Travelling well with diabetes 29 November 2022 With the holiday season on our doorstep, many of us are starting to think about travelling to see our family and friends, or visiting our favourite places. Whilst most holidays or long distance travel take some pre-planning, for those living with diabetes, travel pre-planning is crucial for a safe and enjoyable time away from home. This article outlines a travel and health checklist of sorts to help people living with diabetes enjoy safe, happy and easy-going travels. Encourage people living with diabetes to visit or talk with their diabetes educator or doctor before travelling, about: A sick day management plan, to know what to do in case of sick days: sick day management plan (type 1) sick day management plan (type 2) An updated medications list and how to and how often to take the different medications. If people have a My Health Record their medical history will be digitally accessible to medical teams with internet access. However it’s a good idea, especially if traveling regionally or remotely, to get a printed medical history summary in case of an emergency. Extra prescriptions of regular medications and any extra medications the doctor may think is required, such as those for gut issues (e.g. food or water poisoning). How planned activities (e.g. long walks, fishing trips) may affect blood glucose levels and what to do about changes (e.g. hypos). Travel vaccinations needed and or if not already up-to-date. How and where to access medical help (including emergency services; call 000 or 112 or use Emergency Plus App in Australia) Contact details of the regular health team in case other health professionals need to consult with their healthcare team. A prescription for regular medication can also be faxed from the regular medical team to a local pharmacy near where people are holidaying/ staying. Remind people living with diabetes to consider the following before travelling: Emergencies Consider their destination and the health services nearby. Where will they go in an emergency? In rural and remote areas calling 000 may not be an option. In this case, the Royal Flying Doctor’s service has a 24-hour emergency number 1300 697 337. Know what symptoms require medical attention Encourage people to wear diabetes medical alert identification such as a plastic or jewellery bracelet or necklace which can be brought from local chemist or diabetesshop.com. Food What are they going to eat? Are they going to be bringing food and water, and or preparing meals? If not, what food and drink options will be available on route and at destination and which ones are suitable? Encourage making a meal or food access plan or getting some advice from their diabetes team e.g. dietitian. Exercise Some travelling and or destinations mean less physical activity than usual which can increase blood glucose levels – encourage regular activity or getting advice from their diabetes team e.g. exercise physiologist on how to monitor their activity and blood glucose levels. If people are doing long-haul plane, train or car trips, encourage regular stops and or movement breaks to help manage blood glucose levels and prevent blood clots. Insurance Where possible encourage travel insurance on a domestic trip also, this will generally cover any incident that might happen with diabetes management whilst flying or with accommodation or rental cars, and check the fine print. Health incidents may be better addressed by Medicare and private health insurance if possible. Insulin pumps and some glucose monitoring equipment may be damaged by scanning security x-rays at airports – check with the manufacturer before flying. For people travelling with an insulin pump they may wish to insure their pump for the journey or check if their house and contents insurance covers accidental damage away from home. Medications Medications and glucose monitoring strips are temperature sensitive. Most oral medications (tablets) will require temperatures below 30°C and to be kept out of direct sunlight and in a sealed container or foil packaging. Most medications can be packed by the pharmacy for the duration of their journey. This may be a good option if people are taking multiple medications. Remind people not to leave medications or strips in a hot car or in their under-plane luggage when flying, as this will destroy them. Insulin in current use, should be stored below 25°C. Temperatures outside may be above this most of the time if people are heading north. If this is the case, encourage people to buy a travel pouch for insulin and cool storage containers for stored insulin – check out cooler bags at the local chemist or at the Diabetes Shop here. Alternatively, an esky can be used with an ice block. Remind people to never place insulin directly onto ice or an ice brick. Instead leave insulin in the package it came in from the chemist and wrap it in a towel in the esky. If people are travelling with a fridge, the temperature must be above 2°C – never freezing. Insulin can freeze if too close to the freezer section in a caravan fridge. Check fridge temperatures are suitable for insulin, as frozen insulin doesn’t work well. What to pack to manage diabetes well when travelling: A blood glucose meter plenty of strips and a replacement battery. Most pharmacies in Australia are NDSS agents but may not have stock of the strips you require. Continuous glucose monitoring, Freestyle Libre, and insulin pump accessories will require ordering. It may take a few days before they arrive in the pharmacy. It is best to carry enough supplies for the entire trip. If people are living with type 1 diabetes remind them to pack a ketone monitor and strips. If they have an insulin pump, remind them to take injectable supplies and a plan in case of pump failure. Emergency contacts, health summary, and any insurance policies, cards (NDSS, Medicare, and private health insurance). Sick day management plan and hypo kit, plus a general first aid kit to treat minor ailments. Enough medication for the entire trip and extra for just in case they are delayed returning home. Take prescriptions for regular medications. Additional insulin may be required for sick days. When driving Remind people living with diabetes who drive that they could be at risk of hypoglycaemia (hypos); some medications including sulfonylureas (Gliclazide, Glipizide, Glibenclamide, and Glimepiride) and all insulins, can cause hypos. It is important to remind people at risk of hypos that they need to be above 5 mmol/L to drive. They will need to check glucose levels before driving and every two hours while driving. If they have treated a hypo, they need to wait 30 minutes before driving again. This allows their body time to fully recover from the hypo. Remind them also to always investigate the reason for the hypo and compensate and or talk to their health care team for advice on how to avoid hypos. You can find more information on diabetes education for the health workforce and for people living with or at risk of diabetes this website. Or call the NDSS Helpline on 1800 637 700 to speak with a health professional.