Amanda Epps highlights pre-travel advice for patients with type 1 diabetes.

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Read this article to learn more about: 

  • Providing reassuring advice to patients with type 1 diabetes
  • What a patient can do to look after their medicines and supplies while on their holiday
  • What documentation is required for their condition while travelling overseas

After reading this article, ‘Test and reflect’ on your updated knowledge with our multiple-choice questions. Earn 0.5 CPD credits for reading this article and an additional 0.5 CPD credits for completing the multiple-choice questions.

In January we may start thinking about our summer holidays. For some it may be a flight to an exotic paradise, a camping holiday in the New Forest, or a traditional British seaside holiday where it does not stop raining. For patients with type 1 diabetes, travelling can be tricky if they are not prepared, however, with a little extra thinking and organisation there is no reason why they cannot travel all over the world.

This short article covers some of the advice you need to give to people with type 1 diabetes—provided as a list of dos and don’ts that you can discuss with your patient.

Do

  • Make sure you have enough insulin supplies to last in case you get stuck somewhere for longer than planned. When the ash cloud erupted from Eyjafjallajökull volcano in Iceland in 2010 people were left stranded in airports all over the world. Insulin can be very expensive in some countries, in the US people can pay up to $130 for a vial.1
  • Bring back up pens just in case of pump failure, make sure you have the manufacturer’s telephone number as they may be able to deliver you a replacement pump if things do go wrong while you are away. Keep the insulin vials cool, most insulins once they have left the fridge are only viable for 28 days. Frío make handy cool bags that use evaporation to keep the insulin cool. These are particularly helpful when camping or on long journeys where is no access to a fridge. Simply re-immerse the inner pack into water to refill the crystals, and as the water evaporates the insulin is kept within safe temperatures of 18–26°C, which is cool enough to preserve it.
  • Make sure your travel insurance is up to date and that the insurance company are aware that you have diabetes. There are many horror stories of people having to pay excessive hospital bills due to inadequate travel insurance after an admission to hospital. This is even more important when travelling to countries not within the European Union.
  • Make sure that you have a European Health Insurance Card if you are travelling within the EU. However, this may potentially change in the near future with Brexit taking place.
  • Change the clocks on your devices according to the time zone that you are travelling to, and also do not forget to change them back when you get return home.
  • Carry a medical ID card/bracelet with you.
  • Check your blood glucose before you drive, we have a little rhyme in the diabetes clinics to help us remember—’4s the floor, 5 to drive, 6 for sex and exercise’. The last one always gets a little chuckle when teaching nurses! Check every 2 hours on long journeys.
  • Carry food with you in case of delays.
  • Carry a letter from your GP and a copy of your prescription, you may be asked to show it for proof of why you need to carry sharps.
  • Dispose of sharps responsibly, handy travel bins are available for this.
  • Check your pump is waterproof before you go swimming with it, even the smallest crack can mean it is no longer waterproof. If you have to disconnect it make sure it is not left in the hot sun, or left where thieves might see it, it could look like a nice phone to someone who has not seen one before, therefore, it may beneficial to insure your pump insurance.
  • Make sure you know where the nearest medical centre is, although many countries speak very good English be prepared, Google Translate can be a great tool to use.
  • Speak to your Diabetes Specialist Nurses about time changes to insulin doses if you are using injections.

Don’t

  • Put your devices through the X-ray machine, check with the manufacturers and follow their instructions.
  • Forget to reconnect your insulin pump if for any reason you need to temporarily disconnect it.
  • Use the Bluetooth setting on your device, some airlines do not allow the use of Bluetooth and so some pumps need to be in aeroplane mode.
  • Drop and smash all the vials of insulin while getting it through security when transferring them into those little clear bags. If you have a big family, it might be worth going through special assistance. This way you can concentrate of the task in hand rather than get flustered wondering, ‘Where are my children? Where is the insulin? Where are the passports? Oh no he’s going through X-ray with his pump on arghhhhh.’ Airport security can sometimes feel like a cattle market of people rushing through with no time for conversation. Special assistance just gives you a little bit more time to think and go through security calmly and collectively
  • Forget your hypoglycemia treatment, liquids can be troublesome to get through security, and it may be easier to use glucose tablets or jelly babies for the flight rather than liquid-based treatments. There will also be drinks available past security but these may be at a higher cost than usual. If you have a letter from the GP, you may be lucky enough to be allowed to carry fluids through security, but I would have a back up plan just in case.
  • Store equipment in the hold where it can get too cold. Also, hold luggage could potentially get lost, or arrive at the wrong destination.
  • Keep supplies locked in a caravan where temperatures can reach up to 40°C in the UK.2 I had a person admitted to hospital due to ineffective insulin, when we dug a little deeper I found out that the insulin was stored in a cupboard of a caravan where even the chocolate spread was melting and that was in the UK.
  • Leave test strips in cars this can affect meter readings. Extreme temperatures can affect the quality of the test strips.
  • Keep your pumps connected while you are on a roller coaster, the g-force that you experience could potentially lead to an unintended dose of insulin.
  • Worry about the odd unexplained high or low blood glucose levels, there are over 42 factors that can affect it, such as food, excitement, exercise, temperature, and alcohol consumption.

The patient may feel that it sounds like a lot of advice to take in, reassure them that although it may not all go to plan, the most important thing is for them to remember to have fun during their summer holiday!


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References

  1. New York Times. Diabetes Patients at Risk From Rising Insulin Prices. nyti.ms/2JZeCzD (accessed 10 January 2019).
  2. Evening Times. Sizzling temperatures…summer has arrived. bit.ly/2Frv8oF (accessed 10 January 2019).