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You will need to make some adjustments to standard travel plans if you have diabetes. These tweaks to preparing for travel will help make your trip safe and enjoyable. Some of the points below may not apply to you. Please consider the ones that do.

• Preparing for Travel
• Pre-Travel Medical Appointments
• Air Travel
• While Traveling
• Traveling By Car

Getting Ready

• See your diabetes educator and doctor 4-6 weeks before your trip. They can help with possible medication adjustments and planning for changes to your diet and physical activity.
• If you are traveling with someone else, ensure they know what to do during an emergency.
• Know your eating plan well and know what your usual serving sizes look like.
• Ask your doctor for prescriptions and a letter outlining your diabetes treatment plan.
• Buy health insurance for out-of-country travel. Some credit cards offer this along with trip cancellation, etc. Please note that some insurance companies will not cover you if you have a pre-existing condition. Extra travel insurance may be required in these cases.
• Obtain a loaner insulin pump from your manufacturer. Pumps are only sent within Canada.
• Read the manuals for your devices so you know how traveling will impact their functions. Write down your normal settings in case you need to input or adjust them later.
• Make sure you have all of the vaccines required to travel to your destination country.
• Take anti-malaria drugs if recommended for your destination country.
• Find out what kind of medical services and supplies are available at your destination.
• Research the rules for security and permitted items at airports you will enter during your trip.
• Consider registering as a Canadian abroad on the Government of Canada website.
• Check with the manufacturer of your insulin pump that your pump can safely go through scanners and x-ray machines at the airport.
• Drink lots of fluids in the 1-2 days prior to your flight, during your flight, and after your flight.
• If you are traveling with others, split up the supplies between yourselves.
• Pack your diabetes supplies in your hand luggage and carry them on the plane with you. Do not pack them in your suitcase or checked luggage because they may be lost or damaged.

Packing Checklist

Begin packing as early as possible to avoid forgetting items and needing last-minute purchases. See this document for a printable checklist.

• Letter from your doctor describing your condition(s) and the medications you are taking
• Medical identification (for example, a bracelet or wallet card)
• Clearly labeled diabetes medications and blood testing equipment (double what is needed).
• Loaner insulin pump from your pump manufacturer
• Enough insulin and pens/syringes for twice the duration of your trip. This is important, even if you use a pump, because the pump may malfunction, become lost, or you may want to take a break from using the pump at some point during your trip.
• Extra batteries and charging cables for electronic medical and non-medical devices
• Medications to take if you have diarrhea, nausea, fever, pain, or other symptoms
• Sunscreen and insect repellent
• First aid kit and a foot care kit that includes blister bandages, alcohol wipes, and Polysporin®
• Supply of quick-acting sugar and supply of emergency glucagon
• Snacks (for example, juice boxes, granola bars, dried fruit, crackers, cookies)
• Comfortable walking shoes (worn regularly for at least one month) and cotton socks
• Ketone strips
• Frio® packs or Breezy® packs if a fridge is not available or electricity is unreliable
• A MedAngel® Smart Thermometer to monitor the storage temperature of medication
• A sharps container or large metal water bottle to hold used syringes and needles
• A "Grab and Go" bag in case you must leave your destination residence for an emergency
• Translation phrase book if you are visiting a country where you do not speak the language. Learn to say phrases including "I have diabetes" and "juice please" in case of emergencies
• Download a translation app on your phone to help you communicate while out of the country

It is important to see your doctor and your diabetes educator 4-6 weeks prior to a trip so they can help you prepare. Here are some things to keep in mind for these appointments (printable document here). Some of the points below may not apply to you. Please consider the ones that do.

Before Your Appointments

• Research your travel destination. Factors such as climate, transportation, storage, and available medical services will play a role in how to best manage your diabetes.
• Write down the plans for your flight, eating, and activities you will be doing on your trip.

With Your Doctor

• Complete a routine checkup to ensure you are in good enough health to travel safely.
• Obtain a travel letter from your doctor that states you have diabetes and describes the medical items you must bring on your trip.
• Obtain prescriptions from your doctor for double the amount of any medications you think you will need. Have the prescriptions' names written as their generic names or as the names of the brand in the country you will be going to.
• See if there are any vaccinations or medications (such as anti-malaria medication) that you must take before travelling. Some vaccinations take up to a year to be fully completed, so make sure you plan ahead and schedule them ahead of time.

With Your Diabetes Educator

• Discuss how to adjust your insulin regimen while traveling and when you first arrive at your destination.
• Describe the location and the weather you expect during your trip. Temperature, elevation, and other factors can impact how to best manage your blood sugars.
• Describe what you expect to be eating while on your trip and what you are currently eating.
• Your diabetes educator can explain how your medication needs may change.
• Describe the physical activity you expect to be doing on your trip. This can include walking around more than usual or other activities like hiking and sailing. Changes to physical activity may also change how much insulin you need to use and how much food you need to eat. Your diabetes educator can see if adjustments are necessary.
• Discuss your pump settings and daily insulin totals. Make sure to record them. Your pump settings will be important to have in case your pump malfunctions, your pump is lost, or you would like to take a break from using a pump for any reason (such as being in water or on a beach for the day). Knowing your pump settings and daily insulin totals will make it easier to know how much insulin to use if you are switching to multiple daily injections with pens. Order a loaner pump ahead of your trip just in case yours fails while on your trip.
• Discuss how much insulin and how many pens/syringes to bring. This is important, even if you use a pump, because the pump may malfunction, become lost, or you may want to take a break from using the pump at some point during your trip.
• Ask where and how you may be able to store your insulin and other medications to keep them cool if you are travelling to a hot country. Many hotels do not have fridges in the room, so ask at the front desk if they can hold your medications in their kitchen fridges, including your ice packs.
• Discuss your correction factor (insulin sensitivity) and insulin to carbohydrate ratio.
• Discuss what to do in the event of an emergency. If you are traveling with someone else, ensure that they are also aware of what to do in the event of an emergency.
• Complete a foot care screening and complete any necessary treatment prior to your trip. Discuss if there is anything specific you should do to care for your feet while on your trip.
• Review Diabetes Canada's Sick Day Guidelines in case you become ill during your trip.

At the Airport

Printable document here.

• You should have your insulin pump and/or CGM inspected by hand rather than through body scanners or x-ray machines.
• Handheld metal detectors are safe to use with insulin pumps and CGMs.
• You can request a hand inspection of your insulin if you would like to avoid putting your insulin through scanners.
• You can carry your insulin or other medical supplies even if they are above the limit for normal fluids. Simply make sure to declare these items to airport security.
• Look for sharps containers if you have needles or syringes you would like to dispose of.

On the Airplane

• If you are traveling with others, split up the supplies between yourselves.
• Drink plenty of fluids and avoid caffeine and alcohol. It is important to stay hydrated while flying with diabetes.
• Walk around every few hours if possible. This can help prevent blood clots in the legs.
• When using an insulin pump, changes in cabin pressure during a plane’s take-off and landing may affect insulin delivery. Carefully monitor your glucose levels and make changes as needed.

Arrival Checklist

• Change the time on your watch, phone, insulin pump, and continuous glucose monitor to the new time zone as soon as you arrive to assist with adjusting your insulin.
• Carry your insulin at all times. Do not store insulin in a backpack or car glove box.
• Avoid drinking the water if it is not clean and opt for bottled water or diet soda. Do not use ice cubes if the water is not clean.
• Wear shoes you have worn regularly for at least a month. Do not walk barefoot.
• Check your blood sugar more often if you are eating differently or being more active, you may need to change insulin dosing.
• See where you can safely store your insulin and dispose of needles. Cruise ships often have places to store insulin while only some hotels have fridges in their kitchen you may be able to use.

Adjusting to Changes in Your Eating Habits

• Research the food options in your travel destination.
• Using nutrition tracking sites and apps such as MyFitnessPal, Lose It, and Calorie King makes it much easier to know how much you are eating and how insulin dosing may be impacted.
• Monitor how your blood glucose levels are impacted by new foods.
• Including vegetables and proteins in your meals can make it easier to control blood sugars.
• Always carry snacks and supplies for hypoglycemia.
• If the water is not safe to drink, drink only bottled water or diet pop. Do not use ice cubes. Eat fruits and vegetables that can be peeled and/or cooked.

Adjusting to Changes in Physical Activity

• Choose comfortable footwear that you have already worn for at least 4 weeks. Do not walk barefoot. Avoid flip flops as these can lead to foot injuries and you may not be aware that you have a cut or something else requiring medical attention. Check your feet after your activity to address any hot spots, cuts, etc.
• If you are taking part in organized physical activity, inform staff that you have diabetes and what you have with you to treat hypoglycemia.
• If you plan to be physically active, have extra food or lower your insulin dose beforehand.

Adjusting to Changes in Altitude and Climate

If you plan to hike through mountains or other areas at a high elevation, it is important to consider the following

• A hotter climate can result in more rapid insulin absorption and increase the risk of hypoglycemia. If you’re on an insulin pump, an extended bolus may be helpful in this situation.
• A cooler climate can slow down the absorption of insulin. It may take more time for a bolus to take effect.
• It is important to closely monitor blood sugar levels in new climates and learn how to adjust insulin dosing accordingly.
• Higher altitude can increase insulin requirements and require more time for insulin to take effect. Glucose monitors may also cause a lower blood glucose reading at higher elevations. Altitude sickness symptoms can also be similar to hypoglycemia symptoms, so it is very important to monitor blood sugars at high elevations.
• When traveling to places with high-altitude, as in mountain climbing, there are factors that may increase the risk of developing diabetic ketoacidosis (DKA) such as decreased appetite, dehydration and the additional exercise.  Acetazolamide, a drug used to prevent altitude sickness, may also increase the risk of developing DKA. Please review how to recognize and prevent DKA with your diabetes educator. Also consider proper storage of adequate insulin and diabetes equipment (meters, batteries, syringes, sensors etc.).

Before Your Trip

• Ensure that you are in good health to drive, especially if driving long distances. If you are ill, it may not be safe for you to drive.
• If you are on medications that can possibly cause low blood sugar, know your symptoms. Not recognizing when your blood sugar is under 4 mmol/L can increase your risk of being in an accident.
• Pack extra diabetes supplies with you to make sure you have enough plus 72 hours extra.

On the Road

• Check your blood sugar before you start driving.
• Stop once in a while for a break. During the break, walk around. Walking every few hours can help with preventing blood clots in the legs.
• Take your diabetes medications at the normally scheduled times.
• Try to eat your meals on time (every 4–5 hours). Do not skip meals.
• In case of unexpected delays, carry some food such as cheese and crackers, fruit, and granola bars with you in the car.
• Follow your usual routine for testing your blood sugars. Test more often if you are concerned about lows and test if you have symptoms of a low.
• If your blood sugar is low (under 4 mmol/L), stop driving right away and treat the low blood sugar. Check your blood sugar levels. Do not drive until your blood sugar is above 5 mmol/L for at least 40 minutes. Even after your blood sugar returns to normal, your driving may be impaired for up to 40 minutes.
• Wear a form of medical identification (bracelet, necklace, wallet card).
• Stay hydrated.