Travelling with diabetes and an insulin pump

This leaflet is for children and young people with type 1 diabetes and their parents/carers. Its aim is to give practical tips on how to manage diabetes when travelling abroad.

Introduction

When planning to travel overseas, our diabetes team can provide specific advice on diabetes management and common travel-related problems. So do please speak to the diabetes team in advance before you travel.

Preparing

• Programme a bolus advisor app (such as 'mylife') with up to date carb ratios and insulin correction/sensitivity factor in case you have to revert to multiple daily injections (MDI). Please ask the diabetes team if you would like a tip sheet on how to convert back to injections
• Upload your pump to Glooko/CareLink before you go so you have electronic access to your pump settings
• Save our contact details and out-of-hours contact details on your phone – the numbers are at the end of this leaflet
• Save the number of your pump company customer services on your phone
• Contact your insulin manufacturer before the trip to see if your child’s insulin is supplied in the country you are travelling to. Find out where you can get supplies of your insulin in the country you are travelling to in case of an emergency
• We recommend taking and wearing your medical ID. You can also download medical ID on a mobile phone
• Find out where the nearest local hospital is to your holiday accommodation
• Consider downloading the Carbs & Cals app to help you estimate the carbohydrate content of new foods at your destination
• If flying:
  • We recommend you contact the airline to say that you need to fly with an insulin pump (and/or a glucose sensor). Some airlines may require you to notify them of your medical equipment before the flight in order to fill in additional paperwork
  • At the airport, you should ensure the pump (and/or a glucose sensor) do not go through an X-ray machine or whole-body scanners. This also applies to spare equipment.

Paperwork

• Make sure you have medical travel insurance covering diabetes (with adequate coverage for a potential hospital admission to intensive care unit due to Diabetic ketoacidosis [DKA])
• Find out well before you are travelling if special vaccinations are needed
• Print out pump settings (from Glooko/CareLink) so you have a hard copy to take with you
• Take with you a hard copy of Sick Day Rules (for pump and MDI) as well as an electronic copy
• Take with you your latest clinic letter (this would be useful if admitted to hospital while away)
• Take with you a copy of your repeat prescription items from your GP
• If travelling through security/border control (for example at an airport), ask the diabetes team for a customs letter
• If travelling abroad, consider taking a few useful phrases such as “I have type 1 diabetes” … “I use an insulin pump, it has to be connected at all times” for instance in the local language. It may be helpful if these phrases are translated and written down

Packing

• Take Glucagon (either GlucaGen HypoKit, or Ogluo – whichever your GP prescribes for you)
• Insulin pump consumables (infusion sets/cannulas, reservoir/cartridges or pods):
  • As a general rule bring double the amount of supplies usually required for the duration of your trip. Split this between members of the family/friends who are also travelling with you. If luggage is lost/stolen, remaining supplies should be able to last you for the rest of your trip
  • You may need to ask the insulin pump administration team at Addenbrooke’s hospital to bring forward your delivery if you don’t have enough at home to pack
  • Take enough pens and needle supplies to last for the length of your trip in case you have to revert to MDI
• Insulin:
  • Please speak to your GP so that you can order enough supplies before you go
  • Take the usual vials of rapid-acting insulin for insulin pump. Pack double the amount usually required for the length of your trip
  • Take rapid-acting and long-acting insulin pens (bolus and basal insulin) in case you need to revert to MDI
  • All insulin can be transported in cool bags such as ‘FRIO bags’ to keep it at safe temperatures
  • If flying, keep your insulin in your hand luggage/‘carry-on’ as it is not safe in the hold due to the temperature at high altitudes
• Take a primary and spare glucose meter and plenty of test strips
• Take a primary and spare ketone meter and plenty of test strips
• Take a FastClix lancet (and a spare if you have one) with plenty of refils
• If you are also use a glucose sensor, take double the amount of supplies usually required for the length of your trip. You may need to ask the company if they can provide you with spares if you don’t have enough at home to pack
• Take a sharps bin or small container to dispose of your needles/infusion sets/lancets/test strips/sensor inserters
• Take supplies of hypo treatment and extra food in case of delays
• If your pump is battery powered, take spare batteries.
• If your pump is re-chargeable, take all charging cables and a plug adapter (if required). Consider also packing power banks for convenient charging on the go
• Take supplies of medicine for minor illnesses or for travel sickness
• All diabetes equipment should remain with you (for example in your hand luggage, or at your seat) to avoid the risk of losing luggage. Remember to split theses between others travelling with you.

Journey across time zones

When travelling north or south, no adjustments are needed. However east or west travel across time zones can shorten or extend the day. Usually insulin adjustments are unnecessary if you are crossing fewer than five time zones (meaning that there is less than a five-hour time-lag).

If you travel east across more than five time zones, your day will shorten, on the other hand, westward travel means a longer day.

Guidance for when to change the time on the insulin pump:

• If travelling direct to your final destination you could change the time on your insulin pump when you get there
• If you have stop-overs en-route, change the time in your insulin pump whenever a stop-over occur
• You may find it useful not to change the time on your wristwatch during the flight so that you can see the original time (or use a ‘World Clock’ app on your phone)
• Remember that you may have travel delays, so you may have to factor these into your calculations

We can help with planning for the timings of insulin doses if you are unsure. Please ask the diabetes team if you feel you’ll need more specific advice.

Frequent glucose monitoring during travel is recommended so that you can respond to hypoglycaemia or hyperglycaemia.

When you’re there

• Make sure you can safely store insulin in a fridge at your destination. Ensure the fridge is only accessed by you/your family (for example, it should not be a communal hostel fridge). Alternatively, you could store insulin in FRIO bags
• If your pump is re-chargeable, charge it little and often. Make an effort to your power banks charged up at every opportunity, especially if there are long journey’s without a power supply (for example bus rides)
• Be aware of time difference and how that may affect you being able to contact the team if you need help or advice
• If you are in a warmer climate, consider using temporary basal rates or hybrid-closed loop activity/exercise setting as needed to prevent hypos
• With increased exercise, consider using temporary basal rates or hybrid-closed loop activity/exercise setting as needed to prevent hypos
• Be aware of the location of the nearest hospital is just in case

Further information

• To keep insulin cool during travel: FRIO UK (opens in a new tab)
• UK government advice regarding medication: Take medicine in or out of the UK - GOV.uk (opens in a new tab)
• More travel tips:
• JDRF - ravelling with type 1 diabetes (opens in a new tab)
• Diabetes UK - Travelling with diabetes (opens in a new tab)

CUH paediatric diabetes team

• Email paediatric diabetes team
• 01223 274638 – leave a message
• Hours: Monday to Friday, 9am-5pm

Out of hours diabetes support

• 01438 285000 for clinically urgent queries that cannot wait until when the CUH paediatric diabetes team are back at work.
• Hours: Monday to Friday, 5pm-8am. At the weekend and bank holidays 8am-8am cover.

This is a regional service for which diabetes teams rotate cover. You will reach a hospital switchboard who will take your phone number and the child’s name, then a diabetes practitioner “on call” will phone you back.