1. Traveling With Diabetes
Blake Elkins
Project Echo
4/26/13

2. Diabetes and Travel 25.8 million patients with diabetes in the US
Approximately 8% of the US population
69% of Americans traveled for leisure last year
22% of Americans traveled for business last year
Potentially annual US travelers with diabetes
17 million leisure travelers
5.6 million business travelers

3. Diabetes and Travel
American Diabetes Association (ADA) and Canadian Diabetes Association (CDA) provide online travel recommendation that include:
See Your Doctor Before You Go
Prepare For An Emergency Abroad
How to Pack
How to deal with Issues during Air, Car, and Sea Travel
Issues with Insulin
Issues with Destination
However, few studies have examined patient knowledge and provider practice regarding traveling with diabetes

4. Are Patients Obtaining Advice Prior to Travel?

5. Are Patients Obtaining Advice Prior to Travel?
Are our patients obtaining travel advice?
76% of patient’s have never been asked about travel by a provider
Only 31% of patients have ever asked providers for advice relating to their diabetes and travel
Unpublished Data

6. Are Patients Obtaining Advice Prior to Travel?
Only 28% of our patients on insulin have EVER asked advice regarding insulin during travel
Unpublished Data

7. Are Patients Obtaining Advice Prior to Travel?
Unpublished Data

8. Diabetes and Travel Table 1: Traveling with Diabetes Poses Challenges
Potential problems associated with the Journey
Potential problems associated with the Destination
Increased or decreased physical exertion while in transit
Increased activity
Insulin adjustment across time zones
Exotic foods
Delays in meals
Delayed or skipped meals
Issues with correcting hypoglycemia while in transit
Increased insulin absorption in warm weather
Lost or depleted medications and supplies
Insulin storage
Getting Sharps through Security
Multiple issues with Altitude
Issues with Retinopathy and altitude
Issues with feet
Diabetic feet
Illness while on Vacation

9. Diabetes and Travel
Travel can be potentially hazardous for patients with diabetes
Our findings revealed:
Providers are not routinely advising patients about travel
Patients do not routinely ask providers about travel
When patients do ask, they most commonly ask about insulin and blood glucose monitoring issues
Many patients do attempt to obtain advice from other sources besides providers
Patients do not routinely plan for medical emergencies prior to travel and indicate they would deal with the issues when they occur at their destination

10. Discussion
Currently travel recommendations directed towards patients are available from the American Diabetes Association and the Canadian diabetes association online

11. Diabetes and Travel SEE YOUR DOCTOR BEFORE YOU GO
Bring your travel companion with you
Visit should be 4 to 6 weeks prior to travel
Review sick day protocols
Immunizations
Obtain documentation

12. Diabetes and Travel PREPARE FOR AN EMERGENCY ABROAD
Find a physician in the area where you will be traveling
International Association for Medical Assistance to Travelers (IAMAT)
If an emergency occurs and you can’t find an English speaking provider you can contact the American Consulate, American Express, or local medical schools for a list of doctors
Call your provider at home
Wear a MEDICAL ALERT ID
Learn common phrases such as “I have diabetes” and “sugar or orange juice, please” in the local language
Travel insurance

13. Diabetes and Travel PACKING TIPS Double the medications and supplies
Divide them into separate bags (both to be carried on)
Keep a bag with supplies on you at all times
Make sure to bring
Twice the amount of insulin or oral medications you will need
Twice the blood and urine testing supplies with extra batteries for your glucose meter
Emergency medications for hypoglycemia, diarrhea, nausea, small cuts
DIABETIC ID
FOOD – snacks both simple and complex sugars, protein and fats

14. Diabetes and Travel AIR TRAVEL CAR TRAVEL
Issues with security and supplies
Stressful environment with catching planes
Eating while in the Air
CAR TRAVEL
Check glucose prior to travel and regularly during
Pull over at first signs of hypoglycemia and do not restart till blood sugar is within safe range
Avoid driving in the time period between your insulin injection and the next meal
Limit yourself to 12 hours of driving daily or 6 hours between meals
Keep medication, meal, and snack times as regular as possible
Pack food in case of delayed meals

15. Diabetes and Travel SEA TRAVEL GREAT OUTDOORS Try not to overindulge
Keep active on the ship
GREAT OUTDOORS
GO WITH OTHERS
Bring all your medical supplies with you and teach others how to use glucagon kit
Avoid cuts, bruises, sunburns, blisters, or insect bites
Increase food or decrease insulin for increased activity
Keep hydrated

16. Diabetes and Travel Issues with Insulin Storage
Some countries still may use U-40 or U-80 insulin
Crossing Time Zones
TALK WITH YOUR DOCTOR OR DIABETES EDUCATOR
Bring flight schedule and information on time zone changes
Make plan for travel in both directions
Eastward means shorter day and maybe less insulin
Westward means longer day and maybe more insulin
CHECK BLOOD SUGARS every 4-6 hours during travel
Less of an issue for patients on oral diabetic medications

17. VoyageMD.com

18. VoyageMD.com

19. VoyageMD.com

20. VoyageMD.com

21. VoyageMD.com

22. Pre-mixed insulin Twice daily pre-mixed
Take usual insulin before departure at the normal time
Prior to departure obtain an insulin pen with rapid acting insulin
Check blood sugars every 4-6 hours
If blood sugar above 200mg/dl give a correction dose preferably with a meal
Continue this till the patient is in the new time zone and can give the second injection of pre-mixed insulin in the new time zone after arrival (if taken at 6pm at home you take the dose at 6pm in the new time zone)
Could also consider switching to basal bolus prior to travel

23. VogageMD.com

24. Diabetes and Travel DESTINATION Check blood sugars more frequently
Plan meals and activities remembering you have to take your insulin
Keep medications with you
Keep snacks with you
Keep hydrated
With increased activity check blood sugars more frequently
Wear comfortable broken in shoes and never go barefoot
Check feet daily and obtain medical care at the first signs of infection of inflammation

25. Diabetes and Travel
Converting Mmol/l to Mg/dl

26. Diabetes and Travel Continue taking insulin Drink plenty of fluids
Test your blood sugar more often
Test for ketones
If unable to eat – then eat sick day foods
If vomiting seek medical attention

27. Diabetes and Travel

28. Questions?