Diabetes and Travel

Written by Fiona Scott.

Travelling to far away places, learning about new cultures, or relaxing in an exotic location are things many of us dream about, and for those of us who are lucky enough to do it, the key to a great vacation is planning. Travelling with type 1 diabetes involves a little more preparation, including preparing for the “what if” scenarios.

It’s important to to look at the bigger picture: this ensures that on the off chance your luggage goes missing or you become unwell, you have a plan and there will be minimal disruption to your trip.

Some scenarios to consider:

  • What will I do if I lose my hand luggage with all my diabetes supplies?
  • What’s my backup plan if my pump stops working?
  • What will I do if I get food poisoning and start vomiting?
  • What happens if lose my travel letter?

Once you’ve gone through all of your “what if” scenarios, plan a backup that can be tailored to any emergency situation you may face. Below, we created a quick checklist as a guide to use during packing that includes a packing list breakdown!

Beta Change Travel Checklist

  • Bring a doctor’s letter stating you have diabetes (and which type) and that you need to carry diabetes supplies with you at all times.
    • *Beta Change handy hint: Give a copy of your medical letter to each of your travel companion(s) as a backup and take a photo of the letter with your phone for easy reference.
  • Make a document that lists your emergency contacts, medical team, medical conditions, current medications, sick day plan, and any allergies. 
    • *Beta Change handy hint: Take a photo of this list and share with someone you trust back home and with your travel companion(s). A great way to do this is through email or a messaging app.
  • Create a sick day plan and medical team contacts that includes a management plan for hypoglycaemia and hyperglycaemia in relation to fever, gastrointestinal issue, or vomiting.
  • Sign up for your country’s equivalent of Australia’s Dept. of Foreign Affairs and Trade (smartraveller.gov.au) in case of a natural disaster or emergency.
  • Keep travel insurance details in a secure place.
    • *Beta Change handy hint: Check that your travel insurance covers pre-existing conditions such as type 1 diabetes, and that insulin pumps are fully insured under your plan (if you are using one).
  • Pack double the amount of diabetes supplies you think you may need. If you’re going away for three weeks, pack enough for six weeks and divide them among hand luggage. If you have a travel companion, they can help you divide up the supplies to reduce the chance of losing anything. If travelling solo, divide supplies into two bags.
    • *Beta Change handy hint: remove any boxes or excess packaging.
  • Keep diabetes supplies on you at all times. Never put your diabetes supplies with your checked luggage as temperatures in the cargo area can be unstable, which may affect your insulin or other temperature-sensitive medication.

 Diabetes Supplies

  • Short-acting insulin
  • Long-acting insulin 
  • Insulin pens (and pen needles) and/or syringes
  • Insulin pump equipment: infusion sets and inserters, cartridges/reservoirs, a list of pump settings, loan or backup pump, backup plan for multiple daily injections if pump fails
  • BG meter
  • BG test strips
  • Finger pricker and lancets
  • Urine or blood ketone strips
  • Alcohol wipes
  • Hypo food
  • Emergency simple carbohydrate snacks
  • Glucagon
  • Spare batteries for blood glucose meter/insulin pump
  • Medical ID 

 Other Items

  • Continuous Glucose Monitoring equipment: transmitter, receiver and charger, sensors, insertion device, adhesive and tape
  • FRIO packs or other storage to help keep insulin cool 
  • MedAngel or other device to track temperature of insulin storage container
  • Paperwork confirming vaccinations are up to date for your destination
  • At least two universal power plugs (in case one fails)
  • USB charging cables

Although we are all more than capable of managing our diabetes, there may be times when we need support, especially if we become unwell. If we’re travelling with someone, it’s important that they know when to step in and help. Be sure to brief them on your hypo symptoms, hypo management plan, and when and how to use glucagon.

We’ll leave you with one last Beta Change handy hint: have a bag on you during the flight, not in the overhead luggage hold. This can be a small backpack or bum bag. In this bag, have everything you need for the flight plus two days so you have everything in easy access and are prepared for any flight delays or holdups on the tarmac. 

Bottom line: Exploring the world is exciting! When you take some time to research, plan, and prepare for your travels, diabetes won’t stop you from enjoying your adventures.

Additional Resources 

Diabetes and Travel Preparation

In this minisode, we spoke to one of our own, Fi, and her dad, Kevin, about preparing for travel with diabetes. Check out the minisode to hear about the off-road adventures Kevin took his family out on even after Fi’s diabetes diagnosis and how they prepared for their trips! 

An (Almost!) Adult’s Life with Diabetes – by Nicole Reed

Nicole joined us for her second Beta Change Minisode in early August. Check it out if you haven’t already! Below, Nicole outlines a few important themes when it comes to “adulting” with diabetes in college.

Step Forward
During the fall of my freshman year in 2016, I established the NYU Chapter of the College Diabetes Network to foster, support, and raise awareness about diabetes. Even though I’m the group leader, I sometimes found myself apologizing to people about diabetes, especially when I was sharing meals with people whom I recently met.

They would always tell me *not* to say “sorry” and to continue talking about what life is like with diabetes. It is of the utmost importance not to disregard people who are unfamiliar with diabetes, but to use the opportunity as a way to raise awareness for
those affected by diabetes – and for the disability community at large. If we don’t educate people, who will?

Don’t worry about what people think
When I was beginning my college career, I was very concerned about what people who were not familiar with diabetes would think of me. I was mainly worried about how my roommate would feel about me having to often wake up in the middle of the night to test my blood sugar, then perform insulin injections multiple times per day, and sometimes not be in a great mood due to high and low
blood sugar.

I have learned that 99% of the time, people do not form opinions about what I am doing when I am managing my diabetes. Usually, the issues I have with doing these things in front of people stem from my own thoughts of how people are judging me. Surprisingly,
the vast majority of people I’ve encountered have been very supportive of my journey with diabetes.

I’m a non-confrontational person. I felt timid about advocating for myself in various settings at the beginning of my college career. While I understand that it can be intimidating at times to stand up to people in order to satisfy our medical needs or tell them they are overstepping boundaries, we — people affected by diabetes — need to be our best advocates. Whether we are in class, work, or social settings, it is important to prioritize our health, even if that means taking a step aside from the busy pace of our activities. By taking control of our diabetes, we never allow diabetes to control us.

Diabetes Camp

For people with diabetes, diabetes camps hold a special place in our hearts. If you need proof, check out our Global Postcard video! Members of the Beta Change team recently talked about what camp means to us. 

As Steph so eloquently put it, “camp is a magical playground that encourage and empowers all those involved.” Some team members have had the pleasure of attending camp as a kid living with diabetes, while the rest of us first experienced the magic of camp as adult volunteers. 

No matter when we first joined the diabetes camp community, we all agree that diabetes camp is THE place to meet peers living with type 1 diabetes. We may have had reservations – as Katie said, “I was initially hesitant to get involved in the diabetes community, due to a few common misconceptions of what hanging out with a group of people with diabetes would be like.” 

However, it didn’t take long before she realised that “camps are a place where magic moments are around each corner and lifelong friendships are formed,” as Fi describes her camp experience. 

In our special Beta Change diabetes camp feature, Pei Yan shares with us an in-depth reflection on her experiences with diabetes camps over the years.

I remember my first diabetes camp. It was 21 years ago – in 1997 – and the camp was held at a holiday resort on a touristy island in Singapore called Sentosa. Everyone around me was so happy while I sat alone at one corner, not knowing what to expect and feeling rather afraid. There were a few familiar faces – doctors and nurses from the diabetes clinic I go to – but they were busy with running the camp. It was a simple overnight (three days, two nights) camp and, slowly, I started enjoying myself. 

It was a place where we could talk about diabetes, to take injections openly, and be able to loudly declare “I have a hypo!” That was it: I was hooked on diabetes camp. Year after year, and camp after camp, at various locations both local and overseas, there will always be at least one familiar face at diabetes camps – ME (and some of my friends). We are the so-called “hardcore” campers. Families, parents, and even siblings know us when we appear at camps and that makes them feel at home and allowed us to catch up with each other.

Gradually, I moved from being a camper to group leader, and eventually a young adult volunteer. A few of us who grew up with diabetes camps decided to come together and called ourselves SugarRush. We return to camps to help with planning of family night games, mentoring young campers, and demonstrate to parents how we have journeyed with diabetes from childhood into adulthood. Many of the doctors, nurses, dietitians and social workers have watched us grow up through camp. There is always time to reminisce about the mischievous or hilarious things we have done at past camps and the times where we became living examples during learning sessions.

Pei Yan at Games Night at Diabetes Camp, June 2017  

Diabetes camp means a lot to me. It was my first step to meeting other people with diabetes only a year after I was diagnosed. It was where I learnt to become a leader. It was where I got to eat, play, and chat with healthcare professionals – and even their family members. Diabetes camp was where SugarRush began and where we realised that we want to give back because we benefited so much from it. 

“I have been part of diabetes camps as a camper and as a peer leader, surrounded by those with different perspectives, ages, competencies – and each time I grow from within the sphere of those I’m in company with. And for that, I am rich.” – Steph

Creating Superheroes – by Carrie Hetherington

We first heard from Carrie talking about her first book for children with type 1 diabetes. Now she’s back with a second book and here Carrie gives us a sneak peek with what to expect and how she is giving back to the diabetes community with the proceeds of her book.

I have type 1 diabetes, like many of you reading this article. 

For those of you who don’t, imagine that the inside of your body is variation on a scene from Star Wars: Darth Vader pulls out a lightsaber and destroys all his Storm Troopers – he’s killed his own squad. That’s me! 

My body attacked all its own beta cells – thanks, body! I now have a pretty useless pancreas floating around inside me. My world was turned upside down, but I’ve learned to love living upside down. I’ve had a decade of adventures so far: I’ve travelled the world, made hundreds of broken-pancreas-friends, and the best part is, I’ve published a book. 

The idea was inspired by a meeting with Adejumo Hakeem in 2013 at an International Diabetes Federation conference. We had spoken online as I’d written about type 1 for NGdoc, (Diabetes in Nigeria: Protecting the Future) and I wrote my Masters degree on The Relationship Between Urbanisation and Type 2 Diabetes: a human rights-based approach to health in Nigeria. I knew about the situation and desperately wanted to do something to help. So my book was born: Little Lisette the Diabetic Deep Sea Diver.

I didn’t want to make an instruction manual on how to survive – I wanted children to have a normal book, an adventure where the main character happened to be just like them. Learning was secondary. I wrote about a girl who went to a party under the ocean and had a hypo while she was spending time with her sea creature friends. This was her worst nightmare as she had hidden her diabetes. Eventually she was forced to test mid-karaoke and everyone saw it. Her friends supported her and wanted to know all about her diabetes, explaining that everyone is special in their own way, and, to her surprise, they simply carried on with their amazing party. 

I also tried to make it fun and interactive: children can call out to Little Lisette during the book to remind her to check her blood sugar. The first person we helped with the profits was called Daniel. He was 14 and in hospital with DKA, and his family couldn’t afford to buy insulin, a blood glucose meter, or test strips. We could help, and this made it all worthwhile for us. 

Now it’s time for my second book to be released! It’s about a superhero and diabetes is personified in the form of a mischievous little blue monster. The aim is to help children understand that they are going to be ‘attached’ to this little monster until we can find a way to break the magic glue which is holding them together. Just like the first book, it’s an exciting story; the learning is secondary. The incredible illustrations are by Tim Ingle and the profits will be going to Diabetes and Eating Disorders Awareness (DEDA), an organization created by Lisa Ingle. 

DEDA supports, advocates for, and brings hope to people with eating disorders and diabetes. One in three females with diabetes struggles with an eating disorder at some point in their lives, with potentially devastating consequences such as increased incidences of DKA, accelerated onset of diabetes complications, and at worst, death. DEDA raises awareness amongst the general public and health care providers, and advocates for improved detection and management of the issue. You can find out more at their website, and you can check out the Beta Change Minisode with Georgie Peters, Australian Manager of Diabetes Eating Disorders and Awareness here

Adventuring with Bike Beyond!

Cassidy Robinson is a woman of adventure! She recently completed Bike Beyond and shared her journey with us in a three part series (check them out here: part 1part 2 and part 3). But not only has she cycled across America, she has also driven across the country! Now she joins us to discuss all things adventure and diabetes in this Minisode.

World Health Day: Universal Health Coverage – by Elizabeth Rowley

7th April marks World Health Day and this year, the focus is on Universal Health Coverage. Elizabeth Rowley, founder and director of T1International talks about why the universal health coverage movement is important for people living with type 1 diabetes.

Universal Health Coverage Day, marked annually on 12 December, is the rallying point for the health for all movement. It marks the anniversary of the United Nations’ historic and unanimous endorsement of universal health coverage in 2012.

T1International has been involved in the #healthforall coalition and movement since it began in 2012. In 2016, the coalition launched a petition calling for recognition of 12 December as Universal Health Coverage Day. In 2017, the United Nations General Assembly passed a resolution that made it official.

Excitingly, the WHO has chosen to highlight universal health coverage in 2018 by choosing it as the theme for World Health Day on April 7th. At T1International, we will use the day to continue to highlight the importance of Universal Health Coverage for people with type 1 diabetes.

In our recent letter to the High-Level Commission on NCDs, T1International and the co-signees expressed complete agreement with the WHO’s support for universal health care. We stressed that this idea is essential to ensure survival and positive health outcomes for people with type 1 diabetes, due to the complexity of the condition and the large variety of supplies and care needed to properly manage the condition.

Diabetes is a chronic condition, so its management can be very expensive for both for patients and health systems. As those of us living with the condition know, managing type 1 diabetes requires an extensive array of tools and education, including insulin, blood glucose monitoring, ketone testing, glucagon kits, diabetes education, access to healthcare professionals, and treatment for complications. Access to these necessities on a continuous basis is unavailable in many countries around the world, so plans to ensure ongoing provision of them is essential.

As Emma Kaltman wrote in Diabetes Voice: ‘‘Generally, less-resourced countries have basic public health systems that are free or provide services at a minimal cost, and cover most of the population. Yet, various needed diabetes care components are not usually provided due to high costs.’’

She goes on to explain, ‘‘Some less-resourced countries endeavour to ensure access to health through both public and private health insurance schemes. The schemes may provide a wider range of services but are often beyond the reach of many people as they are costly and may be exclusive to governmental employees…When care components are not supplied in public health systems, they must be accessed at premium prices at private pharmacies and paid for as out-of-pocket expenditures.’’

We have worked with individuals and communities who face the impacts of high out-of-pocket spending regularly. Many spend upwards of 50% of their monthly income on diabetes expenses, struggling to afford insulin and only testing their blood glucose levels a few times a month.

‘‘At times I had to borrow money to buy my insulin, and I missed my clinics because I couldn’t afford the consultation fees,’’ Cate from Kenya told us.

A respondent to our ongoing 2018 survey from Peru said: ‘‘The analyses every three months are expensive and I must pay out of pocket. Emergency insurance or strips are not covered. I cannot access a pump or pay for the cost of a glucose monitor.’’

Thus, at T1International we know that an essential step towards universal health care is ensuring continued access to insulin and other diabetes supplies and care.

As outlined in the aforementioned letter, we propose a few clear solutions to begin to address the multi-faceted issues related to providing universal health coverage for people with type 1 diabetes:

  1. Support the development of diabetes registries, particularly in low-income countries, to understand the scope of the problem and find the best solutions to address it.
  2. Include insulin and diabetes supplies in emergency kits of UN agencies.
  3. Bring the price of insulin and essential supplies down using methods similar to those used to enable widespread ART treatment in HIV/AIDS.
  4. Engage humanitarian and development organizations, specifically patient-centered advocacy organizations.

We urge global health organizations to ensure that additional attention and resources are dedicated to access to medication, care and treatment for people with type 1 diabetes.

This post was originally published on T1International.