After 10 years of travelling with diabetes, I decided to put together all of my top tips and tricks in one place. This guide should help you plan any trip.
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I’ve been traveling the world with diabetes for the last 10 years, so I feel like I’ve learned pretty much everything you need to know about managing your condition on the road.
It’s worth getting any mandatory injections for the country your visiting
If hiking, remember high altitudes can affect blood sugars by making them run higher
How to keep insulin cold while travelling
This is honestly the most common question I get asked when people find out I travel with diabetes. “How do you keep insulin cold when travelling?”.
It was the first thing I wondered before I headed off on my first adventure.
For insulin that’s already been opened and that you are currently using the ideal temperature is 56°F and 80°F (13-26 degrees C).
An insulin cooling case will allow you to keep your insulin at this temperature.
Remember if insulin goes too cold, it can freeze and if it goes too warm, it will turn cloudy and die.
It can also die if it fluctuates between extreme temperatures, so it’s important to keep your insulin cold when travelling.
Thankfully, we live in a world where there are constantly new innovations that allow us to travel easier with diabetes, and one of those innovations comes in the form of insulin cooling cases.
I’ve been using insulin cooling cases to keep my insulin cool while travelling since I first went on my first adventure to Paris.
Most people who have diabetes will learn to carbohydrate count at some stage in their lives. In fact, it's one of the best things you should do if you're a newly diagnosed diabetic.
It allows you the flexibility to try new foods, especially when you’re travelling.
If you don’t know how to carb count, I suggest you get in touch with your diabetes team to find out how you can learn.
When we are at home, we often find we eat the same things during the week because we generally have a routine.
This means insulin management becomes easier because your body knows what to expect and when to expect it.
But, when you travel, you’re suddenly trying new foods, and eating at different times of the day, which can all affect your blood sugars.
That doesn’t mean you can’t try new foods and still retain good blood sugars.
Below are some tips on how to manage carb counting whilst travelling with diabetes.
1. Use carb counting apps
There are a variety of apps online that can help you count carbs on the go. My favourites are MyFitnessPal and CalorieKing.
You simply input what you’re eating and it will give you a rough estimate of the carbs per portion, so you can use this to judge.
It might not be perfect, but it’s a very good starting point!
2. Research beforehand
Before you visit a country, you can easily research the local and most common dishes they eat there and work out the general carbohydrate count before you go.
For example, if you were heading to Thailand, you’d see they eat a lot of Pad Thai, and Thai curry, and you can find out the general carb count for these online and use them as a guide when calculating your carbs on your travels!
3. Check websites
If you feel like you’re really struggling with carb counting and you want to stick to what you know, then fast-food chains, such as McDonalds, Subway, etc are pretty much available worldwide and you can get the full nutritional information of their foods on their websites.
4. Go self-catering
If you feel more comfortable cooking your own food, then there is no obligation to eat out when you are traveling.
You can easily opt for self-catering and prepare your own meals so you know exactly how much insulin to give for each meal.
Another fear often associated with travelling with diabetes is the issue of switching time zones. This is actually quite easy if you’re on an insulin pump, but I’ll deal with insulin pumps and insulin injections separately.
Crossing time zones with multiple injections
I actually talk in great detail about switching time zones with insulin injections in my flying with diabetes post and give you example scenarios to help you plan better.
So check that out here for more information.
Crossing time zones with an insulin pump
I’ve been wearing an insulin pump for the last 8 years, and I can’t imagine I’ll ever return to insulin injections, so this is how I deal with time zone changes with diabetes.
When travelling with an insulin pump you will need to change the date and time of your pump setting to the new time zone.
This can be done either whilst flying, or when you land. I prefer to do it when I land.
After landing I switch my insulin pump to local time and I keep a close eye on my blood sugars.
I typically find I will need to alter my insulin basal rates for different parts of the day after a few days of adapting to my new situation.
An extra tip is that when you’re sitting down for longer periods of time (so a long flight) then you might find your insulin doesn’t seem as effective, and it’s basically because you’re not moving, so you can either get up for little walks around the cabin to try and help or increase your basal rate by 5-10%.
I find increasing my basal rate helps because the combination of not moving much and the adrenaline I get from flying often makes me run a little higher.
At Iguazu Falls, Argentina
Managing diabetes in hot weather
If you heading away on holiday to a warm destination, you might be worried about how the heat can affect your diabetes, and rightly so.
There are a few elements and things that can happen when the heat gets involved with diabetes:
Dehydration can lead to DKA
Your insulin can overheat and die
And you can go into hypo...
Dehydration and diabetes
One of the most frustrating traits of heat and diabetes is the link between hypo, DKA, and dehydration.
All the symptoms and signs kind of blend into one and you can’t really trust your body's’ instinct anymore.
This is because the body’s metabolism increasing in hot weather.
So, if you feel sweaty and dizzy, don’t assume this is just a hypo, dehydration, or even heat exhaustion, you need to check your blood sugars.
When we’re on holiday and having fun, it can be very easy to forget to check your blood sugars, which is when a continuous glucose monitor becomes useful!
Make sure you sip on water or fluids throughout the day.
Dehydration is caused when your body doesn’t get enough water, and this is more common when you’re in hot climates.
The frustrating thing about type 1 diabetes is that if you do become dehydrated, your blood sugars can rise and lead to the usual symptoms of high blood sugars such as dry mouth, going to the toilet more often etc, and as you all know, high blood sugars can lead to further dehydration, which leads to higher blood sugars and turns into a vicious cycle which could result in DKA.
The moral of the story is: Stay hydrated!
In the arid heat of the Atacama desert (Chile)
Tips for dealing with heat and diabetes
Reduce your background insulin (on an insulin pump) or your longer-lasting insulin (on an insulin pen). The amount will depend on how long you’re sitting in the sun and if you’re drinking alcohol or even doing any activities, like swimming, surfing or volleyball. I typically reduce my insulin by around 20% if I’m sunbathing while sipping on a few alcoholic drinks, but you should discuss with your DSN what’s best for you.
Reduce your fast-acting insulin (pens) or next bolus (pump) at your next meal if you have been involved in activities such as swimming or surfing, (any physical activity).
If you’ve got an insulin pump, make use of temporary basal rates. They are a setting that allows you to temporarily reduce your basal rate for a desired amount of time without interfering with your normal insulin regime. Speak to your DSN for further advice.
Keep a closer eye on your blood sugars: You can monitor your blood sugars better when you’ve got a CGM or a device like the Freestyle Libre coupled with a MiaoMiao sensor. They allow you to see what worked and what didn’t work with your diabetes management. Most CGMs such as Dexcom and the Freestyle Libre 2 allow you to set alarms that pre-empt high or low blood sugars so you have a better chance of correcting the situation before it happens.
Wear suncream to protect your skin and avoid sunburn, because sunburn leads to dehydration and we just covered how annoying that can be!
Have hypo supplies at hand: make sure you’ve got dextrose, a sugary drink, or money with you to buy hypo supplies should you need them.
As mentioned before, heat can kill your insulin, so only bring the insulin you need out with you and keep the rest in a fridge. If you need insulin on the beach, try a Frio bag to keep it cool.
Managing diabetes in cold climates
I love cold destinations as much as warm and I’ve spent time traveling to some pretty cold places, such as Finland, Norway, and Iceland.
Check out the video from one of our road trip adventures below, where in Finland, temperatures were hitting -20 degrees Celsius!
If you’re concerned about the cold weather that can affect your diabetes while traveling, I’ve put together some tips that might help.
Fun fact, did you know that we tend to have a higher HBa1c during the winter months? This is because insulin struggles to work in colder temperatures (it does still work, but you may find you need more)
If you find your insulin is like water, i.e it doesn’t seem to be doing anything, then your body might be cold and struggling to use the insulin correctly. On these occasions, you may need to increase your insulin dose.
Be aware of high blood sugars: Higher blood sugars make you “feel” warmer in cold temperatures. This happens because the sugar content in our blood makes it harder to freeze or cool down. Don’t let your blood sugars stay high as an excuse to stay warm.
Boost your immune system: it’s easier to catch an illness in colder climates, so make sure you’re as healthy as possible with vitamins, and if you can get your flu jab to avoid catching it. In the USA it’s around $5-40 for a jab and in the UK it’s free for people with diabetes.
Be aware of neuropathy and feet: if you’ve got neuropathy, then you’ll need to be more careful as your feet will be less sensitive to the cold and therefore there’s an increased risk of infections developing.
Don’t let your insulin freeze: keeping your insulin in a cooling case will help maintain the correct temperature, but I’ve been in conditions where I’ve had to sleep with my insulin to keep it warm (in a campervan), so be wary! You know your insulin has frozen if it forms crystals and clumps and this will typically happen when it is exposed to temperatures of around 26°F (-3 °C).
Keep your diabetes equipment at a warmer temperature: Diabetes monitors, and Freestyle Libre, CGMs ect will not work in super cold temperatures. A warning sign will come up saying it’s too cold to function, so be careful with your technology.
It doesn't get much colder than sitting in a Swedish ice igloo!
How to deal with problems while travelling with diabetes
One of the big factors that put people off traveling with diabetes is a fear of dealing with diabetes-related issues when they go wrong, but honestly, with a little preparation, there isn’t any sort of diabetes-travel-related issue you can’t deal with!
These are some of the most common problems associated with traveling with diabetes and how to deal with them.
1. You become ill
This is a real possibility when you’re travelling.
You can pick up new infections, get food poisoning, or just become burnt out due to long travel hours. But don’t worry.
Falling ill in a different country will require the same rules as falling ill in your home country.
You typically will find that your blood sugars will run higher when sick, so you usually need more insulin.
If you’re struggling, you can always get in touch with your doctor back home for advice.
Bring ketones stick with your on your travels so that you can test for ketones.
Remember they will indicate if your body is going into DKA.
2. Your insulin and equipment is stolen
This would be pretty annoying, but again it’s not something to freak out over.
If your insulin is stolen, you can get more insulin.
Google pharmacies, or hospitals in the nearest city and place an order for insulin.
You might not get the same brand you expect, but you can ring your own doctor for advice.
A great way to pre-empt stolen goods is to split your diabetic supplies.
If you are travelling with a friend or partner, give them half your supplies, or if you’re traveling solo, then split your supplies between two bags.
This means if a bag is stolen, or misplaced, you’ll always have a supply at hand.
3. Your insulin pump breaks
So this has happened to me.
If your insulin pump breaks whilst you are away, you’ve got a couple of options.
Firstly, you need to ring your insulin pump manufacturer and ask for a replacement.
Most times they can send them out to wherever you are in the world, but that will typically take a few days.
So, whilst waiting for your new insulin pump, (or if you can’t get a replacement because it’s not insured), you will need to switch back to using insulin pens.
**Some insulin pump companies allow you to bring a spare pump with you. Roche did this for me on countless occasions**
Actually, Medtronic has a travel loaner program in the USA where you can take a backup insulin pump with you for $50 every 90 days. This can be taken:
Again, this is something else I have experience with.
When in Indonesia, a hotel put my insulin in a freezer (there was no fridge in the room and now I won’t stay in a hotel unless it has a fridge in the room- when possible) and it froze 80% of my insulin supply.
Thankfully I still had insulin in my Frio bag(because I have trust issues, and rightly so, haha), so I had enough to last a week or two.
My sister was flying out to see me, so she was able to get more insulin from home and bring it to me.
But, in most cases, you won’t have someone flying out, so you’ll need to source new insulin from a pharmacy.
You should be aware however that insulin brands vary in each country and they may not stock your exact insulin.
Also, be aware that insulin strengths are different in different countries and you will need the correct syringes to match them. (This won’t count for pre-filled pens).
For example, U-100 insulin needs a U-100 syringe and if you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin and be at risk of a hypo.
remember to take your pump off BEFORE you start swimming with elephants ;)
Flying with diabetes
Flying with diabetes can seem like a stressful event if you’ve never done it before. But with a little preparation, there’s no need to worry.
I’ve got a whole guide on flying with diabetes, but I’ll run through my top 3 tips.
1. Don’t put insulin in your checked luggage
You’ve probably noticed that planes go pretty high up when flying, and since our bodies can’t handle the temperatures up there, our insulin wouldn’t be able to either.
There is always a risk that your insulin a freeze in the hold, and you might not notice either as it will have defrosted by the time you land.
Keep your insulin in your hand luggage…
2. You get an extra liquids bag
Leading on from my last point, if you’re worried about taking up valuable space in your liquids bag, don’t worry, you’re allowed an extra one for medication!
If they ask at security, you just say the words “medication” and it’s all good.
3. Bring a doctors letter
A doctor’s letter while traveling with diabetes is useful in a variety of situations, especially if you’re crossing land borders.
But a doctor’s letter can explain that your carrying medication and why.
This is important because some countries limit what medication you can bring it, and how much you can bring it, so having a letter will verify its use.
If you’re visiting a country that doesn’t speak great English, then have your letter translated too.
You can download a sample doctor's travel letter by signing up to my weekly diabetes newsletter using the form below.
Again, I’ve gone into great detail on this in a different post, but let me give you some top tips.
1. Bring your doctors letter
That same letter I mentioned above for verifying your diabetic supplies should also note whether you are wearing an insulin pump or CGM and state that it cannot go through the 360 body scanners.
Your insulin pump and CGMs CAN go through the over arch walk-way which is a metal detector. But not enough research has been done on the effects of the body scanners on insulin pumps so the companies ask you not to go through.
You can opt for a swab of the insulin pump, and a normal pat-down search.
Again, translate that letter, because some places are more understanding than others.
Download a template letter by signing up to my newsletter:
2. If nervous opt for fast-track
In most airports around the world, you can pay a little extra and go through “fast-track” or “premium” security.
The queues here are typically less and the security officers are more willing to listen to what you’re saying.
So, if you’re feeling a little anxious about entering airport security with diabetes, then this is a great way to put your mind at ease.
3. Bring hypo supplies in non-liquid form
In the majority of airports around the world, there is a limit on the number of liquids you can bring through security (100ml), so it’s best to bring your hypo supplies in the form of sweets or Dextrose tablets.
You should never go travelling without travel insurance that covers your diabetes.
The cost of travel insurance will differ depending on where you are from and what diabetes complications you may have.
My travel insurance comes from the UK, and I have no diabetes complications, so I can get a pretty good deal on my travel insurance for diabetes.
If you’re from the UK, I suggest you use price comparison sites for finding the best deal such as Compare the Market, or for a specific company that I’ve used before I can recommend JustTravelCover travel insurance. They specialize in covering pre-existing conditions.
If you’re from the USA, getting travel insurance for diabetes can be quite frustrating.
You can ask your current insurance provider if there is an option to add on outside USA travel insurance.
Sometimes since insulin in the USA is so expensive, it’s often cheaper to get insulin in other countries you’re visiting.
So if you can’t get extra insulin from your doctor for your trip, then that may be an option.
Type 1 diabetes travel checklist
To round things off, I’ve created a little diabetes checklist to ensure we’ve covered everything!
Get that doctors letter: You can use my template as a basis for what it needs to say
Download any carb counting apps you may need for the trip
Living with type 1 diabetes for over 10 years has given me a lot of life experience, challenges and opportunities. I’ve had ups and downs, but I’m proud that I can live out my dreams whilst managing t1d. I hope my stories can help your daily life with diabetes too!
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