivering, this can lead to hypos too.Hypos are more dangerous in cold conditions. This is because they interfere with your body’s attempts to stay warm and increase the risk of hypothermia.
Guarding against hypos is really important so remember your meter may not be accurate in cold conditions as well.
If you suffer from poor circulation or have neuropathy, it’s particularly important to prevent frostbite, because the numbness in your feet can mean you don’t feel the cold.
https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/travel?utm_source=bronto&utm_medium=email&utm_term=Read+our+top+tips&utm_content=Read+our+top+tips&utm_campaign=Enewsletter+August+2020
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