Heightened airport security in recent years means that it is essential for people with diabetes to plan ahead in order to avoid running into last minute problems. Airport restrictions are subject to change, so contact your airline directly or call the Department for Transport’s enquiry line on 0300 330 3000 for updates. Alternatively you can visit the travel and transport pages on the Directgov website.
Insulin and diabetes equipment
How much insulin and diabetes equipment can I carry in my hand baggage?
Current security regulations state that liquid items are only permitted in hand luggage if they are in containers of less than 100ml. There are a few exceptions including essential medicines for the period of your trip, which may be permitted in larger quantities above the current 100ml limit, but will be subject to authentication. Passengers are also permitted to carry essential medical equipment through airport security, though all medication and equipment must be supported by documentation from a relevant qualified medical professional.
The Civil Aviation Authority states: “It is essential that diabetic passengers carry adequate equipment (glucose meters, lancets, batteries) and medication in their hand baggage. It is also important that insulin not being used in the flight is not packed in the hold baggage as this may be exposed to temperatures, which could degrade the insulin, in addition there is also the potential that luggage may be lost en-route.” It may be useful to print a copy of their FAQs to take with you when you go through security.
What documentation do I need to show that my medication and equipment is for my diabetes?
Take a letter from your doctor or clinic which explains that you have diabetes, the medication you use and all the equipment you need to treat diabetes including insulin, insulin delivery devices, needles, blood glucose monitors, glucose tablets or liquid and ketone test strips. It would be helpful if the letter explains the need to carry all medications and equipment with you in your hand luggage and to avoid storing it in your luggage in the hold – problems will arise if luggage goes missing or your medication is spoiled. It would also be useful to take a recent prescription with you.
On some airlines, once on board the plane, cabin crew may request that medication be handed over for storage during the flight. Keep all diabetes medication and equipment together in the same bag to avoid anything being mislaid or lost.
If I have to put my insulin in the hold, how should I store my insulin it?
Should you have to place insulin in the hold, an airtight container (such as a flask) in the middle of your suitcase would be ideal. Alternatively, if an airtight container isn’t available, wrap in bubble wrap, then in a towel and again place in the middle of your suitcase.
On arrival, examine the insulin for crystals and discard the insulin if any are found. Even if it looks okay, you should test your blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged and ineffective.
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Can I get hold of insulin while I am abroad?
We recommend you take your insulin with you from home, but before travelling find out where you can get supplies of insulin at your destination, in case of emergency. Contact your insulin manufacturer before the trip to see if your insulin is supplied in the country you are travelling to. It is also worth checking that it is sold under the same name. You may/will have to pay for any insulin obtained locally, so make sure you take your EHIC to reclaim the cost when you return to the UK.
Contact details are given below for the insulin manufacturers in the UK.
Eli Lilly & Company, Tel: 01256 315000, website: www.lilly.co.uk
Novo Nordisk Ltd, Tel: 0845 6005055, website: www.novonordisk.co.uk
Sanofi-Aventis, Tel: 01483 505515, website: www.sanofi-aventis.co.uk
Wockhardt UK Ltd, Tel: 01978 661261, Website: www.wockhardt.co.uk
If you want to avoid travelling with all your insulin requirements, though quite expensive, you can get your prescription sent to your destination by courier. There is a pharmacy that specialises in this service, John Bell & Croyden (telephone: 020 7935 5555, website: www.johnbellcroyden.co.uk). You would have to get your prescription fulfilled by the pharmacy who would also provide specialist packaging and export administration and courier it to you. Costs for this service will vary for the size of the package and destinations.
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Insulin pumps and Continuous Glucose Monitors (CGM)
Should I let the airline know I use an insulin pump or continuous glucose monitor?
If you treat your diabetes with a pump or use a continuous glucose monitor (CGM), it is essential that you contact your airline prior to travel, if possible a few weeks before you fly. Some airlines will require you to notify them of your medical equipment in advance and fill in additional paperwork before you fly. Failure to do this can, in some cases, result in passengers not being allowed to board the aircraft with their pump or CGM, so it is really important to check your airline’s procedure.
As well as discussing this with your airline before travelling, you should also speak to your diabetes team – should you need to remove your pump for any reason, they can provide you with any extra equipment such as insulin pens and help plan your doses throughout your journey. People using Medtronic equipment can request an airport card from the manufacturer which gives technical details of the equipment, specifically for the purpose of airport security and cabin crew. The Civil Aviation Authority’s Advisory Health Unit recommends that people with diabetes should always contact their airline before travelling to discuss medical devices they intend to take on board aircraft. Individual airlines can then assess each piece of equipment individually.
Why does the airline need to know that I use a pump/CGM?
Safety caution around insulin pumps and CGM onboard aircraft is due to wireless functionality, which may interfere with aircraft communication and navigation systems – in the same way people are asked to turn off other portable electronic equipment such as mobile phones and games consoles. Pumps or CGM with remote handsets (where the handset is not attached to the insulin pod or body) sends wireless signals, so you should check with your manufacturer whether this can be turned off for the duration of the flight.
In most devices the frequency is very low and wouldn’t actually cause problems – however, cabin crew need to exercise caution and if in doubt, could ask people to remove their equipment altogether if they can’t turn off the wireless capability.
If your pump or CGM cannot function without a wireless signal, then you may need to be prepared to remove your CGM and pump and administer insulin with an insulin pen for the duration of your journey. You would also need to test your blood glucose levels manually with a standard blood glucose meter.
Is it safe to go through the x-ray machines or full body scanners?
The advice given by the Civil Aviation Authority regarding pumps and scanners is as follows:
"There are a number of manufacturers of insulin pumps and unfortunately they do not all give the same advice. This varies from assurance that the pumps can safely go through any screening equipment, including X-ray equipment, to advice that the equipment may be affected by even the low-dose X-ray equipment used in some whole body scanners.
"If you use an insulin pump, it is therefore important to contact the manufacturer of the particular pump that you use for advice. It is also sensible to contact your airline and the airports you will travel through, to find out their requirements if the manufacturer advises that your pump cannot go through some screening equipment."
For pumps that are not able to pass through body scanners, the advice is as follows:
"There are some airports where you will not be allowed to travel if you refuse to be scanned. It is therefore advisable to check with your airline and the airports you will be passing through to see if they do allow an alternative check."
If your pump cannot pass through a scanner and the refusal to pass through will result in refusal to fly, our advice is to remove the pump temporarily, pass through the scanner without the pump and re-attach.
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There is no restriction on the quantity of tablets you take through airport security with you, but you would still need to take documentation from a relevant qualified medical professional or your prescription for authentication.
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Food choices for your journey
What meal should I choose from the menu?
Airlines can provide information on the times of most meals so you can plan your insulin administration. It is best to order the standard meal (rather than the ‘diabetic’ meal) though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. If this is the case, cabin crew are usually able to provide extra fruit, crackers or bread rolls.
What do I do about snacks?
On long flights, you may require snacks in between meals and at bedtime to prevent blood glucose levels going too low, so try to carry extra starchy carbohydrate foods, such as biscuits, cereal bars or fruit buns, on board the aircraft.
For the journey, some people allow their blood glucose to run slightly higher than usual to avoid the inconvenience of hypos. If you are on insulin, monitor your blood glucose levels frequently and be prepared to make changes to your dosage.
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What hypo treatment should I take with me?
Glucose tablets, Lucozade and fluids used to treat hypos can be carried on board along with longer-acting carbohydrates such as biscuits; remember, liquids must be purchased after going through airport security.
Should you have any problems buying glucose tablets or Lucozade after going through customs, remember that the following are effective in treating a hypo: any sugary non-diet drink (eg lemonade or cola), sugary sweets (eg Barley sugar), a carton of fruit juice. Then to prevent blood glucose from dropping again, follow with longer-acting carbohydrate, such as a sandwich, fruit or biscuits.
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