Traveling Abroad with Diabetes
Pack wisely, plan ahead for peace of mind.
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
May 2006 —The arrival of summer vacation means that my family is making preparations to visit relatives in Europe for a few weeks. Although I don't expect to need medical care while traveling, I like to be prepared for any eventuality. I'm sure that no one likes to think about the possibility of needing emergency medical care on a pleasure trip abroad, but a few advance planning steps can bring peace of mind to people with diabetes who are traveling outside the country.
First, it goes without saying that it's critical to pack ample supplies of medications, syringes or insulin pen if necessary, and testing supplies. Knowing that these must be packed into carry-on luggage and not checked baggage is also a no-brainer. A bit more tricky can be the decision of how to pack everything. Personally, I prefer to keep everything diabetes-related (insulin, syringes, testing supplies, glucose tablets, and other medications) in a small bag that fits into my larger tote bag or purse, meaning that it goes where I go until we've reached our climate-controlled hotel room and doesn't get left in hot cars or stored in car trunks, where temperature extremes can affect the quality and effectiveness of your medications.
It's also important to leave all medications in their original, pharmacy-labeled containers. The U.S. FAA advises air travelers who bring insulin on board to bring the insulin vial in its original pharmacy box. If you know you'll be traveling in circumstances where extreme heat is a consideration, you can purchase small insulated travel containers that contain mini-reusable ice packs to protect your insulin. Just be sure that there is a protective layer, like a paper towel, between the insulin and the cold pack to prevent freezing (and inactivation) of insulin.
We'll be traveling in Germany and Holland, where I am certain to be able to obtain replacements for any medications or supplies that become damaged or lost. But even in Europe, the brand names of drugs are different from those used in the U.S. It's important to take a list of your medications that includes the generic name of the drug that will be recognized by doctors and pharmacies throughout the world. (For example, the oral diabetes medication Prandin is called NovoNorm in Europe, but its generic name, repaglinide, is the same everywhere). If you need to replace your insulin supplies abroad, be aware that the same insulin may come in different strengths in other countries and may require different syringes to avoid mistakes in dosage.
I'd also recommend checking with your health insurance provider to find out exactly how to handle medical needs abroad, should they arise. You may be surprised to learn that your insurance provider doesn't cover medical expenses overseas; in fact, both Medicare and Medicaid do not cover expenses for medical care administered abroad. Even if they do offer international coverage, some insurance companies require that you pay up-front for any services (including hospitalizations) in other countries and file for reimbursement upon your return to the U.S. Those who do not have international health insurance coverage can purchase individual trip policies through a travel agency, many of which also offer medical evacuation coverage for the cost of an emergency trip to the U.S. for medical treatment.
I always make sure that I know the locations and phone numbers of U.S. Consulates in the countries I'm visiting. If you need a doctor and cannot find one, U.S. Consulates throughout the world can assist in locating English-speaking health care providers. Consular staff can also help you to wire money to foreign countries if you need to cover medical or other expenses.
Before you leave, check with your doctor about the timing of medication dosages, including insulin, whenever you are traveling across multiple time zones. You may have to pay extra attention to the timing of your meals and to test your blood glucose levels more often until you adjust to the time zone of your destination. Unusual foods and alterations in meal schedules will also most likely require a bit of extra monitoring. During the trip, always stow a snack and water bottle in your carry-on bag; remember that the airline meal may be delayed, served at an unexpected time, or simply not to your liking. Wait until the meal is being served before taking your insulin; last-minute delays in food service are common. If you need to take insulin while in flight, be careful not to inject air into the bottle when drawing up the insulin into the syringe, since airplane cabin air is generally pressurized.
All travelers to foreign countries, especially developing countries, should check with their doctor or a travel medicine clinic to determine whether immunizations or medications may be necessary to protect you from diseases that occur in other parts of the world. It's best to check at least 4-6 weeks prior to your trip in order to receive the maximum level of protection if immunizations are necessary.
Finally, arm yourself with a bit of the local language. You may need to ask locals for assistance before you locate that English-speaking physician you're seeking. I learned the importance of this first-hand when a security screener at an airport in Russia became upset after seeing my insulin pen on an x-ray scan of my bag and pointed to it angrily, presumably demanding an explanation. Since my limited knowledge of Russian included the phrases "I have diabetes" and "That is an insulin pen," I was spared major inconvenience. Anyone living with diabetes, especially when traveling alone, may also want to consider wearing diabetes identification (such as a bracelet) in the language of the countries you'll be visiting.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...