Tips to Trip By
The art and science of traveling with diabetes
Twice a month for 16 years, Paul Friedrich, 80, has commuted from Chicago to Virginia to visit family. In 2008, 26-year-old Leighton Rockafellow Jr. will have backpacked through more than two dozen countries. Both bring an extra companion on every trip: their diabetes.
For Friedrich, a semiretired University of Chicago anthropology professor, it's type 2, managed with pills and careful meal planning; for Rockafellow, it's type 1, managed with insulin. But whether you're backpacking through the Andes or hopping a single time zone, hitting the road with diabetes is kind of like traveling with a small child: In both cases, forethought pays off.
The week-by-week plan that follows will give you an idea of how the pros do it. Feel free to tailor it to your own situation—and let it inspire you to pursue your own adventures, too.
7 Weeks Before Departure: Visit Your Diabetes Team
Notify your doctor's office early, especially if you're traveling abroad. "We don't know you're traveling unless you tell us," says James Chamberlain, MD, a diabetes specialist at the Utah Diabetes Center in Salt Lake City. "It makes it tough for us if you come in and say, 'I'm leaving next week for Brazil for a month.' " For international travel, be sure to get doctors' notes (especially if you use syringes) for officials who want to know you aren't smuggling drugs or carrying contraband. You'll want to give the doctor's office plenty of time to produce these letters. No matter where you're going, you should bring the original pharmacy labels for all the meds you'll have on hand, plus a list of your medications (and their generic names, if you'll be abroad). Make sure you have your doctor's on-call or emergency number. Ask how time zone changes may affect your regimen, particularly if you're on insulin. And it's wise to get copies of prescriptions in case you need a refill on the road. If you run out of your meds in the United States and happen to use one of the national pharmacy chains, any local branch should be able to access your prescription electronically—and even advance you a few pills if you've forgotten them. If you use an insulin pump, you may want to pack both short- and long-acting insulins to use in case your pump fails and you don't have a backup. Talk to your doctor about what to do in case of pump failure. You should also write down the pump's settings before you leave, says Davida F. Kruger, MSN, APRN-BC-ADM, a nurse practitioner and author of The Diabetes Travel Guide (American Diabetes Association, 2006). "You'd be surprised how many calls I get from people … [who] don't know their settings." And don't forget to talk to your nutritionist, advises Robyn Webb, MS, LN. "If you're going to, say, Italy, and you know that even a small bit of pasta doesn't work for you, you'll know in advance that you'll need to order protein and a vegetable at most meals. That's doable."
6 Weeks Before: Check Yourself
Consider how well you manage your diabetes at home, suggests diabetes educator and frequent traveler Karen Poenisch, RD, CD, CDE, who has type 1. What do you need to adjust now so that managing your diabetes on the road will be simpler? For instance, you may want to refine your carb counting and make sure you're on track with blood glucose testing and taking your meds at the right times, says Poenisch. At the same time, prepare to be flexible. "Be aware that everything may change: Your doses may change according to what you're doing, your food could change, the timing of the food could change, the amount of exercise you're getting could change," says Poenisch. This is also a good time to think about any problems you've had with travel in the past and what worked well before. You may want to make a note of this in your travel checklist.
5 Weeks Before: Time to Double Up
No matter how long you're gone or how far you'll travel, "you shouldn't be with just one vial of medication," says Kruger. "You should [bring] twice what you need in case any of it gets stolen or damaged." If you're traveling with someone else, put half of your medications in their carry-on, she advises. That way, if your bag is lost or swiped, you'll still have enough to get you through the rest of the trip. (The exception, says Chamberlain, is people with type 2 who are well controlled with pills. They're unlikely to need quite so many supplies, but should check with their doctors about how much to bring.) To ensure your medication stockpile arrives before you leave, order it a month in advance, recommends Chamberlain. If you need to set up mail-order delivery, through which you can often obtain a three-month supply, a month's lead time should be enough to establish an account.
4 Weeks Before: Do Your Homework
Ask yourself logistical questions about your destination, suggests Kruger, including: What foods are available? Where's the grocery store? Kruger notes that most injectables can be stored at room temperature, but if you're headed to a very hot climate, you'll need a fridge. "Even if you're going to a place like an amusement park, it's hot outside," says Kruger. "You need to find out where you can store your medications, where you can get ice." Kruger also suggests checking where the local hospital is—and if your health insurance will cover a visit there. Simply call the number on the back of your insurance card and ask about travel coverage. If you are traveling internationally, you may want to look into insurance that covers emergency airlifts. "You're taking a little bit of a chance when you travel in [developing] countries, so gather information about the medical care available," says Chamberlain. "I had a patient who was in Malaysia or Vietnam and got sick," he recalls. "He was hospitalized. He was on a pump and the medical staff was familiar with it. They got him on IV insulin, and he got good care. He knew he was in a good place, and he'd planned well."
3 Weeks Before: Call in Reinforcements
It's your job to manage your diabetes, but family and friends can help, too. Before you leave, stash some copies of your prescriptions with loved ones in case you lose your supplies, advises globetrotter Rockafellow. (He left his with his parents.) Because he's traveling with a backpack and a small daypack, Rockafellow only brought half of his medication with him and arranged to pick up the rest from his sister during a mid-trip layover. If you're traveling with, or to, relatives, you might be able to recruit family help with eating as well. But if they're not up to the task, bring or prepare your own food, advises nutritionist Judith Stern, ScD, distinguished professor at the University of California at Davis. "You almost have to take a compulsive approach to food when you travel," she adds. "Problems may never arise, but if you have diabetes, you'll want a safe supply."
2 Weeks Before: Make a List
Now that you've covered your bases, you'll want to check on your supplies. Include in your carry-on:
- Doctors' notes and prescription copies if you're traveling internationally.
- Your doctor's emergency number.
- Medications with their prescription labels attached.
- Your glucometer, manual, extra test strips, extra batteries, a backup meter, and control solution.
- Syringes, even if you have a pump; it could malfunction.
- One meal for the road for unexpected delays.
- Emergency carbs, like preportioned 100-calorie snack packs, granola bars, preportioned whole-grain crackers, small boxes of raisins, glucose gel or tabs, or sturdy fruit like apples or bananas.
- A glucagon kit, if it's been prescribed for you.
In your checked luggage, consider packing the following:
- Ketone testing supplies for those with type 1.
- A backup pump. Some manufacturers will loan you an extra for travel.
- A food pack: foil pouch tuna, dehydrated soups, crackers, water-packed canned fruits, raisins.
- Recipes for diabetes-friendly snacks and meals.
1 Week Before: Get Organized
To keep your supplies organized and safe, follow Poenisch's plan for separating supplies in small clear plastic bags:
- A bag for wet supplies, such as injectables or alcohol swabs.
- A bag for dry supplies like pills or powders.
- A bag for testing supplies.
1 Day Before: Don't Panic—You're Ready
Given all the prep work involved, it can seem overwhelming to travel with diabetes. But remember: All this advance planning is designed to make any emergencies easier to handle. Best of all, it allows you to relax and enjoy your trip. The world is waiting for you. A Heather Boerner is a health writer in San Francisco.
The Skies Are Friendly
If you've flown anywhere since Sept. 11, 2001, you know the drill about screening for sharp objects and liquids. But travelers with diabetes have reported few problems boarding flights with syringes and insulin. That's because the American Diabetes Association and the Transportation Security Administration (TSA), along with other groups, teamed up after 9/11 to develop protocol for travelers with diabetes. To find out more—or to report problems—call the ADA at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org.
Where in the World Is Leighton Rockafellow Jr.?
"When you step back and look at what it means to have diabetes," says Leighton Rockafellow, 26, "much of it is simply logistics. I must always have enough insulin, supplies, carbohydrates if I am low, ketone strips if my blood sugars are high, and so on. It can become a bit of a nightmare when I have to fit everything in one backpack and sleep in a different hotel every other night, thousands of miles away from my pharmacy." But mastering those logistics has allowed him to travel the globe. By the end of the summer, Rockafellow, a Tucson native who has lived with type 1 since he was 14, will have visited Bolivia, Peru, Chile, Argentina, Uruguay, Vietnam, Cambodia, Laos, Thailand, India, Turkey, and Greece. "I feel proud to know that I have not let diabetes keep me from doing the things I love," he says, "such as hiking the Inca Trail in Peru or sailing through the fjords and glaciers of Patagonia." He is traveling with his fiancée, Amanda Petran, a photographer; you can follow their progress at www.leightonamanda.blogspot.com.
Heather Boerner is a health writer in San Francisco.