Air Travel And Diabetes

I remember a weekend trip to New York City for a wedding; and the morning we were supposed to fly home, a snowstorm hit and our flight was canceled. I was at the very end of my bottle of insulin and had to find a pharmacy to buy another bottle. I didn't have a prescription and I think it was a Sunday, so I was unable to call my doctor's office at home, so I had to pay full price for the insulin. I was frustrated at myself, at the weather, the pharmacy, and the fact that I had diabetes at all. It was the end of a great weekend and a rude reminder of my responsibilities. Looking back, I wish I could say that I've learned my lesson since that day,

TIPS ON AIR TRAVEL

■ See your doctor before you go. Get a letter describing your diabetes management and a copy of your prescriptions.

■ Whenever possible, bring prescription labels for medication and medical devices (Although not required by TSA, making them available will make the security process go more quickly).

■ Pack medications in a separate clear bag and place in your carry-on luggage.

■ Keep a quick-acting source of glucose to treat low blood glucose (glucose tabs), as well as an easy-to-carry snack such as a nutrition bar.

■ Carry or wear medical identification (a cute diabetes bracelet) and carry contact information for your physician.

■ Pack extra supplies, at least twice as much medication and supplies as you think you'll need.

■ Because prescription laws may be very different in other countries, write for a list of International Diabetes Federation groups (IDF, 1 rue Defaeqz, B-1000, Belgium) or visit http://www.idf. org. You may also want to get a list of English-speaking foreign doctors in case of an emergency. Contact the American Consulate, American Express, or local medical schools for a list of doctors. Insulin in foreign countries comes in different strengths. If you purchase insulin in a foreign country, be sure to use the right syringe for the strength. An incorrect syringe may cause you to take too much or too little insulin.

but I can count on both hands the times I've run into trouble while traveling, and have had to scramble to get my hands on test strips or a pump or insulin. I think I must have some sort of emotional stubbornness that kicks in when it comes to travel or an inability to plan appropriately for my trip, and I end up in a state of panic and short on supplies. One of the most frustrating parts of diabetes is that you never become an expert.

After 25 years of living with this disease, I still make mistakes. And even though I try not to beat myself up when I go for a run, forget to bring glucose tabs and get low, or go out of town for the weekend and run out of test strips, I feel like I have no one to blame but myself. So I'm gathering as much information as I can offer to my readers, but I'm also laying my own cards on the table and saying, I screw up all the time, don't expect perfection.

Lesley Hoffman Goldenberg's rule is to always pack double of what she'll need on her trip:

I always make up a scenario that I get stranded in whatever country I'm traveling to or that I have to change my site every day, since it's going to get ripped out every single day. Therefore, I always travel with double (which you see is based on no logic whatsoever). When traveling internationally, I always bring the phone numbers of their local MiniMed or pump supply companies, just in case. I always, always travel with a travel pump that MiniMed so graciously lets us borrow for about $50. It's the best and makes me feel so safe and secure!

Linda Frick has been traveling for pleasure since the year 2000:

At first, I would wear my pump in my bra like I normally do, and the airport metal detector would never alarm. As the airport security got tighter over time at some airports, the battery in my pump would make the metal detector alarm, and it was at that point I started wearing it on my waistband as they will not let you move it once you are picked out of line for a pat down procedure. I do have issues with TSA staff touching my pump. I have had them wipe down my pump with their cloth for gunpowder testing and I believe they need more extensive training on touching the pump. I also have learned to never ever wear a long skirt as a woman going through the checkpoint. There is nothing more humiliating and frustrating than a TSA agent frisking your inner thighs while the whole world is watching!

Kristin Makszin is currently living in Budapest, Hungary, working on her PhD in political science. She was diagnosed in 2003, at the age of 21, with type 1 diabetes; she is a frequent globe-trotter:

I have had many lows while traveling, but just treated them like I usually would. Always have something with you to treat your low. While traveling on a plane, make sure that it is in the seat pocket or under the seat so that you can access it even when you must keep your seat belt fastened.

When I am traveling by plane by myself, I always order a diabetic meal. The food is not always low carb, but usually a bit fresher and healthier than the other meal (though sometimes a bit more bland too!). The main reason that I order it is then the flight attendant also knows that I have diabetes. If there was an emergency, that could be helpful!

Most of my travels were while I was studying abroad. So I would make international trips at least once a year. I have also traveled a lot within Europe (by train, plane, or bus) while I have been studying there. The only inconvenience is always needing to carry more than enough supplies and food. By planning ahead, traveling with diabetes should be just like traveling without diabetes.

Diabetes was never really a problem during my travels. I love traveling and I am so thankful that diabetes never prevented me from exploring the world!

Crossing Time Zones

If you take insulin shots and will be crossing time zones, talk to your doctor or diabetes educator before your trip. Bring your flight schedule and information on time zone changes. Your doctor or educator can help you plan the timing of your injections while you travel. Kristin Makszin says:

You should change the time on your pump. For example, I usually do a 6-hour time change, and during the flight, I change it back/forward 2 hours, three times. If the time change is more than 2 hours, then don't do it all at once! This is particularly important if you have drastic differences in your basal levels throughout the day.

TiPS WHEN TRAVELING BETWEEN DiFFERENT TIME ZoNES

■ Remember, eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.

■ To keep track of shots and meals through changing time zones, keep your watch on your home time zone until the morning after you arrive.

■ If you inject insulin while in flight, frequent travelers suggest being careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to resist. This can make it hard to measure insulin accurately.

■ Check your blood glucose while traveling as you would when you're at home.

■ In addition, check your blood glucose level as soon as possible after landing. Jet lag can make it hard to tell if you have very low or very high blood glucose.

Lesley Hoffman Goldenberg says that when she travels within the United States, the time change doesn't usually affect her sugars:

I usually change my pump clock about 3 hours after I land in a new location and am starting to do activities that are different than what I would be doing at home. When I travel internationally, I usually do the same thing actually. I just carefully monitor my blood sugars and try not to get the trip really going until I've been there at least a day.

Traveler's Insurance

Travel insurance is purchased to cover travel-related risks, including last-minute cancellations because of sickness, severe weather, or even terrorist attacks. Insurance also provides coverage for emergency/accident care, medical evacuations, travel delays and missed connections, lost/stolen baggage, and more. Travel medical insurance is purchased by travelers leaving their home country for a few days or up to a year and provides emergency medical treatment, medical evacuation coverage, and emergency assistance.

Travel medical policies are for travelers who are going overseas and need medical insurance. When you travel outside your home country, your health insurance from home might not cover you. If it does, the limits might be too low to cover the expenses, or it might not cover your medical evacuation costs. There are over 15 companies in the travel insurance business, and each one sells various plans. Some companies specialize in simple, easy-to-use policies for the everyday traveler. In general, the premium amount for a travel medical plan is based on the length of the trip, the age of the traveler, and the amount of coverage.

Kristin Makszin says that most travel health insurances don't cover diabetes, because it is considered a preexisting condition. She says, "Many insurance plans can be used outside of the United States for a certain number of days (mine used to be 90), but for longer than that, it might be difficult to find insurance coverage for diabetes."

Whenever Linda Frick travels outside of the United States, she always purchases travel insurance that includes medical and medical evacuation in the event that she needs to be transported back home:

Thankfully, I have never had to use this insurance. I also always travel with a family member or friend who knows my health needs and can respond appropriately. Several years ago, I was in Hong Kong with my father, and we were sightseeing with a group of travelers who seemed to have very long legs and speed-walked/ran everywhere. Now, I'm only 5 feet 3 inches with short little legs, so you can imagine how hard it was for me to keep up with them. Not knowing how much exercise I would be getting can be difficult, and sometimes, I have to do things by trial and error. Well, we walked so fast and so long that I had an abrupt hypoglycemic episode and my legs collapsed. Also, since I've been diabetic for so long (going on 50 years now) I have hypoglycemia unawareness and can't always tell when I'm going low. I grasped and hung on to the closest thing to me (which happened to be a light pole) and waited for my group (including my father) to realize that I was down. Of course, they immediately came to my rescue once they looked back and wondered what had happened to me and fed me candy. I did have candy on me but because the incident happened so quickly, I did not have time to respond. Of note, no one in the large city metropolis came to my rescue other than those that knew me. I could clearly see that many thought I was intoxicated. I do wear a medic alert bracelet at all times.

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