COMMENTARY

Traveling With Diabetes: Help Your Patients Prepare

Anne L. Peters, MD, CDE

Disclosures

February 28, 2012

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Travelling With Diabetes

Hi. This is Dr. Anne Peters. Today I am going to talk about helping our patients with diabetes travel. I am going to focus on patients who take insulin. For many, it is a daunting task to travel, particularly if they are going abroad and must figure out all the things they need to do to manage their disease. I do this often, so I thought I would share with you the things I do.

A Letter From The Provider

First of all, think about the paperwork from the beginning. Make sure that each patient carries a list of all of their medications, but in addition, write out a separate set of prescriptions. The patient can use this letter when traveling within the United States, but it also helps to have it to show to a pharmacist if the patient is in some other country and needs a medication or at least something like the medication that the patient is routinely taking.

Make sure that the letter basically states they have diabetes and that they need to carry their medications, testers, and syringes. It may or may not work with the Transportation Security Administration, but at least the patient has it so he or she can show it, if needed. Finally, make sure that the patient carries a vial of insulin and perhaps some syringes that have the patient's name and the official prescription on it, because that helps show that they have officially been prescribed that medication.

Planning for Emergencies

Those are the first things that I do. Then, I work with the patient to figure out exactly where they are going and what the requirements are in terms of vaccinations or other things -- much like we do with any patient, but I will often have the patient contact the US Embassy in the country to which they are going to get a list of hospitals that have physicians who would speak English and be able to help them. I can't always find a diabetes specialist for a patient, but I can often at least find somewhere that they can go if they get sick.

Dealing With Time Changes

In terms of medications, if the patient is on an insulin pump it's pretty easy. I might change their insulin pump basal rate so it's the same for 24 hours and when they change time zones they won't have to worry about whether their body thinks it is nighttime or daytime. If a patient is on once-a-day, long-acting insulin, I may split the dose. Instead of taking 50 units all at night, I will have them take 25 units in the morning and 25 units 12 hours later, just while they are traveling so they don't get confused if the time zones are shifting 6-8 hours and they don't quite know where they fit.

Make sure that patients don't overlap the doses. They shouldn't take a dose of long-acting insulin and then another dose too soon, causing their blood sugar to drop too low. If anything, make sure patients spread out the doses so that they can take rapid-acting insulin or regular insulin to bridge them over until they get to the new time zone. Then, patients should follow the new time zone. In other words, I don't have them do something strange about night/day. I tell them to stay in the new time zone. Wake up in the morning and go to bed at night even if you can't quite sleep. Take your medications on the new day-night cycle.

Other Medications to Take Along

Other things I do, particularly if it's a patient with type 1 or a fairly brittle type 2 diabetes, is to make sure that they bring some sort of antidiarrheal medicine as well as an antiemetic in case they develop nausea and vomiting. Depending on where they are going, if it's a country where they might develop infectious diarrhea, I may give them antibiotics. I will give antibiotics to some of my patients who are on pumps, so if they develop a local site infection they have something on hand to treat it. If it's a woman, don't forget to give them some sort of antifungal agent in case they develop fungal vaginitis from the antibiotics.

Carrying Enough Supplies

The most important thing I can do is to help patients with supplies. I often have lots of extra things in the office, so I try to help a patient stock up before the trip. Patients who are going a significant distance or who will be away for a significant length of time need to have double of everything. In most cases, I am able to give patients extra meters, because I tend to have all kinds around the office. I give them an extra one so that they can put it in a second carry-on bag or, if they can't do that, at least in their luggage. I make sure they have enough meters and enough strips. I may have samples or in some cases I may be able to write prescriptions for strips. If they are getting a 3-month supply, they can carry extra with them so they will have enough for 3 months. Make sure you include prescriptions for supplies like lancets to make sure patients carry enough.

Insulin Options

It is very important to make sure that patients have a prescription for insulin syringes because you can always use insulin if you have a syringe. If the patient uses pens, he or she needs to have pen needles. But if they lose them, or for whatever reason can't get them, they can take the top of an insulin pen and use the syringe and withdraw insulin from the insulin pen. So a syringe will work in a pen. A syringe will also work in vials. Patients who carry vials (which often make it easier than pens to carry a larger volume for patients who are on higher volumes of insulin) can use the vial. Vials are pretty easy to use, and many of our patients still know how to use them. They also might be easier to transport.

Finally, I and many of my patients like insulin cartridges. These are pen-filled cartridges that are very small. They don't hold quite as much as a vial, but they are really easy to carry. This little cartridge has 3 mL of insulin. It is intended to be put in a pen, but it can be used with a syringe by just withdrawing the insulin from it. So there are all sorts of ways that patients can carry insulin. Make sure they have lots of insulin, lots of supplies, and are able to carry these in different places so if they lose 1 set they have another set as backup. In many places around the world your patients can get the things they need, but there is a certain security in knowing that a patient is prepared when they travel. This has been Dr. Anne Peters for Medscape.

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