WorldAware's Health Intelligence Department strives to ensure travelers and expatriates have as much information as possible to mitigate potential health risks or complications prior to travel, including those with chronic illnesses such as diabetes.
Traveling with Diabetic Testing Supplies and Insulin Pumps
Personal diabetes-related supplies, medication, and equipment may cause confusion and delays at some airport screening checkpoints. Insulin pumps and continuous blood sugar monitors are made by many different manufacturers and do not give the same advice regarding equipment safety when passing through whole-body X-ray scanners at airports. Contact the manufacturer of your insulin pump prior to travel, as well as airport(s) you will travel through to find requirements and restrictions. Some airports may not permit travel if you refuse to be scanned.
Diabetes testing supplies may be difficult to obtain or unavailable in many countries. Be sure to bring plenty of testing supplies and all prescription and non-prescription medications that might be needed. To minimize issues with customs officials, keep medications in their original labeled containers (not mixed in other containers), carry your original written prescriptions and, in a separate place, list the name (including the generic name), strength, and dose of your medications, with your doctor's name and contact information. Obtain a note from the prescribing physician on letterhead stationery for controlled substances and injectable medications, including insulin. For the most up to date information regarding the importation of personal medication, we highly recommend that you contact the embassy of the countries you are traveling to for specific instructions for the importation of your specific medications. Leave copies of all prescriptions with a trusted contact at home in the event your copies are lost.
Diabetic Complications While Traveling Abroad
Insulin Absorption in Different Climates
In colder climates, injected insulin is absorbed slowly at first, but may be absorbed suddenly once an individual is warmer. This sudden shift can accidentally cause hypoglycemia, or low blood sugar, which can also be caused by prolonged periods of shivering in cold weather. Low blood sugar is especially dangerous in cold conditions and increases the risk of hypothermia (dangerously low body temperature, which can progress to unconsciousness). Always carry convenient snacks when in cold areas to prevent blood sugar from becoming too low.
Conversely, in hotter climates, insulin is routinely absorbed quickly from an injection site, causing sudden drops in blood sugar. This requires diabetics to monitor their blood sugar more often, and adjust food intake accordingly. Travelers tend to eat more frequently and indulge in richer or more sugary foods while away from home; bring more insulin than you think you may require for your trip, and be mindful of meal timing and nutrition. The American Diabetes Association provides an introduction to carbohydrate counting to assist in meal planning.
Extreme temperatures can also negatively affect the accuracy of blood glucose meters and damage insulin, highlighting the importance of keeping all testing supplies and medications in cool, dry areas when possible. Individuals with diabetes may not notice burns developing during long periods of sunbathing, highlighting the importance of consistent use of approved sunblock and appropriate clothing to protect from the sun’s harmful rays.
Neuropathy and Infection
Diabetics with neuropathy (nerve pain, tingling, or numbness in their feet and legs) are less likely to notice cuts, scrapes, or blisters on their feet or legs due to nerve damage and poor circulation. More importantly, reduced blood flow to these areas creates a recipe for severe complications if wounds go unnoticed, as diabetics take significantly longer to heal and are less able to fight infections. In severe cases, infections have led to amputation of toes, part of a foot, or a foot in its entirety. Properly managing diabetes through diet, exercise, and/or medication remains key to reducing the risk of long-term nerve and tissue damage.
Always consult your primary care physician and a travel medicine health provider prior to embarking on an international trip or expatriate assignment. Mitigating health risks and preparing for obstacles in obtaining diabetic supplies or insulin is vitally important, especially in countries that may be more restrictive on allowable “importation” of prescription medication, lancets, or needles for insulin injection, despite paperwork to support their legitimacy. Diabetes UK and the US CDC both provide helpful tips and resources to mitigate travel concerns with diabetes.