Archive for August 2013

Travel and Diabetes

Travel and Diabetes

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In todays world,one needs to relax in between to recharge ones mental and physical faculties. Just being a diabetic should not ruin your chances for a pleasurable trip.

See Your Doctor Before You Go
Before a long trip, have a medical exam to make sure your diabetes is in good control. Schedule the exam with enough time to work on your control before you depart. Get immunization shots — if you need them — at least one month before you leave. If the shots make you sick, you’ll have time to recover before your trip. Some countries do insist on some vaccinations which are mandatory. Most of the vaccines are available at the Tertiary care centers here in the Sultanate. They will issue a vaccination card as well which you may have to produce at the port of entry.

You might be needing a letter stating you are carrying the insulin shots, the glucometer kits, syringes and the pump in your carry bag. The site www.OneBag.com will help. The site diabetesaliciousness.blogspot.com  also helps in knowing rules at airports around the world.

Before any trip, get two papers from your doctor: a letter and a prescription. The letter should explain what you need to do for your diabetes, such as take diabetes pills or insulin shots. It should list insulin, syringes, and any other medications or devices you use. The letter should also list any allergies you have or any foods or medications to which you are sensitive.

The prescription should be for insulin or diabetes pills. You should have more than enough insulin and syringes or pills to last through the trip. But the prescription may help in case of emergency. It may be useful to have a prescription in the language of the country you are visiting as English is not widely spoken or understood in some parts of the world.  The sites https://translate.google.com as well as packitup.com give an idea how to do this translation.

It is safer to have enough stock of the medicines with you. It will be cumbersome to hunt for a doctor and schedule an appointment in the middle of enjoyment. This can even ruin your vacation. Carry enough stock of batteries for the glucometer or pump.

Prepare for an Emergency Abroad
No matter where you go, wear a medical ID bracelet or necklace that shows you have diabetes. If you’re leaving the country, also learn how to say “I have diabetes” and “sugar or orange juice, please” in the language or languages of the countries you’ll visit.

Insure yourself if need be. InsureMy Trip.com can help.

Medical IDs
Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times.
In the event of a severe hypoglycemic episode, a car accident, or other emergency, the medical ID can provide critical information about the person’s health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc. Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can’t speak for themselves.
Packing Tips
The second rule of travel for a person with diabetes: pack at least twice as much medication and blood-testing supplies as you think you need. Pack all of them in your carry-on bag so that your medication is always with you (checked luggage can get lost). Keep a photograph of the medicines you are on in your smartphone. This will help in case the prescription is lost.
Whether you travel by car, plane, boat, bike, or foot, you’ll want to keep this “carry-on” bag with you at all times. Pack this bag with:
• all the insulin and syringes you will need for the trip
• blood  testing supplies (include extra batteries for your glucose meter)
• all oral medications (an extra supply is a good idea)
• other medications or medical supplies, such as glucagon, antidiarrhoeal medication, antibiotic ointment,  drugs for motion sickness.
• your ID and diabetes identity card
• a well-wrapped, air-tight snack pack of crackers or cheese, peanut butter, fruit, a juice box, and some form of sugar (hard candy or glucose tablets) to treat low blood glucose.
Eating in the Air
When you fly, you can request a special meal low in sugar, fat, or cholesterol. Make your request at least two days before the flight.
If you take insulin, wait until you see your food coming down the aisle before you take your shot. Otherwise, a delay in the meal could lead to low blood glucose. To be safe, always carry some food with you. If your meal is delayed or an order is mixed up, you won’t be stuck with an empty stomach.
I am on insulin

  • When you travel with insulin, give some thought to where you’ll be storing your supplies. Insulin does not need to be refrigerated, but insulin stored in very hot or very cold temperatures may lose strength.
  • Do not store your insulin in the glove compartment or trunk of your car. Backpacks and cycle bags can get quite hot in the direct sunlight. If you plan to travel by car or bike or to be out in the elements, take steps to protect your insulin. Many travel packs are available to keep your insulin cool.
  • In general, you should stick with the exact brand and formulation of insulin that you have been prescribed by your doctor.
  • However, if you run out while you are on the road, and your regular brand is unavailable, you may substitute another brand’s equivalent formulation (for example, NovoLog for Humalog, Humulin R for Novolin R). Changes in formulation (for example, from rapid-acting Humalog to to short-acting Humulin R) require medical supervision.

Insulin can come as U-40, U-80 U-100 and U-500. This means one ml of that insulin could have either 40 units or 80 units or 100 units or 500 units.
If you need to use these insulin preparations, you must buy new syringes to match the new insulin to avoid a mistake in your insulin dose. If you use U-100 syringes for U-40 or U-80 insulin, you will take much less insulin than your correct dose. If you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin. However, the pen devices do not have these problems.

Crossing Time Zones
If you take insulin shots and will be crossing time zones, talk to your doctor or diabetes educator before your trip. Bring your flight schedule and information on time zone changes. Your doctor or educator can help you plan the timing of your injections while you travel.

Remember: eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.Visit www.voyagemd.com for insulin dose calculation while going on long hours. One may also need to adjust the insulin dosages when going on trekking or climbing mountains when abroad.

  • To keep track of shots and meals through changing time zones, keep a watch on the home time zone until the morning after arrival.
  • Keep the home time in the watch for half a day after arriving so that you take the shots of insulin at the normal time as back home. The time can be set after 8 hours.
  • If on an insulin pump, change the time to new country before take off and program the pumpaccor
  • If one injects insulin while in flight, those traveling frequently suggest you be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to “fight you.” This can make it hard to measure insulin accurately.
  • Checking the blood glucose while traveling is as important as when at home. Also, check the blood glucose level as soon as possible after landing.
  • Jet lag can make it hard to tell if one have very low or very high blood glucose.

Welcome to a new place
After a long flight, take it easy for a few days. Check your blood glucose often. If you take insulin, plan your activities so you can work in your insulin and meals.

  • If you are more active than usual, your blood glucose could go too low. Take along snacks when hiking or sightseeing. Don’t assume you will be able to find food wherever you are.
  • No matter what kind of diabetes you have, it’s smart to watch what you eat and drink when traveling. Avoid tap water overseas. This includes ice cubes made from tap water.
  • Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and hurt your diabetes control. But you will also find foods that give you a healthy taste of culture.
  • Wear comfortable shoes and never go barefoot. Check your feet every day. You should look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation.
  • Go wherever your heart leads you. Just remember that you take your diabetes with you. Take your self-care along, too.
  • It is always refreshing to have soda, slushies or coffee when traveling. Remember that these can have a lot of calories and carbohydrates.Try to have plain coffee with low fat milk rather than the fancy Cuppa Mocha, Starbucks or Latte which can pack quite a lot of calories. You must enjoy the vacation and so even if you wish to have all these, go for a stroll after the meals or these beverages.
  • Those planning on visiting a beach, must remember to carry some cool fluids and keep the medicines cool. Those who wish to have their blood sugar checked by pricking must remember to wash their hands well before doing so. Some have alcohol while in the pool or on a beach.
  • The effects of alcohol can be blunted while in water and so many may consume more to get the “kick”. Alcohol can increase the sugar levels. Cocktails can be pretty dangerous in terms of calories and sugar levels.
  • Please do not walk barefoot however beautiful the beach may be.
  • For those on an insulin pump, have the pump disconnected while taking off or landing as the pressure changes can sometimes deliver more insulin than needed. During the reconnection, remember that small air bubbles must be removed or else less insulin will be delivered. The extreme heat can sometimes damage the insulin in the infusion tubing which can work less effectively.

Carry the following with you to avoid problems at the airport
• Some document from the doctor mentioning you are diabetic
• A document to explain why carrying an insulin pump, glucometer, lancets for pricking blood, test strips, insulin pens and the needles, insulin storage cans or packs.
• Carry enough stock of insulin
• Quick acting carbohydrates such as glucose powder.( remember that chocolates, juices may get damaged with travel and the glucose tablet may harden)
• Slow acting carbohydrates such as biscuits or cereal bars.
• Let the flight attendant know of your diabetes as low sugar can mimic drunken behavior!
• Inform the flight attendant or airlines of your diabetes status, so they know what to do if traveling long distances. They may give you extra leg room seats.
• You can also request for a special menu which comes with some of the leading airlines.
• While flying, never aim for perfect glucose control ( keep the levels between 8 – 13 mmol/L or 144 – 203 mg/dL)
• Check the sugar levels in between if long haul flights( more than 4 hours)

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