Diabetes and Travel
In Nigeria about 5.5 percent of Nigerians have diabetes and about 4 million have Type 2 (Adult onset) Diabetes. In the UK about 3.5 million residents have been diagnosed with Diabetes.
Preparing for travel: Modern day travel can be stressful for many people, and sometimes more so for those with medical conditions especially chronic conditions such as Diabetes. The advice below may vary depending, on if you are on Insulin or oral medication. With careful preparation, the trip should go on without incidence, and you should enjoy a pleasurable and rewarding experience. Make sure you have a Traveller’s Check list (https://www.diabetes.co.uk/
Also have a specific Diabetic Kit Bag and about 3 weeks before you go, make sure you have enough spare insulin and spare blood test strips to see you through your trip and back to your doctor/pharmacist for more supplies.
Plan in Advance: Discuss your travel plans with your Diabetic Consultant, Family Doctor or Travel Consultant preferably 8 weeks before your travel date. Blood glucose should be monitored more frequently due to change in meal times and activity levels especially on long haul flights. Gets a covering letter from your Doctor explaining the need to carry medication? You may need to carry medication, needles, syringes and insulin which may cause problems for you at immigrations and customs. Make sure you have enough supply of your medication for at least a week after your planned date of return. Carry all medication on you in your hand luggage along with some carbohydrates or sugar/glucose in case of delays, and you could also give some to a responsible adult travelling with you, who should know about your condition and should be able to assist you in any crisis situation more so if you will be undertaking sporting activities and adventure travel. In checked in luggage, medication can get lost, damaged and in some transport situations may get frozen and rendered useless. Wear some form of diabetic identification tag especially if hypoglycaemic attacks are a concern. Arrange for adequate travel health insurance. As a pre-existing medical condition it must be declared to the insurer. If your diabetes is not well controlled you may need to inform the airline you are travelling with.
Things to note during the journey: There may be dietary problems en route and at the destination. Delays, cancellations re-routing or stopovers can affect you. Carry extra food and snacks. Remember fresh foods may not be allowed into some countries. Traveller’s diarrhoea and resultant dehydration may be more serious. If prone to travel sickness, take an anti-sickness drug in advance of travel or wear pressure point wrist bands. Note that persistent vomiting can lead to hypoglycaemia and along with fever and diarrhoea ketosis may develop.
There is a higher risk of fungal infections like Candida and athletes foot especially in hot and humid environments due to moist skin. Wounds and bites may become more easily infected. Insulin users should be prepared to adjust the timing of insulin administration which is more complicated in the elderly especially on long journeys. (Keep to your local time until you arrive at your destination then gradually adjusts to the destination time). Insulin users may experience hypoglycaemia during flight and should adjust food intake if the need arises. Those on diet and or oral medication only, usually travel without problems. Try to get information on the availability of the different types of insulin available in the country visited and also types of food available. Insulin can remain stable for up to a month at ‘normal room’ (8-28°C) temperature. Extremes of temperatures can reduce its activity. Insulin must not freeze. At your destination use a refrigerator if available.
Note that extremes like high altitude, cold and hot climates can affect insulin storage, absorption and glucose monitoring. Minimise alcohol especially while airborne.
Vials should be kept in a cool, dark place e.g. vacuum flasks, polystyrene containers etc. Adjust your insulin according to your level of activity, also your diet and oral medication. The rate of insulin absorption may be affected by climate. Watch your calories as sugar level in foods vary from country to country. In warm climates, maintaining a high fluid intake to compensate for loss is important. Glucose strips should be carefully stored as humidity may affect accurate readings. Some Glucometers tend to under read at altitudes above 1500 meters. Also in cold conditions, try to keep the glucometer warm (in insulated pouches close to your body). Take readings in the shade and away from wind and use large drops of blood to prevent drying.
Foot care is very important; wear adequate footwear for protection against injury especially on the beach were hidden hazards may lie. Take first aid kit for minor injuries and observe the ‘Sick day Rule’ if unwell. That is travellers should ensure they are aware of how to maintain glucose levels when ill, how to check urine for ketones and when they need to seek medical attention.
Remember a high BMI which is a calculation based on your Height, Weight, (sex and age especially in children) (Normal range 18.5 – 24.9) 25 and above is overweight and 30 and above is obesity) puts you at high risk for adult onset diabetes (Type 2 Diabetes) and diabetes is strongly associated with heart disease, so watch your weight and BMI at all times. Don’t forget you can suffer from other travel conditions like jet lag and this should not be misinterpreted, but if you are not sure seek medical advice.
Have local currency on arrival for any emergency purchase.
Visit www.istm.org.
Remember to always have a mobile phone that can roam in all countries to be visited. Have a safe trip and most of all, Enjoy Yourself.
Next write-up should be on Asthma.
Dr Ade Alakija