Travel and type 1 diabetes booklet

Travel insurance is highly recommended for all people but especially for people living with type 1 diabetes. It’s best to read the terms and conditions before booking travel insurance to make sure the accident and health cover applies to each of the following:

• pre-existing condition (e.g. type 1 diabetes)
• the places you will visit
• the activities you may undertake (e.g. bungy jumping, skiing).

Some companies charge an extra fee for a person with type 1 diabetes and loss of insulin/diabetes supplies are treated differently by various insurers, so it’s best to check this out when booking insurance.

If you plan on travelling internationally, check the regional information about the rules and regulations as well as the safety of your destination dfat.gov.au/geo and be sure to register with Smart Traveller in the event of an emergency smartraveller.gov.au.

The Australian Government has arrangements with a range of countries providing travellers with benefits similar to Medicare if needed, but only for acute or emergency care. In this event, you would need to produce your Medicare card. For more information, call Medicare Australia on 13 20 11 or visit their website servicesaustralia.gov.au.

Speak to your general practitioner or a doctor at a specialist travel clinic to work out what specific vaccines (e.g. Hepatitis A) or special medicine (e.g. against Malaria) you will need. This will vary according to the countries you plan to visit. Allow at least 3 months prior to your travel date as sometimes a series of injections is required.

Make sure you see your diabetes doctor or educator four to six weeks before you travel.

Ask your doctor for a typed letter proving your medical condition. The letter should state your full name, address, date of birth and that you have type 1 diabetes. The letter should also list the medications, insulin delivery devices (syringes, insulin pens or pumps) that you use, blood glucose measurement equipment you use, and should state that you must be allowed to carry these items with you at all times. If you are currently on an insulin pump, make sure to outline that at no time is your insulin pump to be removed from your body. You should also ask your doctor to state that you need to carry sharps such as insulin needles and lancets for fingerprick measurement on board a plane. Make several copies of this letter before you travel.

Get extra prescriptions for any of your current medications, including glucagon. Ask your doctor for prescriptions to purchase all necessary medications you will need while you are away as it can be hard to access the required medication in some countries. If you are on a pump make sure that you carry back up pens.

Develop an action plan for managing your diabetes and insulin dosages during the flight. If the journey involves a long flight and/or travelling to a different time zone, you may need to adjust your insulin schedule.

Discuss meals and foods available in the region you’re travelling to.

Develop an emergency plan if diabetes complications occur while travelling. This includes a list of all emergency contacts including your doctor, diabetes nurse educator, general practitioner and family members.

Give a copy of ALL your documentation to someone at home. This way if you need extra copies while travelling they can be emailed or faxed to you. If you are taking an iPad with you, make sure to keep a copy of all documents on it as well.

Print off a list of hospitals or contact the embassy in the area you’re travelling to so that you can find out about the health system there.

Have all syringes and insulin supplies clearly marked with the pharmaceutical pre-printed label. It is recommended that people with type 1 diabetes travel with their original pharmacy labelled packaging. All prescription medications need to be carried by the person they are prescribed for. Your insulin will not be damaged if x-rayed when you pass through security checkpoints.

Carry all of your diabetes supplies in your carry-on luggage. This is not only to prevent loss from bags being misplaced, but also because luggage stored in cargo holds can be subjected to extreme temperature changes which may inactivate your insulin.

While on an insulin pump

Notify security screeners that you have diabetes, that you are wearing an insulin pump and are carrying supplies with you.

You can continue to wear your insulin pump or continuous glucose monitor (CGM) while going through airport security systems as it will not harm the device or trigger an alarm.

Don’t disconnect your pump from your body if requested by security. In Australia, a visual screening of the device can be undertaken but a screening officer must not ask the person to remove the device. If required, show your medical letter proving you are a person living with diabetes and that your pump must remain connected at all times.

If travelling internationally, your insulin pump may be swabbed for explosives while still attached to your body.

Keep your insulin supplies and hypo/emergency snacks close to you and not in the overhead compartment during the flight. This ensures that you have snacks on hand in the event of hypoglycaemia or delayed meals or snacks.

Leave your wrist watch or pump clock unadjusted during the flight so you can continue to judge the timing of injections and meals during the flight according to ‘Australian time’ (or the time zone of place you are leaving).

Avoid ordering the ‘diabetic friendly’ meal option as these are too often low in carbohydrates. It is best to order the standard meal option and hold off from injecting insulin until your meal is served and in front of you. You may need to carry your own artificial sweeteners if you use them.

Check your blood glucose levels often to make sure you are in target range.

Adjust your wristwatch or pump clock to the time of your destination. This may also require calculating when your next meal or injection may be. You can formulate a plan with your diabetes team using your flight itinerary.

Take care with food and drink choices, particularly in developing countries where food and hygiene may not be optimal and where the risk of gastroenteritis from contaminated food and drinks is more common.

Remember: Difference in activities, foods and routines may require adjustments to your insulin doses or pump settings.

If you are on a pump. On your return REMEMBER to reset your pump times to your home time zone.

With all of this planning it is unlikely that something will go wrong! However, if a problem arises, don’t panic. The first thing to realise is that medical assistance will be available.

Replacing lost supplies

Remember to keep insulin, delivery devices (pens/syringes) and testing equipment on your person at all times when you are in transit.

After you have passed through security, it is a good idea to split your diabetes supplies between your bags or give some to your travel partner if not travelling alone. If you happen to lose your luggage or diabetes supplies during transit, it is best to attend a major hospital’s emergency room which should be able to supply you with enough to get you through.

You may also wish to contact the diabetes organisation in the country in which you are travelling (if applicable) to explain how to obtain supplies in their country. You can find contact details for the local organisation in advance by visiting the International Diabetes Federation’s website idf.org.

Emergency assistance

In a worst case scenario where you are admitted to hospital, you should contact your emergency contacts outlined in your emergency plan, with advice from your travel insurer. Most costs can be recovered through health benefits or through your own medical insurance when you get home.