Travelling with diabetes and insulin injections

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.

Introduction

When you are 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 back-up bolus advisor app (such as 'mylife') with up to date carb ratios and insulin correction/sensitivity factor in case the primary phone used breaks
• Upload your bolus advisor app settings electronically (for example sync to Glooko or save PDF report) before you go in order to have electronic access to your settings just in case
• Save our contact details and out of hours contact details on your phone – the numbers are at the end of this leaflet
• 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 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 insulin supplies (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 glucose sensors 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
• Take with you a hard copy of Sick Day Rules as well as an electronic copy
• Take with you a 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 insulin injections” 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)
• 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
• Insulin:
  • Please speak to your GP so that you can order enough supplies before you go
  • Take your usual rapid-acting insulin pens (NovoRapid/ Fiasp/ Humalog) and basal/long-acting insulin pens (Lantus/Levemir/Tresiba). Pack double the amount usually required for the length of your trip
  • 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 refills
• If you are also using 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/lancets/test strips/sensor inserters
• Take supplies of hypo treatment and extra food in case of delays
• 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 these 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, and you may need a reduction in your long-acting (basal) insulin dose, because insulin doses would be given closer than normal with the risk of hypoglycaemia.
• On the other hand, westward travel means a longer day and you may need to take extra doses of rapid-acting (bolus) insulin before the next dose of long-acting (basal) insulin is given.
  • To get further advice on this, speak to our diabetes team (remembering to give them the times of your flight, the duration of the flight and your current insulin doses)
• While travelling, inject rapid-acting (bolus) insulin with any meal that contains carbohydrate, no matter what time of day or night.
• 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
• 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 insulin dose reductions as needed
• With increased exercise, consider using insulin dose reductions as needed to prevent hypos
• Be aware of where the local 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 - ravelling with diabetes (opens in a new tab)

CUH paediatric diabetes team

• Email paediatric diabetes team (non-urgent queries)
• Telephone: 01223 274638 – leave a message for urgent queries
• 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.