10 Tips for Hassle-Free Traveling With Diabetes

Don’t let diabetes hold you back from that much-needed vacation.

Vacation—all you ever wanted. As exciting as it is to finally head out on a much-anticipated getaway, having a health condition like diabetes can add to the packing and prep challenge. How to pack light with all that medication and insulin? What snacks can travel safely on an airplane (and through TSA’s tight bag checks)? What if you have a health issue hundreds (or thousands) of miles away from your trusted doctors?

When it comes to traveling with diabetes, extra planning can go a long way toward making you feel comfortable. In this video, nutritionist Amy Hendel, RD, shares some tips to manage diabetes while traveling, whether it’s a flight to Greece or a camping trip a couple hours away.

Don’t focus on packing ultra light. Yes, it’s sometimes ideal to arrive at the airport with only a carry-on bag, but this may not be the safest option for you if it means compromising your needs. Pack twice as much medication and blood testing supplies as you think you’ll need.
Wear a medical ID bracelet or necklace to alert others that you have diabetes, just in case of an emergency. (It probably won’t happen, but it’s best to be prepared.)
Learn how to say “I have diabetes and I need sugar or orange juice, please,” in the language of the place you are visiting. This is not the time to depend on others to know English, especially during a low-blood sugar moment.
Alert TSA agents. Keep your medication in your carry-on, just in case your checked bag gets lost (ugh), and let an agent know that you have medical supplies for diabetes in your bag. This may help you get through a horrendous security line a little faster.
Request a diabetes-friendly meal. If you’re flying a longer distance that serves an in-flight meal, alert the airline in advance that you have diabetes and will need a diabetic, low-fat, or low-sugar meal.
Pack snacks. In case your flight doesn’t serve a meal—or it’s simply taking too long to get to you—you’ll want to have snacks on hand to avoid blood sugar emergencies. Try one of these diabetes-friendly (and TSA-friendly) snack options: quarter cup of trail mix, apples, oranges, baby carrots, or some blueberries. (Here are some of the best snacks for diabetes.) Again, don’t pack light. Take more snacks than you think you’ll need in case of flight delays.
Alert a flight attendant that you have diabetes. If something happens to you during the flight, the attendant will be more prepared to assist you—fast.
Beware of cabin pressurization. If you need to give yourself injectible medication during a flight, the syringe may give more resistance than usual, which may make it tricky to get the right dose.
Take note of time zones. Eastward travel results in a shorter day, so you may need less insulin, but westward travel may require a little extra. Check your glucose levels more often to monitor how you’re handling all that extra vacation craziness.
Beware of insulin in other countries. Insulin comes in varying strengths outside America, so know the right dose with the proper syringe before any injections are needed.

Traveling with diabetes might feel like a lot to keep track of, but the majority of the work happens in the packing and planning process. With a little extra planning, you can step into the airport with no worries—well, except whether or not TSA is going to confiscate your favorite shampoo.

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This video features Amy Hendel.

Duration: 4:34. Last Updated On: May 25, 2014, 5:09 a.m.

Reviewed by: Dr Holly Atkinson, Dr Mera Goodman, Dr. Preeti Parikh, . Review date: Sept. 2, 2014

00:00 [SOUND]
00:01 [MUSIC] Welcome to HealthiNation.
00:04 I'm nutritionist Amy Hendel.
00:07 These days traveling can be a real hassle.
00:11 And if you're one of more than nearly 26 million Americans living with diabetes,
00:17 then you know that being on the road can be especially challenging.
00:21 In this video you'll see that with some important information, and
00:26 a little organization, you won't have to clip your wings.
00:31 In some ways technology has made traveling across the country or
00:35 around the world easier and less expensive then ever.
00:40 But if a long road trip or flight seems just too difficult because you've got to
00:45 manage your diabetes let me assure you that you can do it.
00:49 Here are some things to keep in mind for smooth sailing.
00:54 Forget packing lightly.
00:56 Instead pack twice as much medication and
00:59 blood testing supplies as you think you need for your entire trip.
01:04 Remember that although insulin doesn't have to be refrigerated if it's kept
01:09 in very hot or very cold conditions it may not work as well.
01:14 Wear a medical ID bracelet or necklace that will let people know you
01:18 have diabetes and any other ongoing health conditions just in case of an emergency.
01:25 And learn how to say, I have diabetes and I need sugar or
01:30 orange juice, please, in the language of every place you'll be visiting.
01:34 To help you get through security checks more easily,
01:38 identify yourself to security officers as a person with diabetes and
01:43 explain that you're carrying medical supplies with you.
01:46 It's also a really good idea to have all medications and supplies especially
01:51 syringes clearly marked with the original pharmacy label packaging and
01:57 never check any of your medications or supplies just in case luggage is lost.
02:02 Now if you're flying longer distances, request a diabetic, low fat or
02:08 low sugar inflight meal, ahead of time.
02:11 Don't depend on the airline to serve meals when you need them though.
02:16 Take your own healthy, diabetes friendly snack options.
02:21 You can try a quarter cup of trail mix, an apple or
02:24 a orange, a handful of baby carrots, or maybe some blueberries.
02:29 Remember, take more then you expect to need just in case there are delays.
02:35 Now if it ends up that you do need insulin during the trip,
02:38 wait to take it until you see your food is just about to arrive.
02:43 Otherwise, you really could end up with low blood sugar levels.
02:47 If you're traveling by yourself, it's probably a good idea to
02:51 let the flight attendant know that you have diabetes.
02:54 If you do need to inject while in flight, just be careful.
02:59 The cabin on your plane will probably be pressurized.
03:02 So the plunger on the syringe may give you just a little bit of resistance, and
03:06 it may be difficult to administer the full correct dose.
03:10 Also, factor in time zone changes so you know when to take medication.
03:16 Remember, eastward travel typically means you'll have a shorter day.
03:21 So if you inject insulin less may be needed.
03:25 Westward travel typically means you will have a longer day so
03:29 more insulin may be needed.
03:31 And to keep track of doses and
03:33 meals through changing time zones, keep your watch on your
03:37 home time zone until the morning after you arrive at your final destination.
03:43 Also keep up your exercise routine while away from home.
03:47 This will help with any jet lag.
03:50 If you are changing time zones, be sure to check your glucose levels more
03:55 often because a shifting schedule of sleep, food, and
03:59 physical activity can all affect blood sugar levels.
04:03 Out of the country and need more insulin?
04:05 Be careful.
04:08 Insulin comes in varying strengths outside the US.
04:12 Make sure you have the proper syringe for
04:15 the coinciding strength to ensure you get the right dose.
04:19 With these tips in mind and
04:21 some preparation ahead of time, you can have a safe and worry free trip.
04:27 Enjoy the ride and thanks for being apart of HealthiNation.
04:31 [MUSIC]

Diabetes Mellitus Review

Reviewed August- October 2014, Mera Goodman

General comments: can do better job delineating type I vs II vs other dm

Video 1: The Gold Standard Test for Diabetes

A1C twice a year (0:49)
1. US Preventative Health Services Task force – says you can use either fasting plasma glucose, oral glucose tolerance test or A1C, Screening Intervals. Evidence on the optimal rescreening interval for adults with an initial normal glucose test is limited.1 Cohort and modeling studies suggest that rescreening every 3 years may be a reasonable approach for adults at low risk with normal blood glucose levels.3-6 For adults at high risk or those who have near abnormal test values, repeat annual screening may be warranted (fresh 2014 guidelines).
2. Mayo clinic: how often you need the A1C test depends on the type of diabetes you have, your treatment plan and how well you're managing your blood sugar. For example, the A1C test may be recommended:
  1. Twice a year if you have type 2 diabetes, you don't use insulin, and your blood sugar level is consistently within your target range
  2. Three to four times a year if you have type 1 diabetes

Four times a year if you have type 2 diabetes, you use insulin to manage your diabetes, or you have trouble keeping your blood sugar level within your target range

Uptodate:
1. If you had an A1C test to check for diabetes and your A1C was less than 5.7 (meaning you do NOT have diabetes), you should have A1C tests done every 3 years.
2. If you had an A1C test to check for diabetes and your A1C was between 5.7 and 6.4 (meaning you do not have diabetes but are at risk for it), you should have A1C tests done every year.

If you do have diabetes and your blood sugar is well controlled, you should have A1C tests every 6 months.

If you have diabetes and you recently changed treatment plans or you are having trouble controlling your blood sugar, you should have A1C tests every 3 months.

A1C gold standard
1. Mayo clinic: An international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommends that the A1C test be the primary test used to diagnose prediabetes, type 1 diabetes and type 2 diabetes.
2. Us preventative task force / Cochrane – fasting / challenge okay alternatives

Video 2: Managing Diabetes

70-130 before meals, no higher than 131 180 after eating (2 hours after eating) (American diabetes association cited as source) – (1:21)
1. Ideally, this means levels between 70 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, - See more at: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html#sthash.4nDRW0OU.dpuf -ADA, does not mention 131 as low which is only on text not said verbally in video
best way to treat – maintain a healthy weight – utd, stills says will likely need medication

Video 3: Diabetes and Foot Care: The Basics – all from nih

talc between toes
do not use medicated lotions or razors for callous

Video 4: Diabetes and Foot Care: Top Concerns

Video 5: Diabetes and Alcohol (great video)

nearly 26 million americans with diabetes (0:10)
1. ADA - In 2012, 1 million Americans, or 9.3% of the population, had diabetes. In 2010 the figures were 25.8 million and 8.3%- See more at: http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav#sthash.QdnJ4IDB.dpuf
2. Cdc national surveillance report 2014 -1 million people or 9.3% of us population
Recurrent pancreatitis can cause diabetes – diapedia and mayo
Moderate drinking 1 drink/day woman and 2 drinks/day for men >65 if over 65 – 1 drink/day – have source
1 drink = 5 oz wine – 100 calories , 12 oz beer = 150 calories, 1.5 oz of 80 proof distilled spirits – 100 calories (2:21) ,ada limits
1. Women should have no more than 1 drink per day. Men should have no more than 2 drinks per day. *One drink is equal to a 12 oz beer, 5 oz glass of wine or 1 ½ oz distilled spirits (vodka, whiskey, gin, et- See more at: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html#sthash.dUOf9HkW.dpuf
2. Calories: diabetes association of Canada says wine has ~120 calories; the other calories are correct; ucsf dm center agrees w video http://dtc.ucsf.edu/pdfs/alookatyourliquor.pdf
3. Nih: wine slightly more than 100,
2 hours for ounce of alcohol to be metabolized - mayo clinic

Video 6: Diabetes and Celebrations

Video 6: Diabetes and Travel

References:

Pancreatitis: Basics. Mayo Clinic, MN. http://www.mayoclinic.org/diseases-conditions/pancreatitis/basics/causes/con-20028421. Downloaded 11/4/2014.
Alcohol and Diabetes: Mayo Clinic, MN. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/alcohol-and-diabetes/bgp-20056464?p=1 11/2/2014.
AIC: Basics. Mayo Clinic. MN. http://www.mayoclinic.org/tests-procedures/a1c-test/basics/why-its-done/prc-20012585. Downloaded 11/1/2014.
Alcohol and Diabetes. Canadian Diabetes Association. Toronto, ON. http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/alcohol-diabetes Downloaded 11/3/2014.
American Diabetes Association, Alexandria VA:
1. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/alcohol.html downloaded 11/1/2014.
2. Statistics about Diabetes. http://www.diabetes.org/diabetes-basics/statistics/ downloaded 11/4/2014.
3. Tight Diabetes Control. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/tight-diabetes-control.html. Downloaded 11/4/2014.
National Diabetes Statistics Report, 2014. Atlanta, GA.
Chronic Pancreatitis. Amsterdam. http://www.diapedia.org/other-types-of-diabetes-mellitus/chronic-pancreatitis. Downloaded 11/2/2014.
Draft Recommendation Statement: Abnormal Glucose and Type 2 Diabetes Mellitus in Adults: Screening. US Preventive Services Task Force. Rockville, MD. http://www.uspreventiveservicestaskforce.org/Page/Document/Recommend…entDraft/screening-for-abnormal-glucose-and-type-2-diabetes-mellitus Downloaded 11/1/2014.
Prevent diabetes problems: Keep your feet healthy - National Diabetes Information Clearinghouse. National Diabetes Information Clearinghouse (NDIC) A service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). Bethesda, MD. http://diabetes.niddk.nih.gov/dm/pubs/complications_feet/#can 11/2/2014
Alcohol and Diabetes: A Look at Your Liquor/USDA National Nutrition Database. San Francisco. 2005.
Uptodate:
1. McCulloch DK. Initial Management of Blood Glucose in Adults with Type 2 Diabetes Mellitus. September 2014.
2. Patient Information: Hemoglobin A1C (The Basics). Downloaded 11/2/2014.
3. McCullock DK and Hayward RA. Screening for Type 2 Diabetes Mellitus. September 2014.