People with both Type 1 and Type 2 diabetes can travel all over the world – diabetes is no barrier. Make the right preparations and you should be able to minimise any potential problems.
The diet for people with diabetes is the same healthy diet recommended for everyone so you should be able to choose items from the usual menu while away from home. If you are travelling alone, you may like to let the staff know when you check in as a precaution in case you become unwell during your stay.
Things to check before you go
- Carry diabetes ID and a letter from your GP, which says you have diabetes and the medication you need to treat it if you are carrying insulin or an injectable medication.
- Take twice the quantity of medical supplies you would normally use for your diabetes.
- 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's also worth checking that it is sold under the same name. You can get your prescription sent to your destination by courier.
- Flights often cross time zones. If you treat your diabetes with medication or insulin, it’s important you check with your diabetes care team. If you need to make any changes to your regime be mindful that a hot or cold climate may affect how your insulin and blood glucose monitor work.
- Apply for the free European Health Insurance Card (EHIC) if you are travelling to a European Union member country – it will ensure that you have easy access to healthcare in that country. Apply for your card on theEHIC page on the NHS choices website, by calling 0845 605 0707, or fill in a pack at the Post Office. Beware of websites which offer to take care of the application for you: they are likely to charge an unnecessary administration fee.
- Buy travel insurance. Even if you have the EHIC, it's still advisable to buy travel insurance, as the card doesn't cover, for example, emergency repatriation, and not all countries give the level of cover of the NHS.
Packing for your trip
- Split your diabetes supplies in separate bags.
- If flying make sure you have some diabetes supplies in your hand lugguage in case your bags get lost.
- Pack extra snacks in case of delay with your journey.
- Make sure you have all your diabetes medication and equipment packed.
- If you are carrying syringes and insulin on your flight take a letter from your doctor.
Note: In some countries, blood glucose is measured in milligrams per 100 millilitres (expressed as mg/dl) and not in millimoles per litre (mmol/l). A blood glucose conversion chart is below.
Considerations when flying
Heightened airport security 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. Or, you can go to the travel and transport pages on the Directgov website.
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.
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.
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.
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.
Important: Caution around insulin pumps and CGM onboard aircraft is due to wireless functionality, which may interfere with aircraft communication and navigation systems. 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 journey. You would also need to test your blood glucose levels manually with a standard blood glucose meter.
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.
Find out where you can get supplies of insulin at your destination, in case of emergency.
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.
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.
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.
- Eli Lilly & Company, tel: 01256 315000
- Novo Nordisk Ltd, tel: 0845 6005055
- Sanofi-Aventis, tel: 01483 505515
- Wockhardt UKLtd, tel: 01978 661261
Cabin crew may request medication be handed over for storage during the flight. Keep diabetes medication and equipment in the same bag to avoid anything being mislaid or lost.
There is no restriction on the quantity of tablets you take through airport security, but you would still need to take documentation from a medical professional or your prescription for authentication.
Is it safe to go through the X-ray machines or full-body scanners?
- "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."
What meal should I choose from the menu?
Airlines can provide information on the times of most meals so you can plan your insulin.
It is best to order the standard meal, though this may not supply you with enough carbohydrate if you are on insulin or certain diabetes tablets. Cabin crew are usually able to provide fruit, crackers or rolls.
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. Should you have any problems buying glucose tablets or Lucozade after going through customs, remember the following are effective in treating a hypo: any sugary non-diet drink, sugary sweets, fruit juice. Then, to prevent blood glucose from dropping again, follow with longer-acting carbohydrate, such as a sandwich, fruit or biscuits.
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. If you are on insulin, monitor your blood glucose levels frequently and be prepared to make changes to your dosage.
In hot countries, the biggest health threat is the sun, so keep covered. Wear long sleeves, loose trousers, a wide- brimmed hat and sunglasses with a UV400 label. For areas of the body left exposed, including the backs of your hands and feet, you need a high factor sunscreen.
Take particular care of your feet if you have neuropathy – numbness in your feet can mean you’re not aware skin is burning. Protect them from the sun with socks or sunscreen, and wear well-fitting sandals on the beach, so they don’t burn on the hot sand.
Sunbathing can affect your diabetes control, making blood glucose levels higher than normal.
Long periods of sunbathing on the beach can affect your diabetes control, making blood glucose levels higher than normal.
On the flipside, insulin will be absorbed more quickly from the injection site in hot weather and this increases the risk of hypos. You’ll need to monitor your levels more often and be ready to adjust your diet or insulin dose accordingly.
Be wary of misleading test results – extremes of temperature may affect the accuracy of your meter. Another thing to consider, if your levels are higher, is whether your insulin could have been damaged by the heat.
In cold weather, insulin is absorbed more slowly at first, but can then be absorbed suddenly when you warm up later in the day, which could cause a hypo. As your body also uses up more energy staying warm, eg by shivering, this can lead to hypos, too.
Hypos are more dangerous in cold conditions – they interfere with your body’s attempts to stay warm and increase the risk of hypothermia – so guarding against them is really important. As with hot climates, remember your meter may not be accurate in cold conditions.
If you suffer from poor circulation or have neuropathy, it’s particularly important to prevent frostbite, as numbness in your feet can mean you don’t feel the cold.
Food and travelling
There’s normally plenty of opportunity to try different foods when abroad – and there’s no reason not to just because you have diabetes, but if you keep in mind the basics of healthy eating, you’ll feel guilt-free.
Since starchy carbohydrates are an important part of a healthy, balanced diet, it’s worth knowing what carbohydrates will be available locally.
A good travel guide will give you an idea of the cuisine available, or you could carry a pocket dictionary or learn the words for a few basic foods. There’s also the Carbs & Cals Pocket Counter (£6.99 from Amazon) or the Carbs & Cals app (£3.99) for Android or iPhone, which allow you to compare the food on your plate to the photos in the book or app, to quickly see the nutrients in your meal.
Allergies & intolerances
If you have food allergies or intolerances, try to find out the phrases for asking if foods are suitable for you. Allergy UK sells laminated translation cards in various languages – go toAllergy UK's websiteor call 01322 619898.
Gluten-free products may not be readily available in some countries, so if you have coeliac disease, take plenty of gluten-free staples with you, eg bread, biscuits and crackers. For more on coeliac disease and travelling, go toCoeliac UK's website.
Whatever food allergies or intolerances you have, if you’re staying in a hotel ask well in advance whether they can cater for you. If you’re eating out and are in any doubt whether food is suitable, stick to plain foods where you can clearly see what you’re getting, eg boiled potatoes, salads, meat, fish or plain rice.
Hot climates pose a greater risk of food poisoning, especially in countries where levels of sanitation are not as high as you’re used to. Food cooked hot to order is the safest option – be wary of anything that may have been left standing or reheated. Watching where local people eat, or asking for recommendations, is a good way of finding the most reputable eating places.
If you’re concerned about the safety of the local tap water, stick to bottled or sterilised. Remember to also avoid ice in drinks, salads that may have been washed in tap water and fruit that you can’t peel. Bottled water and sugar-free drinks are readily available in most places.
Dealing with illness while abroad
You should talk to your doctor for advice before you go, and get information from the tourist office, embassy or high commission of the country you're visiting about getting medical treatment while you're there.
- Check your insurance policy, so you know what your insurers will pay for.
- Give the doctor the generic name – not just the brand name – of your medication.
- Read more aboutdealing with illness.