Dr Aidin Rawshani

Traveling with diabetes

Contents

Traveling with diabetes is safe but requires planning

You who have diabetes can travel all over the world. This applies to both type 1 diabetes and type 2 diabetes. To make your trip as comfortable as possible, it is important to plan your trip. The longer the journey is, the more important it is that planning is done carefully. The detailed planning needs to be done depends on the type of diabetes you have, and how it is treated. If you have type 2 diabetes that is treated with tablets, planning is usually very simple. However, if you have treatment with insulin, you have to take several things into consideration. Below you can read about how to plan your trip.

Medical certificate proving that you have diabetes

The first item on the list is to ensure that you have a certificate proving that you have diabetes. When you are in Sweden, you can always provide your social security number when you contact a healthcare provider or pharmacy, and they can immediately see which medicines you are using. This is not possible abroad and therefore it is important that you have a certificate proving that you have diabetes. The Swedish Diabetes Association certificate can be used. Ask your doctor to issue the certificate for you. Here you download the Swedish Diabetes Association’s certificate.

Tell me you have diabetes

If you are going on vacation or staying in the company of others you do not know, it may be useful to tell you that you have diabetes (for example, to the tour manager or another responsible person). If bad luck occurs, it will be easier for other people to help you if they know you have diabetes. Many people with diabetes do not dare (for various reasons) to tell others about their illness. This is, of course, very boring and can thus become a problem in the event of (for example) a fall in blood sugar (hypoglycemia). So you may find yourself in a situation where you need help and the opportunity to help you increases if other people know you have diabetes.

Your medicines (tablets, insulin)

Always bring more medicines than you usually consume during the same period. Do not store all medicines in the same bag, as you will be without medicines if that bag gets away.

It is beneficial to take your prescriptions abroad because the prescriptions can be used as evidence that you are using a specific medicine. Do not forget that the medical certificate (see above) may include information about what medicines you are using.

For those who use insulin

If you are using insulin, make sure that there is insulin where you will be staying. There are no guarantees that the insulin you are using is there. Subsequently, the same type of insulin may have different product names in different countries.

If you lose your insulin, or if it is stolen, your insurance company can reimburse the costs of new insulin. However, if you acted without caution, the insurance company may refuse to reimburse you the costs of new insulin. If the insulin is destroyed by cold or heat, you must have an all-risk insurance to receive compensation. Please contact your insurance company before departure to find out exactly what applies.

If you are using insulin, it is important to make sure that you can get your hands on insulin at your destination. Contact your manufacturer to ask if there is insulin available for sale at your destination.

Traveling by insulin pump or continuous glucose meter (CGM)

If you have an insulin pump or a continuous glucose meter (CGM), you should inform the airline before. In Sweden, airlines are used to insulin pumps and CGM, which is because type 1 diabetes is relatively common in Sweden. However, in other countries these technical devices are rare and therefore the medical certificate should include information that you have an insulin pump and/or CGM. Some airlines require that they be informed of all the medical equipment they intend to carry on the plane. You may be denied to board the plane unless you can confirm why you have an insulin pump.

Some airlines require that all wireless equipment be switched off during flight, which means that some insulin pumps and CGM must be switched off during the journey. Then you need to have extra insulin pens and glucose meters with you.

The unexpected can happen when you’re abroad. Therefore, it is advisable to bring extra insulin pens if you have an insulin pump. For example, the insulin pump may break during the trip and at most destinations, there is no possibility to get a new pump, which is why it is important to include additional insulin.

Some insulin pumps do not, according to the manufacturer, manage to be exposed to X-ray radiation. Manufacturers may then advise against passing safety checks where X-ray radiation is used. You should ask your healthcare provider if your insulin pump passes such safety checks.

General provisions on medicinal products

Always contact the country’s embassy to ask if there are special rules for the introduction of medicines and aids. Keep in mind that most countries do not allow the introduction of more medicines than is consumed for 12 months. In order to collect medicines for more than 3 months of use, Swedish pharmacies need to see a medical certificate confirming your stay abroad. Otherwise, they may refuse you to give you the medicines within the pharmaceutical benefit. In some countries, you can collect medicines with Swedish prescriptions, but it must be an original prescription. If you use drug-controlled drugs, it is allowed to take with them medicines for no more than 30 days of consumption. In addition, certificates for medicinal products which are controlled must be provided.

Insurance for travel: healthcare and medicines abroad

If you are traveling within the European Union (EU) or EEA, you should apply for the European Health Insurance Card (European Health Insurance Card) which allows you to get quick access to healthcare in all EU countries. The card costs nothing and you must carry it throughout the journey. With the EHIC card, you will have access to healthcare in your country for the same fee as other citizens of the country. Click here to order EU Card (EHIC). The card is also valid in Switzerland.

The right to care in other countries is primarily about emergency or necessary care, which means care that cannot wait until you return home to Sweden. For such treatment, you pay the same fee as citizens of the country you are in.

Outside the EU

Outside the EU and Switzerland, the European Health Insurance Card does not apply. For those traveling to countries outside the EU and Switzerland, it is therefore important that you have a private insurance policy because you have to pay the full fee yourself. Find out what is included in your home insurance and if you need additional travel insurance. Your insurance company should help you with these questions

In general, home insurance travel security covers the first 45 days (accident, acute illness and acute deterioration of existing illness). If you are expecting more than 45 days, you should extend your home insurance travel security or take out separate insurance. Always check what is included in your home insurance.

If you are going to fly

You should always carry your medicines in your hand luggage. This way you always have access to your medicines and you do not risk it being destroyed, lost or contaminated. Keep in mind that insulin does not cope with the cold in the cargo compartment of an airplane (the insulin is destroyed and works worse or not at all). You must also carry blood glucose meters in your hand luggage. If you have technical equipment powered by batteries, additional batteries must be carried, especially if the journey is long.

Keep in mind that blood glucose meters in other countries may use other blood sugar units. In Sweden, we use mmol/L, but in many other countries, we use mg/dL. You can use our tool to convert blood sugar between different units.

Security checks

You may become suspected of drug smuggling if you bring tablets, needles or syringes. To avoid this, you should do the following:

  • Medicinal products which are in liquid form must be presented to the security check. This means that insulin must be shown up.
  • You may bring all the medicines you need during the trip. Remember to bring extra medicines to safety.
  • To travel with needles or syringes you need a medical certificate (see above).
  • You may carry a cooling container for insulin.
  • You may be subjected to a random sample of medicine or food. This means that a security guard at the airport can ask you to taste the liquid or put some liquid on your hand.
  • You should be able to certify all medicines and aids (e.g. insulin pump) when you pass the security check. Your medical certificate must contain information about this. You can also bring your prescriptions or original packaging.
  • Never leave your equipment and medicines without your supervision.

Read more: What is allowed to carry on airplanes?

Food during the trip and at the destination

For longer flights, it is important to know when and how many meals are served. Nowadays, airlines serve small meals, which are rich in carbohydrates. In the case of shorter trips, food may not be available. Should you need carbohydrates, and have not brought any yourself, you can always ask the staff.

You have the right to bring small snacks and drinks up to 100 ml on board the plane. If you have type 1 diabetes, you can, of course, bring glucose tablets or other things that you usually use in case of hypoglycemia (blood sugar fall). Keep in mind that delays are common when traveling and therefore you should include extra carbohydrates for such situations.

You will and can enjoy all the food during your holiday. Most likely, you have already received training in the food’s nutrients (carbohydrates, fats and protein) and then you can determine approximately how much carbohydrates are in the food. You do not have to feel guilty (for both type 1 diabetes or type 2 diabetes) if you treat yourself to extra carbs. Instead, make sure to adjust insulin doses according to the carbohydrate content of the food.

Don’t forget that you can download our Carbohydrate check and have it on your mobile.

For you with gluten intolerance (celiaki)

Many individuals with type 1 diabetes also have celiac disease (gluten intolerance). You cannot expect gluten-free alternatives abroad because celiac disease is rare in most countries. Instead, make sure to bring gluten-free options with you.

If you travel to warmer latitudes

In hot climate, it is important to drink plenty of water and to protect yourself from the sun. UV protection is important for everyone, regardless of whether you have diabetes or not.

People who have had diabetes for many years may have neuropathy (nerve damage) that makes them not feel if they burn themselves in the sun. It is important to keep an extra eye on your feet if you have neuropathy and are in warmer latitudes. Walking on the beach is of course wonderful, but if you are unlucky, you can cut yourself on sharp objects and foot wounds heal badly if you have neuropathy. Therefore, be sure to wear proper slippers if there is a risk of getting hard-to-heal wounds on your feet.

When the skin is warm, insulin is absorbed faster, increasing the risk of hypoglycemia, but this is usually not a big concern. However, it may be useful to control your blood sugar a little more often during the first hours and days when you come to a new climate.

Keep in mind that insulin does not last as long at high temperatures.

If you travel to colder latitudes

Insulin is absorbed more slowly if the skin is cold. Keep in mind that insulin must not be stored in too cold temperatures. Contact your doctor/nurse to ask how cold your insulin can be stored.

Keep in mind that if you have neuropathy (nerve damage) in your feet, and hence less sensitivity, you can not always detect when your feet are too cold.

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