It’s time to pack your suitcase for your long-awaited vacation again. But before you start feeling excited, have you ever wondered how diabetes would affect your trip? Fret not.
Diabetic patients can have an enjoyable and stress-free holiday. Read on to find out more.
Diabetes mellitus (DM) is a lifestyle disease, and the prevalence of this illness increases with age.
According to the National Health Survey Singapore 2010, one in nine (approximately 11.3%) Singaporeans suffered from DM, and 90 to 95% of diabetic patients were classified as Type 2 DM. The prevalence of this disease was 1% in young adults ranging from 18 to 29 years of age and it peaked as high as 29.1% among those between 60 to 69 years old. Therefore, it is not uncommon to meet a travelling companion sharing this medical condition during a trip.
However, how can you ensure a healthy and hassle-free journey without compromising the fun of travelling? Unsure of where to start? A little homework will keep your trip as smooth as silk.
Overseas vacations require adequate preparation. There are language barriers to consider, luggages to pack and currencies to exchange. With diabetes, vacation planning involves even more homework.
1. Bring plenty. Whether you are heading across the globe or making a cross-border day trip, always pack more supplies than you will need. It is even more crucial if you are heading to a country where you do not speak the language and may have a hard time finding medications and supplies.
2. Visit the doctor. About six to eight weeks before your trip, visit your doctor and ask for prescription refills. A doctor’s note on the chemical name of each medication you take is important because many countries will carry foreign versions of the brand names you are used to. Keep in mind that your body may react differently to the same medication obtained at a pharmacy in another country because the medication may have been prepared differently or use varying additives. For trips to less developed countries, consider visiting a travel clinic for all vaccinations, medications and tips for minimising health risks.
Rest stops mark the miles and fast-food joints litter the roads right off the highway, but if you are looking for something healthy to eat on the road, you may end up frustrated. While it is definitely harder to eat well and quickly on the road, it is still feasible.
1. Pack a cooler. The most obvious solution to the healthy-eating dilemma is to bring your own food. Have absolute control over what to pack and what you wish to eat. Fill a cooler with snacks and meals containing fruits, vegetables, nuts and seeds as well as fibre-packed carbohydrates and lean protein, both of which will keep you feeling full longer. Peanut butter on whole-grain bread, vegetables and whole-grain crackers, non-fat yoghurt with fruits and mixed nuts all travel well. If your snack needs to be kept cool, surround them with ice packs or bags of ice. Even food that requires refrigeration, such as luncheon meat and yoghurt will be safe in a cooler for a few hours. For longer trips, bring gallon-sized plastic bags and fill them with ice from convenience stores along the way when your ice packs turn warm.
2. Drink responsibly. Driving for hours will tire anyone, but be careful how you refuel. Soda, tonics and coffee drinks may seem like ideal road trip refreshments, but they are notoriously high in carbohydrates and calories. Always stay hydrated with water. If that is too boring for you, try making ‘spa water’: Squeeze lemons, limes or oranges into your water bottle. When it comes to coffee, stick to the basic. Plain coffee with low-fat milk is fine, but fancy coffee drinks are loaded with sugar. A 350ml café mocha with whipped cream contains as much as 270 calories, 13 grams of fat.
Up in the Air
Of all the ways to travel, air flights pose the greatest hassle for people with diabetes. There are airport security, questionable airline food and the ever confusing task of altering insulin regimes when crossing time zones. The following pointers can help you reduce the stress of flying with diabetes.
1. Plan for meals. The food available on long flights is generally unhealthy. When booking your flight, many airlines will give you the option of picking up a meal suited to your health concerns, but if you do not have that option, call the airline. Request for a diabetic-friendly or vegetarian meal. Many airlines will offer hearthealthy or low-sodium options too. If the thought of eating airline food turns you off, buy snacks at the airport. You can find nuts, seeds, fruits, yoghurt, veggies and dips, sandwiches with lean meat and salads at various feature feature vendors. If you did not carry glucose to treat unexpected hypoglycemia, this is also a good time to stock up on candy, soda or juice.
2. Carry a doctor’s letter. Your trip through airport security will go smoother if you plan ahead. Ask your doctor to write a letter stating your conditions and need to carry insulin, syringes, test strips and other supplies. Also carry pharmacy-labelled pill bottles and insulin vials with you. You will spend a lot less time explaining that the gadgets attached to your abdomen are what we call insulin pumps and continuous glucose monitors.
3. Pack a carry-on. As heavy as the bag on your back may be, avoid the temptation to store all your diabetes supplies in your checked-in luggage. The cargo storage can get pretty chilly at 30,000 feet (not such a pleasant atmosphere for insulin). An even bigger worry is lost luggage. The safest way to ensure your supplies make it to your destination is to keep them with you while flying. If you plan to stuff your hand-carry luggage in your overhead compartment, keep a smaller bag beneath the seat in front of you, so you have easy access to your meter, test strips, syringes and insulin, snacks and fast-acting glucose. After all, meals may be delayed because of turbulence. To deal with eating uncertainties, consider dosing rapid-acting insulin after your meal arrives.
4. Mention your diabetes. If you are travelling alone, it is important that someone on the flight knows about your diabetes in case of an emergency. Alert a flight attendant when you on board. You do not have to go into details, but let them know that you may need a soda or juice if you become hypoglycaemic.
5. Adjust Insulin. Crossing time zones is tricky for people with diabetes because it requires adjustment to insulin injections and is highly subjective. You may need to reduce your insulin dose if you are travelling east as days are shorter. On the other hand, your insulin dose needs to be increased if you are travelling west as days are longer. Thus, you should visit your doctor at least a month before you leave for your trip. For a general idea of how travelling may affect your insulin needs, you may use various online resources such as VoyageMD.com, which has a flight calculator that can help you determine what changes to make to your insulin regime. In general, no adjustment is required for travelling north or south and crossing fewer than five time zones. It is important to discuss with your doctor any travel-related changes you may need to make to your insulin plan. You may need to dose more or less insulin depending on your itinerary. If you will be walking all the time, you may also need to adjust your insulin dose.
6. Disconnect your pump. You may want to consider disconnecting from your pump briefly during takeoff and landing. Some studies have shown that the changes in pressure on a flight can make the pump deliver more insulin. Once the plane has reached its cruising altitude, it is safe to connect. Before reconnecting your pump after takeoff and landing, check for air bubbles caused by altitude changes. Reprime the pump if necessary.
By Dr Khor Hong Tar
Associate Consultant in the Department of Endocrinology at Tan Tock Seng Hospital