Going on Holiday

Plan your Holiday

Having diabetes should not affect you being able to travel, but just takes a little more planning to make sure everything is in place so you enjoy your holiday.

Before going away take time to plan your holiday. Work out how much travelling is involved, the type of accommodation (urban or remote). If you are going abroad you need to consider the potential impact of the difference climate and food can have on your diabetes. Access to medical supplies services may not always be available. Do not take it for granted that you can get a fresh supply of insulin if you run out!

We will look at what needs to be planned in advance, what needs to be taken in the hand luggage and a few general considerations.

What needs to be considered before a holiday:-

• Vaccinations – check whether any vaccinations are needed prior to the holiday. Speak to your GP or practice nurse. It may be advisable to have these in advance because they could upset your diabetes control in the short term.
• Medication – ensure that you have enough medication ordered for the whole trip, take double what you would normally need, in case of delays in returning home. Also ensure you have sufficient supplies of blood glucose monitoring equipment and a spare. If someone is planning to go away for a long time, then they must consider finding out how to get more supplies of their medication whilst they are away. The NHS is not obliged to give more than three month’s supply of medication.
• Identification – People that are treated with insulin should carry identification and a letter confirming they have diabetes and the medication and equipment they will be carrying. This can be requested from the GP in advance.
• EHIC – Order the European Health Insurance Card (EHIC), which was previously known as E111. This card is free, it can be applied for online via ehic.org.uk or by telephone on 0845 606 2030. This allows the person to get healthcare at a reduced cost or sometimes free within all European Economic Area countries. This does not replace travel insurance
• Travel insurance – Ensure your travel insurance is adequate and check it covers any diabetes related problems, this is especially the case if the policy was taken out before the diagnosis of diabetes was made.
• Diabetes UK – Establish the contact number for Diabetes UK, they have a list of contact numbers for the diabetes association of the country being visited. A useful source of advice.
• Time zones – Calculate the difference in time zones and make a plan for adapting your insulin regime during your flight and change in schedule once you reach your destination. If you are not sure how to adjust your insulin or tablets, please contact your diabetes specialist nurse for advice or visit voyagemd.com

 Packing for holiday

There are several items that need to be taken in the hand luggage to prevent them becoming lost or damaged. It is a good idea to split your items between your own hand luggage and your travelling companion if you have one.                                                                           The items recommended for hand luggage are:-

• Insulin and needles – because insulin will freeze in the hold of the plane
• A container, pouch or bag that is able to keep your insulin cool
• Monitoring equipment
• Sharps container
• Ketone testing strips (if you use these)
• Copy of the ‘Sick day rules’ advice for if you become ill
• Hypo treatments – short acting carbohydrates
• Snacks – in case of delay and for follow up treatment of a hypo
• Identification
• Letter confirming diagnosis and equipment being carried

Travel and Health Insurance

It is a good idea to sort out your travel and health insurance to cover your stay. Make sure your travel agent or provider of travel insurance is aware you have diabetes. Diabetes UK offers travel insurance though it is a good idea to shop around for the best quote. If you have been diagnosed after you took out your travel insurance check that you are covered prior to leaving.

Your Insulin

Take more insulin than you would normally need. If you are travelling with someone else it’s a good idea to put half your supply in the other person’s baggage just in case yours goes astray!

If you use an insulin mixture, consider taking a small supply of soluble or ‘clear’ insulin which you can use if you are ill, you will need to speak to your doctor or nurse about this.

If you are travelling to a tropical climate take a cool bag such as a Frio bag www.friouk.com or vacuum flask to keep you insulin cool. While on the plane always keep your insulin in your hand luggage to avoid the solution freezing in the hold, if this happens it will not be reliable and should not be used.

Make sure you have an extra supply of pens and syringes in case you lose a pen or the device malfunctions.  Carry a letter or document which states that you have diabetes. You may find it difficult to explain why you are carrying a suitcase full of syringes and needles!

Airlines are not likely to agree to place insulin in a refrigerator. They will however provide you with enough ice to keep your insulin cool during a long flight.

If travelling for longer than one month and on insulin therapy we would suggest you speak to your doctor, nurse or pharmacist for advice as insulin is only safe out of the fridge for one month and must be discarded after this time.

Dealing with Time Zone Changes

Dealing with time zone changes is complex and best discussed with your doctor or diabetes nurse specialist. The following general tips are useful if there is a time zone difference of four hours or more in between home and your destination.

• A long haul flight to the WEST ‘lengthens’ your day (or night) so you need to make up the insulin deficit. The easiest approach is to give your usual dose followed by an extra dose of soluble (short acting) insulin according to your blood tests.
• If you are on a long flight heading EAST, your day (or night) is shortened. Take half your usual dose of insulin before the flight and use your soluble insulin to cover any deficit.

A website that will help with your insulin calculation is www.voyagemd.com

While on Holiday

Many people are more active when on holiday and meal times are often erratic as you may be travelling. You are therefore likely to be at risk of hypos! Stay aware of your hypo symptoms and make sure your travel companions can recognise the symptoms of hypoglycaemia.

Caring for your feet on holiday

Take care of your feet. Many ulcers start off as blisters on holiday. Wear footwear at all times and never walk barefoot on the beach, because hot sand can cause damage. Your feet can sometimes swell on holiday due to the heat, making normally comfortable footwear tight and more likely to rub, also check shoes for sand because this can rub and cause blisters. If you are swimming in the sea watch out for sharp shells, sea urchins and other sharp objects which are scattered on the ocean floor! Continue to check your feet daily and care for them as you would at home.

Vomiting and Diarrhoea

Traveller’s diarrhoea is unfortunately a very common cause of a ruined holiday. Watch what you eat – take sensible precautions and always drink boiled, cooled water or bottled water. If you do develop vomiting or diarrhoea do not miss your insulin doses (see ‘sick day rules’), keep up you intake of fluids and seek medical attention early before dehydration sets in.

Holiday List

Draw up a list of all the things you need to take with you. A sample list is given below

• Plan your holiday. If travelling abroad it may not always be possible to get fresh supplies of medicines.
• Print this list off, and even if you forget your toothbrush don’t forget your insulin !
• Medications – insulin, syringes/pens, needles,
• Testing equipment – meter, test strips, lancets,
• For Hypos – glucose tablets, Lucozade, hypostop, glucagon
• Anti-sickness medication and anti-diarrhoea tablets
• Emulsifying cream and sunscreens
• Food – sugar free drinks, snack bars, biscuits
• Sweeteners if you need them
• Identification documents / bracelet (Medic-Alert) giving details of name, address and instructions for hypoglycaemia.
• Travel insurance documents.

For further information visit our films and podcasts:

www.nnuh.nhs.uk/videos/adultdiabetes

www.nnuh.nhs.uk/podcasts/adultdiabetes