Diabetic Travel Advice
For Special Circumstances
This is a long page, so I have put in text links to allow you easy access to the different sections.
Hot climates is directly under this and the others may be accessed here:-
Cold Climates.
High Altitude.
Visiting Under-developed Countries.
Tourist Beware.
Hot climates
Give yourself time to get used to tropical temperatures. Don’t partake of any strenuous activity the moment you arrive, acclimatise first.
Very warm climates can cause your insulin to be absorbed much more quickly from the injection site, increasing the risk of hypoglycaemia. Check your blood glucose more often and adjust your diet or insulin dosage.
However if you do not drink enough fluids in a warm climate you will get dehydrated and this causes insulin to be absorbed more slowly.
You need to drink plenty of sugar free fluids. Alcohol and caffeine are okay but in moderation, plain bottled water is, needless to say, best of all.
Note the number of time you need to go to the toilet – going a lot less than usual means you are becoming dehydrated and need to drink more, even if you think you are not thirsty.
Remember high temperatures can affect your blood glucose meter, test strips and insulin. Most meters work best within the temperature range of 15-35C. Likewise some test strips tend to give false highs in hot weather.
It is recommended that you take a vial of control check glucose solution with you so you can check that the meter is reading accurately. These solutions have a short shelf life once opened, around 3 months, so don’t try to save money by using an old one or keep an opened one for next year’s holiday.
Keep your meter and test strips in a cool dark place, as close to normal room temperature as possible and out of direct sunlight. Don’t be tempted to refrigerate them as cold temperatures can also give inaccurate results.
Your insulin is best kept in the fridge.
If possible request a room with an air conditioner and a fridge. If this is not possible then find the coolest, darkest place, wet a facecloth and cover your insulin with it – the evaporation will help keep it cool.
Also if there is no fridge available but you can persuade your hotel manager to give you some ice blocks then putting your insulin in a plastic bag and placing the bag in a container of cold water with a few ice cubes will work for a time.
If you have neuropathy and thus reduced sensation in your feet and legs, beware of sunburn in these areas. Use a high factor sun cream. In fact diabetics should always use such a sun cream so as to reduce the risk of bad sunburn. As we tend to heal more slowly we are at risk of secondary infections in damaged skin, especially in foreign countries where we have little immunity against the local ‘bugs’.
Remember that some medications can cause photosensitivity, amongst which are the Sulfonylureas.
Paying attention to the clothes you wear can help keep you cooler. Cotton clothes are better than synthetics as they ‘breathe’. Light colours do not absorb as much heat as dark colours.
When walking around out in the sun wear loose clothing that will protect you. There is a reason the desert nomads are dressed in flowing robes, not skimpy halter tops and shorts!
Do not just assume that because it is a hot climate that all you need is light, cool clothes. Some countries that are very hot during the day can become extremely cold at night.
Do not tramp around barefoot, especially if you have diminished feeling in your feet. It is quite possible to get burns from hot roads, pavements or beach sand in very hot climates. I have actually seen someone fry an egg on the sidewalk outside their shop in Zambia.
You can get shoes that are especially made for wearing on the beach and even into the sea from sporting goods store and sometimes from the myriad of shops down near the beachfront.
Remember feet tend to swell in hot climate. Make sure you take along comfortable, well fitting shoes – don’t go for the ‘new for the holiday’ type, the ‘old friend’ variety is best.
Hot weather can also be responsible for causing any latent athlete’s foot to flare up, so if you have had a problem with that in the past remember to take along a suitable remedy ‘just in case’.
Beware of the sun - although a ‘warm shade of golden brown’ may sound attractive ‘bright lobster pink’ doesn’t and is usually accompanied by blisters. Remember we diabetics are more prone to skin infections than healthy folk and weeping blisters can up the anti.
My advice, and remember I come from a hot climate, is to stay out of the midday sun, keep to the shady areas wherever possible and remember the clothing advice given above.
Always use a sunscreen of Factor 15+ or above and reapply it every 2 hours. If you are swimming or sweat a lot use a water resistant one.
If you are very fair skinned go for a higher factor. Children should definitely use a higher factor, possibly as high as 40+.
Don’t forget a sunhat and not just one with a visor that keeps the sun out of your eyes. You need one that covers the top of your head. Sunstroke can also be got from sun beating down on the top of your head.
If you do get sunburnt applying calamine lotion will help to soothe it and a painkiller like Paracetamol will ease the pain.
If it is really bad you are going to need a doctor. He may prescribe steroid creams and antibiotics. Don’t forget to tell him you are diabetic.
Prickly heat is a common but not a serious rash unless you let it get infected. It manifests as areas of red inflamed skin covered in millions of tiny blisters.
Treatment is to keep your temperature down by taking cool showers and dry yourself by patting the skin – do NOT rub it or you will take the top of the blisters and leave yourself wide open to infection. Apply calamine lotion.
Sunglasses are a good idea as UV light can damage the back of the eye, but you need good ones that filter out the UV. These are especially important if you already have retinopathy.
In underdeveloped countries always use bottled water and make sure the bottle seal is intact before you open it. If bottled water is unavailable then either boil your water before using it or use water purifying tablets. Remember to use purified water when cleaning your teeth.
Beware ice cubes as they are possibly made from unpurified water.
Crockery and cutlery should also be washed with sterilised water.
The UK diabetic association tells us fizzy drinks, tea and coffee, beer and wine and fresh coconut milk are safe to drink. Sugar-free drinks are not available in all countries so it is worth taking some along with you.
Be careful what foods you eat, especially in undeveloped countries. Some general rules are:-
1. However tempting, do not buy foods from roadside vendors.
2. Carefully wash (in purified water) and peel any fruit.
3. Try and avoid buffets as food goes off quickly in hot climates and you have no idea how long it has been sitting there. Also the salads may have been washed in water that is not properly purified.
4. Eat well cooked foods, no raw or undercooked ones.
5. Make sure any dairy produce you eat or drink has been pasteurised. If you are uncertain avoid them.
6. Avoid shellfish.
Special info for pump users in hot climates
If you are a pump user and intend to do various water based activities while on holiday in a hot climate (and which of us doesn’t?) think about getting a special water proof /protective box to put your pump in so it will not get damaged. For certain pumps these are available at the following online stores:-
Hocks.com on line pharmacy
Minimed.com.au
If you are planning to spend your time on the beach, alternatively swimming and sunbathing, then wearing your pump all the time can be a nuisance. Some people choose to give themselves their morning bolus and then remove the pump until lunchtime, when they reconnect it and give themselves their lunchtime bolus, remove it again and then reconnect it for the night. This may require some adjustment in doses and you will need to monitor your blood glucose very closely to make sure you have your insulin amounts right.
Remember to follow the same rules as you would for any insulin –keep your pump, including the tubing, out of direct sunlight. If you cannot keep it in the shade cover it with a thick towel. It is possible to wrap it in a Frio wallet to help keep it cool.
Tapes that hold the cannula in place may not stick so well on hot, sweaty bodies. You may need to use extra tape or a different kind of dressing.
Cold climates
The problems you will encounter here are more physical than nutritional.
If you are cold getting blood from your finger for a test can be more difficult. It may be necessary to warm your hands first, either by keeping them that way with gloves or, if available, with warm water.
Your insulin needs to be protected from freezing.
Your meter and test strips are also susceptible to the cold so must be kept warm. Strips can give false lows in cold weather.
Remember that even if it is cold it can be sunny and very bright at the same time. Direct light is detrimental to both insulin and test strips.
Because it is cold the blood flow through your skin may be reduced, which will result in your insulin being absorbed much more slowly. However, if you then warm up, either due to returning to a warm place or to exercise, the insulin could suddenly be absorbed. This can really affect your control. It would be wise to monitor your Bg’s more often so you know what is happening.
The very act of shivering can cause a drop in blood sugars and unless you can get warm and stop shaking a hypo can be much harder to control. Expect to take longer than normal to respond to hypo treatment.
Frost bite is always a problem in extreme cold but for a diabetic with poor peripheral circulation or neuropathy that causes loss of sensation this can be a really dangerous as they may be unaware that any problem is occurring.
So what can they do?:-
1. They should go inside frequently so as to get warm.
2. They can wear shoes or boots that are manufactured in such a way that they protect the feet from conditions such as cold and moisture.
3. They can wear socks that are insulated and made from materials that keep moisture away from the feet but also supply warmth. There are any number of such socks to be found on websites and in stores selling goods for our mountaineering friends. They may be pricey but they are worth every penny.
Most of us who go to cold climates partake in some form of winter sport. We need to make sure that the skates or ski boots fit properly. If you have neuropathy it is better to buy your own ski boots in advance than hire them as it is not easy for you to notice if they are too tight. This will give you a chance to plod around the house in them and break them in. Skates, needless to say, are a tad more difficult!
Do remember if you do buy your own boots to try them on with the socks that you will be wearing when you are using them.
Every evening carefully check your feet for any signs of pressure or rubbing.
High altitude
If you are planning a holiday at a high altitude then there are certain factors you need to be aware of.
Hypothermia (very low temperature) can easily be mistaken for hypoglycaemia and vice versa. Testing your Bg’s will tell which you have.
Your metre itself can be a problem. Not all meters work well at high altitude, especially if they work on a glucose oxidase reaction. They tend to read low.
Below 1500 metres this is not much of a problem but above that the readings can be significantly affected.
Temperature can be an issue as most meters work best in the range of 10-40deg C. High altitudes are often much colder than this.
Check with your manufacturer to see if your meter is suitable for the conditions you are going to and if not you may need to buy a new one.
If you chose to use reagent sticks that require visual comparisons you need to take into account that light is ‘more blue’ at higher altitudes.
The dry air and thus lack of humidity of high altitudes may cause any blood sample you take to dry very rapidly, as can wind. Blood can also be thicker at high altitude due to dehydration . If you are testing outside in the weather make sure you and your test equipment is warm, try to shield yourself from the wind and use a large drop of blood to stop it drying to fast.
Headache and fatigue, which we may put down to a problem with our diabetes, can actually be symptoms of altitude sickness. One either has to return to a lower altitude or take some form of medication such as acetazolamide (Diamox).
From around 16,000 feet and above, retinal haemorrhages can occur. If you already suffer from diabetic retinopathy you need to be concerned about this.
Visiting under-developed countries
Use your head – however much you might want to travel to these areas, if you have diabetes that is not under total control then do NOT go alone. You need a travelling companion who knows you well, knows what you look like when things are going wrong and knows what to do in any such situation.
Many of these countries lack the medical care available in first world countries. You need to plan carefully in advance, taking with you a selection of medications that you might need, so as to avoid, as much as possible, relying on local supplies.
If you do fall ill and require medical care, especially outside the large cities, there are certain precautions you should take:-
If you need to see a local doctor try and take an interpreter who speaks the local language with you to avoid confusion.
Avoid an injection if possible, try and get an oral medication for the problem and then remember to take it with bottled water from a sealed bottle.
If an injection is the only option then insist they use a syringe from your personal sterile supplies – (see A comprehensive emergency first-aid kit for diabetics).
Money is tight in many of these countries and syringes can be used over and over again on more than one patient.
If at all possible avoid any form of surgical intervention. One cannot guarantee the sterility of the equipment or the hygienic nature of the post-op care. Try as they might the medical staff may be fighting a loosing battle against lack of funds and basic ignorance.
Unless it is immediately life threatening try and get the next flight out to you home country. This should, if you have done your homework, be covered by your medical insurance.
Another thing to avoid is blood transfusions. Again you have the questionable sterility of the equipment but there is the added fact that if the countries screening processes are not up to scratch then there is the very real possibility of contacting diseases such as HIV/AIDS or Hepatitis B or C from contaminated blood.
For the same reasons as those above you need to avoid any dental treatment as they also leave you open to blood infections.
Take toilet paper with you, even if visiting cities or towns. There are some countries that do not use it!
If you are intending to have, to put it politely, a more intimate acquaintance with some of the locals then be sure to take along supplies of condoms from your own country. The standards and sizes of these differ from country to country and you need to be very sure of what you are using.
In South Africa at one time the free condoms handed out to sex workers were great except for one fact – some bright individual had chosen to attach them to the packaging – by stapling them!!!
As disease such as HIV/Aids are rife in many under-developed countries you need to be aware of the risks you are taking.
Tourist Beware
Though the next points do not pertain directly to your diabetes they need to be said.
This is not scare mongering, it is just common sense:-
Beware of the unknown – ask your local hotel manager or tour guide if there are areas which you should avoid but use your own intelligence as well. Remember that they make their money from tourists and do not want to put you off by telling you that a place is not safe. This may seem short sighted but it happens!
As a general rule never wander around alone and stay away from quiet areas where there are few people. Those narrow alleyways which may seem like great shortcuts but you never know where you could end up! Stick to crowded places. You may get your pocket picked or your mobile stolen but at least you will be safe physically.
If you feel you must go out at night then stay in well lit, well populated areas. A stroll along the beach in a first world country may be romantic but in certain third world countries it is taking your either your virtue or your life in your hands!
If you are walking around clutching a map and looking puzzled you may get offers of help - don’t trust strangers, especially those offering you help. They may not be as honest and helpful as they appear. The trusting and ignorant tourists are ready targets.
Don’t encourage crime. Remember the people of under-developed countries are often extremely poor and what is everyday stuff to you may be great riches to them. So forget the conspicuous designer clothing, leave your jewellery locked in the hotel safe and keep your mobile phone well out of sight.
Carry just enough money for what you intend to do that day. This limits what you will loose if it gets stolen. If you pay for something do not advertise the amount of cash you have. Pulling great wads of cash out of your pocket may look impressive and make you feel important but it can definitely attract the wrong kind of attention!
Using a credit card for payment is a good idea if it is covered by insurance.
Carry your wallet in an inside pocket or a ‘fanny pack/bum bag’ under your clothing and if possible leave any spare cards locked in the hotel safe, along with a list of the phone numbers of your the credit card and travellers cheque company. in case you have to contact them to cancel a card that has been lost or stolen.
Another thing to leave in that hotel safe is your passport. You should make a couple of copies of the identification page, one which you leave at home with a relative and another that you can use if you need to satisfy local law. Getting the real one stolen can really spoil a holiday, unless you crave spending your time at your local embassy or consulate. Having a copy of the identification page can speed up the process of getting a new one.
When you want to exchange money or cash travellers cheques only deal with authorised agents. Never trust a local who says he can get you a ‘better deal’.
This applies to buying stuff as well. Do not try to be greedy and end up being caught for a sucker. Deals that appear to be ‘to good to be true’ usually are!
The word ‘special’ means ‘something that is different to the usual’ and believe you me the special deals you can get in third world countries are just that!
And the folk selling them to you can be really plausible. They won’t look like down at heel bums – after all who would listen to them if they did? They can be very well dressed, well spoken confidence tricksters who are experts at ripping people off.
There have been a number of stories in South Africa of tourists who have been approached in bars by someone offering to sell them diamonds or emeralds at special prices. The victims thought they were being canny when they insisted that the jewels be assayed by a jeweller but somewhere between that assay and their actually owning the goods the stones had been swapped and they were left with what turned out to be very expensive fakes and with no leg to stand on because the transaction was illegal.
Don’t ever accept a drink from a stranger in a strange bar or such like surrounding unless it comes in a sealed bottle that you open yourself. You never know what it could be laced with and you do not want to wake up in an alley sans possessions or even clothing.
Do not travel in a taxi that has not been specifically ordered for you by a trusted local such as the hotel manager and never use the very crowded public taxis or buses.
If you have hired a car travel by day if possible and stay on well marked roads. Curb any desire to wander of onto beaten tracks so as to ‘get the feel’ of an area. You may get more than you bargained for! And NEVER travel rural roads by night.
Remember that roads may not be as well maintained as they are in your home country and likewise the cars. Drivers may also have less regard for the rules of the road and many may have ‘side-stepped’ such minor issues as training and licenses. This puts you at a greater risk of an accident with all it’s danger and inconvenience.
In some countries drug trafficking or using results in really severe penalties, from life imprisonment to death. For this reason it is even more important to have an official written explanation for any syringes you carry. Make sure you have more than one copy of this documentation and store them in different places, such as in the hotel safe and with a companion.
Spending even a few hours in a prison in third world countries is nothing to be casual about.
If you can, try and learn how to say a few important sentences in the local language, in case you need to explain yourself. Things like “I am a diabetic” and “I inject insulin” may help. If you are ‘linguistically challenged’ then carry a piece of paper with these sentences written on, that you can wave under the nose of any authority figure.
If you do get into trouble in a foreign country you need to be able to contact your embassy or consulate office. Make sure you get their address and phone number before leaving home and keep copies with your other documents.