Q: I'm travelling to a hot country – how can I keep my insulin cool?
In very hot climates, it is best to store insulin in a hotel fridge (if there is one in your room) or in a cool bag (providing it does not freeze). A variety of cool bags and storage containers are available. If using a cool bag that uses plastic ice blocks, make sure that the insulin does not come into contact with the frozen plastic containers.
For information on insulin storage products, contact the Diabetes UK Helpline.
Q: I'm going on holiday – how do I manage crossing time zones?
Time zones and insulin
Journeys across time zones may mean that you need to adjust your insulin. All international flights eastwards or westwards involve crossing time zones and days will be shortened or lengthened. There is no need to be alarmed about this. Many people across time zones regularly, without any serious problem. Remember that "running a bit high" for up to 24 hours is unlikely to cause you any harm.
When travelling east to west, the day is lengthened and some clinics will advise you to take an extra meal and to cover it with extra insulin. When travelling west to east, the day is shortened and the amount of insulin and carbohydrate may need to be reduced.
In general, if your time zone change is less than four hours, you will not need to make major changes to your injections.
If you are on two injections of insulin a day, a greatly lengthened day may mean that you need a small amount of insulin with a meal between two main injections. This will usually be short-acting insulin, but you will need to discuss the details with your diabetes doctor or nurse. A shortened day may mean that you need to reduce your pre-flight insulin. Again, it is important to discuss this beforehand with your diabetes care team. When discussing this, make sure that you have your flight details to hand, including your departure time, the length of the flight, and the local time of arrival.
Many people now have three short-acting injections during the day, followed by a medium or long-acting injection in the evening. Because this regime gives a great deal of flexibility over the timing of injections and meal times, it can be easily adapted to time zone travel. Many people who regularly travel by air switch to this system.
Some people may have a problem with this system because the normal sleep cycle is broken by time zone travel. As a result, the medium or long-acting insulin is being taken more than once in every 24 hours. It may then build up in the body and cause a hypo. Many diabetes doctors and nurses now recommend a variation on the above; you leave out the medium or long-acting injection entirely and rely on short-acting injections before meals until you are safely back on a 24-hour clock in your country of arrival. Many travellers find this very helpful because it allows them the flexibility they need.
Both systems allow you to adjust your dosage and timing of insulin injections as the day becomes shorter or longer.
Time zones and tablets
If you take diabetes tablets, you are unlikely to have any particular problems. Very occasionally, it may be necessary to take extra tablets to cover a longer day. Do discuss this with your diabetes care team beforehand. You may, on occasions, need to leave out one dose of tablets on a short day, when you are travelling on a long west to east journey. Again, speak to your diabetes care team about this well in advance of the trip.
Q: Will they let me take my insulin in my hand luggage on the plane?
People with diabetes can still take insulin with them onto aircraft despite new security restrictions. Those traveling should bring a letter from their doctor explaining their need to carry syringes/injection devices and insulin. The doctor's letter explaining your need for insulin and injection devices should be presented to the airline staff, and if you do encounter any problems you should request to speak to a manager or senior member of staff.