By: Jo Lamb
My husband, Simon, was diagnosed with type 2 diabetes in October 2004. It was managed via oral medication at first, but his blood sugar levels were hard to control, and his doctor prescribed insulin to stabilize his condition.
In 2007, we packed up our life in the United Kingdom and moved to Italy. This was in itself a huge undertaking, and, of course, managing diabetes made it a little more complicated. Although our experience with the Italian healthcare system been largely positive, it has not been without its misunderstandings and frustrations. In general, however, those have been due to our slow grasp of the language rather than the care provided. Some of the issues we experienced and the lessons we learned may be useful if you are travelling abroad for business or pleasure.
We first made contact with the British Embassy in Rome and were able to communicate with a doctor who had responsibility for the diabetes policy in Italy. The advice and support we received were invaluable during our move and when accessing healthcare once we arrived in Italy. Making contact with a medical professional also gave Simon a great deal of confidence and a reference point in case he encountered any difficulties. By the way, all embassies have a website and offer information on the countries in which they are represented.
From our communication with the embassy, we discovered that in Italy, blood glucose levels are measured differently. This wasn’t something that we had even considered. We spent some time familiarizing ourselves with the different system before we went. Simon was provided with three months worth of medication, which gave us time to register with the Italian healthcare system and find our way around. Our physician gave us a letter confirming that Simon has diabetes and listing his prescribed medication and doses.
- Before leaving on any travel abroad, for business or pleasure, discuss your arrangements with your healthcare team, particularly if you have been experiencing any problems. Sorting them out before you go will help to prevent any difficulties while you’re away.
- Make sure all your vaccinations are up to date and check for any particular requirements for the country that you are visiting.
- It’s a good idea to take twice as much medication as you need, just in case of loss or mishap.
- Take a list of your medications with you, along with a signed letter from your healthcare team. Although languages are very different, drug names are more generic and are familiar to both medical personnel and pharmacists.
- Before you go, find out the units of measurement for monitoring and administration, so you can be prepared if you need to access advice or medication.
- It’s also useful to make a note of any medical and travel insurance policies to take with you, just in case. Keep photocopies of all your important documents with your travel information.
The International Association for Medical Assistance to Travellers offers lots of useful information, including access to English-speaking doctors in the area in which you are travelling and details about the vaccinations you may require.
Medication and equipment
We made sure that all the equipment we needed was in good working order before we left and obtained a second glucometer in case of loss. We travelled overland, so we needed to make sure the insulin was stored correctly. This is just as important, however, if travelling by air. Depending on the type of trip you are taking, you might need to arrange storage while you are travelling. Insulin should be kept cool and out of sunlight , but do not pack it in “checked” luggage because it may freeze. Buy a small cool bag or store it in your hand luggage until you reach your destination.
Simon found it useful to talk to other people with diabetes about their experiences via an online forum. The Internet is loaded with opportunities for people with diabetes to connect and share information. Diabetes Health readers connect on our Forums, via our Twitter and Facebook pages, and by exchanging comments at the end of our articles.
We found useful information via the Diabetes Association in the U.K., but it’s important to ensure that you seek locale-appropriate medical advice for medication and dosage issues. (We checked out the British Diabetes Association, the Canadian Diabetes Association, and the American Diabetes Association.)
- If you are travelling with a partner, each of you should carry half the medication, just in case of loss or misplacement.
- Wearing some kind of medical identification about your condition is a good idea, particularly in countries where you do not speak the language. These can be obtained via the Internet and from pharmacy outlets. Read more on medical IDs.
- If you are travelling to a country with a different time zone, it may be helpful to figure out before you go how to time your insulin administration. Seek medical advice if you are unsure of how to handle the timing.
- Different climates can also affect insulin absorption, so this should be taken into consideration. Talk to other people with diabetes who have experience travelling to the same location or a similar climate.
- Some glucometers are affected by different climates. Contact your supplier for advice if you think this may be the case.
Taking time to research the local diet and common foods of the country you are visiting is time well spent. We checked out the caloric values of some of the delightful Italian cuisine, so Simon could still enjoy the experience but still adjust his diet and medication if necessary. Since Simon was diagnosed, he has learned that regular meals help him. These can be interrupted during travel for a number of reasons, so it’s important to be prepared for all eventualities.
- Pack a snack in case you are delayed-this can be a frustrating experience at any time, but particularly so if you have diabetes and need to eat.
- Take a supply of your preferred solutions for dealing with hypoglycemic episodes, for example, glucose tablets. Depending on where you are going, supplies might be difficult to locate.
- If you are prone to travel sickness, you will need to consider appropriate measures in case of excessive vomiting, which will affect your blood sugar levels and lead to dehydration.
- It’s wise to take bottled water with you to prevent dehydration, although you will need to observe the usual airline restrictions regarding fluids.
- If you’re staying in a country where you do not speak the language, a phrase book that includes the terms for menus, food items, and accessing medical help is essential. Simon and I have also become quite expert at miming what we want to say, often with surprisingly good results. We have found that most of the time, locals are very helpful, and learning to say a few of their words makes them feel respected.
Because different climates can affect blood sugar levels, regular monitoring is important. Simon kept a record and varied the times to help him develop a picture of his highs and lows. We also kept a dietary record for a short time to compare with his results.
Regular monitoring is important on long journeys, so you will need to have easy access to your equipment and medication. Make sure you know where they are before you need them. You will also need to be able to dispose of lancets and needles safely.
- The normal preventive measures for travel are equally applicable to people with diabetes. Make sure you wear loose-fitting clothes and shoes in case of swelling and take walks whenever possible to stimulate the circulation system.
- Pack a simple first aid kit for minor injuries and consider taking medication for gastric upsets. Be aware of insect bites, which can swell up and become infected. Consider using some preventive spray in addition to preparations to apply to a bite. Keep an eye on any cuts, bites, and inflammation, and seek medical help if you are worried.
- Do join in activities, but make sure you monitor regularly and adjust your medication if compensation is necessary.
Follow your usual regime for dealing with any “sick days” you experience while you are away, and seek medical help if appropriate. The following are key rules for managing your diabetes if you are unwell.
- Never stop taking your medication
- Test your blood sugar levels every two to four hours and adjust accordingly
- Prevent dehydration-try to drink a glass of water every hour
- Substitute solid carbohydrates with liquids if necessary
- If you suffer from loss of appetite, try taking milky drinks or ice cream
- If symptoms don’t improve within 24 to 48 hours, seek medical assistance
There is no doubt that having diabetes changes your life, but we have learned that it does not have to control it. With a little bit of organization, you can be prepared for most eventualities, and you can sit back, relax, and enjoy your travels!