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Travelling with Diabetes ...

General Tips for Travelling with Diabetes

1. Have a list of all of your prescription items. This can be obtained from your pharmacist before you leave.

2.  Make sure you have prescription labels on all of your supplies. The name on prescription medicine must match the name on the passenger's ticket.

3.  Contact your doctor ahead of time and ask he/she to write you a letter of medical necessity stating that you must carry all of your diabetes supplies and/or insulin pump Security staff who may not be familiar with an insulin pump, the note should explain why it cannot be removed. The name on the doctor's note must match the name on the passenger's ticket

4.  Wear Medic Alert or other medical awareness jewelry.  If you do not subscribe to MedicAlert, you may wish to contact the Canadian Diabetes Association and ask for an information card which will detail the type of diabetes you have and your treatment regimen.

5.  Check that your travel medical insurance covers existing conditions. If not, travel insurance can be purchased through the Canadian Diabetes Association.

6. Never pack all of your supplies in the same place. Things can be lost, stolen or somehow destroyed so make sure that you spread your supplies out in various suitcases or bags.

7. ***Carry extra glucose, water, and food in case you are not able to locate a store or restaurant when an emergency strikes.

8.  Check carry-on regulations with individual airlines before travelling. At this time liquids or gels (including water and juices) are not permitted to be carried on board aircraft leaving Canada, so passengers must carry an alternative form of fast-acting glucose. Some airlines have additional requirements depending on the destination. As of August 14, 2006

9. Bring a container of some sort for disposal of sharps.

10. If using an insulin pen, bring back up pen as well as syringes. Pens do malfunction and you are not always near a pharmacy when this happens.

11. If using an insulin pump, bring syringes in case of pump failure.

12. Set your pump to vibrate when flying. The noise of the engines may make it difficult to hear the alarms.

13. If you inject insulin while in flight, frequent travelers 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.
  
14.  Keep spares of all supplies with you in a carry on.  Have twice the number of strips you would require for that period of travel. Have extra needles as your pen may malfunction at that time. Have spare infusion sets as your set may go bad when you least expect it. Have extra insulin cartridges and batteries ready as they will go low at the worst times.
***Because of recent changes to airline regulations this may no longer be possible. Contact the airline or travel agent. You may be able to have the airplane staff to provide you with water or juice to keep at your seat in case of emergency on the plane.

Insulin

1. Store insulin in insulated bag or cooled thermos.

2. Store insulin in more than one place if possible. If one vial of insulin becomes exposed to extreme heat or cold accidentally, you will still have a back up supply.

3. If you are skiing or camping, keep your insulin in an insulated back or close to your body.

Air Travel with Diabetes

Passengers are now permitted to bring liquids, gels and aerosols through security screening at Canadian airports provided that the items are packaged in containers with a capacity of 90 ml / 90 grams (3 oz.) or less, and that the containers fit comfortably in one clear, closed and re-sealable plastic bag with a capacity of no more than 1 litre (1 quart). One bag per passenger is permitted. Passengers must remove the closed, re-sealable plastic bag containing all permitted liquids, gels, and aerosols and place them directly into the trays provided at the beginning of the screening process.

Liquid prescription medicine and essential non-prescription liquid medicines are exempt from the container size restrictions and are not required to be placed in a plastic bag. However, passengers must declare all such items not in a bag or over 90 ml / 90 grams (3 oz.) in capacity to screening authorities. These passengers may be subject to additional screening.

Check carry-on regulations with individual airlines before travelling. Some airlines have additional requirements depending on the destination.

1. Insulin will lose its potency if repeatedly exposed to x-ray machines. Do NOT allow insulin or insulin pumps to go through the x-ray at the airport. Do not disconnect at any time. If there is a problem, ask for the wand to be used. Putting the pump through such a process can damage the internal programming.
2. Carry insulin with you at all times. Insulin is sensitive to temperature changes.

3. Advise the security personnel that you have diabetes and that you are carrying your supplies on board. It is recommended that you have available a letter from your physician which indicates that you have diabetes and that you need to carry your diabetes supplies.

4. Organize your medication and supplies into one separate container in your carry-on baggage.

5. Syringes must have needle guards in place and be with your insulin. There is no limit to the number of syringes you may carry.

6.  Make  sure insulin (vials or outer box of individual doses), jet injectors, pens, infusers, and preloaded syringes are marked properly (professionally printed label identifying the medication or manufacturer's name or pharmaceutical label).  If the pharmaceutical label is on the outside of the box containing the insulin, the insulin kept in its original packaging

7. Your lancets must be capped and must be accompanied by a glucose meter that has the manufacturer’s name imprinted on the meter

8. Notify screeners if you're wearing an insulin pump and ask if they will visually inspect the pump since it cannot be removed from your person.

9. Insulin pumps and supplies must be accompanied by insulin with professionally printed labels described above.

10. If possible, advise screeners when/if you are experiencing low blood sugar and are in need of medical assistance.

11. If you have any difficulty throughout the screening process, you can request to speak to the screening supervisor.   If you are traveling outside of Canada, you should consult with your airline for applicable international regulations.

12. Carry extra food and water in case of hyper- or hypoglycemia as airline food service has seen a dramatic cutback over the years.

13. You may request a visual inspection of your supplies. You have the option of requesting a visual inspection of your insulin and diabetes associated supplies. Keep in mind that:

•   You must request a visual inspection before the screening process begins otherwise your medications and supplies will undergo x-ray inspection.
•   You should separate your medication and associated supplies from your other property in a pouch or bag.
•   Medications should be labelled so they are identifiable.
•   In order to prevent contamination or damage to medication and associated supplies and/or fragile medical materials, you will be asked at the security checkpoint to display, handle and repack your own medication and associated supplies during the visual inspection process.
•   Any medication and/or associated supplies that cannot be cleared visually must be submitted for x-ray screening.  If you refuse, you will not be permitted to carry your medications and related supplies into the sterile area.  

For more information on airport security screening and your pump, you may wish to read "Your Pump and Airport Security...What you need to know."

Animas has also provided some great posters to help you understand what precautions to take.
(click for larger images)
xrays airport security
 

Traveling by Car with Diabetes


1. Check you blood glucose levels before you leave and at least every four hours when traveling.

2. Stop every few hours to stretch and do some physical activity.

3. Try to limit your driving to a maximum of 12 hours and go no more than 6 hours between any two meals.

4. Be sure to have snacks and glucose sources in the vehicle with you as you may not be able to reach a restaurant or store on time.  

5. Make sure that you have spare supplies in the car with you. Murphy's Law says that if you don't, you will find that you need more strips than are in your canister, your site will fail for the first time, or your insulin cartridge will suddenly be empty.

Sea Travel


1. Keep active to compensate for the added food you will probably eat while onboard.

2. It’s a good idea to make ship staff aware of your condition in case any problems arise.

3. Have all of your medication well documented.

Hiking


1. Avoid going alone.

2. Make sure someone knows where you are and when you will be back.

3. Bring along a first aid kit and if you use insulin, a Glucagon Emergency Kit
4. Make sure that your traveling companion knows how and when to use Glucagon.

Handling Time Changes


1. Test often.

2. When traveling east, your travel day will be shorter. If you lose more than two hours, you may need to take fewer units of intermediate or long-acting insulin

3. When traveling west, your travel day will be longer. If you gain more than two hours, you may need to take extra units of short-acting insulin and more food

4.You can change the time of your injections and meals by up to two hours in a day without adjusting your insulin dose or your meal plan.

Checklist of things to do before you leave…

___ Have a medical check-up to ensure that you are fit to travel.
___ Do you have travel medical insurance?
___ Do you have a medical identification card and MedicAlert jewellery?
___ Do you have information on the local foods served and quality of local drinking water?
___ Do you have a list of your prescriptions and medications?
___ Do you have a letter from your doctor stating that you must carry these supplies?
___ Do you need any special vaccinations? Get this done at least a month before you travel in case you have any reaction to the vaccine.
___ Have you located the nearest medical facilities and do you have any contacts in the area?  

List of Items to Pack


___ insulin (twice what you would normally need)
___ long acting insulin if you are on a pump in case of pump failure
___ extra syringes, pen needles, pens and/or infusion sets and cartridges
___ extra glucose in case of lows
___ bottled water in case of highs
___ extra food to cover delayed meals such as crackers and fruit juices
___ Ketone strips and/or ketone meter
___ Dixie cups if using Ketostix
___ Glucgaon (2--one for sick days and one for emergencies)
___ spare meter in case you lose or break your main meter
___ twice the amount of strips as you would usually use
___ spare batteries for your meter
___ spare batteries for your insulin pump
___ lancets if you change them regularly
___ sharps container
___ spare lancet in case your’s breaks or gets lost
___ telephone numbers for your doctor and/or diabetes educators
___ calculator to total carbohydrates and figure out boluses
___ mini carb guide book for strange foods and restaurants
___ portable scale
___ alcohol wipes
___ hand cleaner for those times when clean water and soap is not readily available
___ Emla cream for pumpers who don’t like to do changes without it.
___ Tegaderm bandages for site changes and may be used to cover sites
___ IV prep, Mastisol, or other adhesive agents to help infusion sets stick in hot weather
___ log book
___ Band-Aids
___ letter of medical necessity from your doctor
___ Medic Alert  jewellery on

References:
http://www.childrenwithdiabetes.com/pumps/life.htm
http://www.childrenwithdiabetes.com/d_0j_211.htm
http://www.diabetes.org/advocacy-and-legalresources/discrimination/public_accommodation/travel.jsp

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