Travel with Type 1?

My daughter and I both have T1D. We are also frequent travellers. I never thought too much about my diabetes and travelling (other than bringing extra everything), but since my daughter’s diagnosis in November, I’ve become more concerned about our travel destinations. Anyone have suggestions, thoughts, concerns, etc. regarding more remote destinations (e.g., Thailand, Cambodia, Romania). For example, in countries where medical care has been identified to be below Western standards, with medical supplies limited, and variable sanitary conditions.

I know diabetes doesn’t mean you should stop travelling, but I also don’t want to take unnecessary risks. I just keep thinking…what if she gets a stomach bug and cannot keep anything down…

Always pack 3 times the amount of insulin and supplies you think you’ll need.

All D-supplies always go into carry-on luggage.

Utilize Frio pouches and check every 2 days to make sure they are “charged” adequately with cold water. Do not keep Frio pouches containing insulin in anything air-tight.

Never use a hotel fridge (or any fridge with which you are not familiar) to store your insulin.

Pack an extra emergency glucagon kit and read up on how to use mini-glucagon.

Happy trails!

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I’ve never been to any type of remote location, but Frios are great for protecting things from heat. I’ve heard of people sticking those stick-on thermometers meant for fish tanks onto things like EpiPens stored inside Frios so that it’s easy to pull htem out and see if they are overheating.

If worried about stomach bugs, it’s probably also not a bad idea to bring some basic medications for that type of thing.

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I basically follow all of Rose’s rules with two exceptions.

  • If it’s to be a long trip—say more than 4 or 5 days—I carry several days’ worth of supplies on my person and check the rest. (That does not apply to insulin; all the insulin always goes with me.)

  • I will use a hotel fridge, but first I dial the temp way down and test it using a glass with half an inch of water in the bottom. If the water stabilizes at a good temperature and does not freeze, then I’ll take advantage of the fridge.

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Another thing I do (though I’ve never had to use it) is have a note from my doctor explaining that I have Type 1 diabetes (and also severe food allergies in my case) and need to keep my medical supplies with me at all times during the flight. Like I said, I’ve never had to use it, but you never know when airline personnel may try to take things away. Once they tried to take my white cane away, claiming it could be used as a weapon and needed to be stored in cargo (this was a very small plane, but still, mind-boggling as far as I’m concerned).

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I would also add that it’s wise to have a physical copy of your doctor’s prescription for insulin (and needles) and it should be translated into the languages of all the places you’re going to visit. Then if something happens to your insulin or supplies, you can find a pharmacy and get the insulin or other related supplies you need.

In some countries, you don’t need a prescription. Years ago in Israel, I didn’t need a prescription for a “prescription” medication (which wasn’t insulin, however); I simply pointed to the medication in the PDR when my pathetic Hebrew didn’t work. Likewise, some countries won’t fill prescriptions written by doctors in other countries.

Neither of these concerns should dissuade you from following Timbeak’s advice, however!

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It might also be a good idea to have the number of the consulate in the country you’re visiting. They might be able to steer you to pharmacies and clinics who could help you out should the need arise. I would do this when you get to that country if you’re going to be there a few days or more.

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I travel to remote areas in Southern Africa often. Get travel medical/evacuation insurance. In order to cover a preexisting condition, you need to get it within a week of your first trip payment. Read all the fine print so you are covered. I use www.insuremytrip.com. Unfortunately with a preexisting condition you need to insure the travel, you can’t just get med/evac. It adds a lot to the cost but no one should travel without insurance. Anyone can get hit by a bus. They will transfer you to better hospitals once stabilized - even other countries.

I rarely suggest it, but ask your Dr for a Cipro prescription and fill it. For bad “stomach bugs” it can be the only thing that helps. Drink bottled water, stay in higher end hotels/lodges with purified water, stay away from street food. I’m bad about those - I drink tap and eat everything (low carb, real food). Take it only as directed by your dr. It’s not an antibiotic that should be taken “willy nilly”.

Get vaccinations recommended for the area traveling. Malaria is common in Asia and take recommended actions. (It’s almost eradicated in Southern Africa - very exciting!).

A prescription written by a U.S. dr is not valid overseas. You will need to see a dr and get an rx in most places you travel.

Sign up with the State Department Smart Travel (STEP) program when you travel. I’m not concerned but I also include dates of travel through airports. It just lets them know you’re there and easier to reach out, or they’ll reach out to you, for help if you need it. I let them know I have T1D n the form.

Get an unlocked cell phone and buy a local Sim Card for making calls in addition to your regular phone. That way calls are cheap and people can still reach you. Text is best.

Make sure your fellow traveler(s) know how and when to use glucagon.

Know the airport, security and flight rules for what you can carry on. It’s different everywhere. European airport security requires insulin not used on the flight be packed in checked luggage - I won’t do that so plan well. It’s my biggest travel problem. I try to only travel with carry on - luggage gets lost too often. Some of our trips we’ve packed up a cooler instead of luggage.

I take a soft sided cooler for snacks, drinks, etc on planes and everywhere. Sometimes a Frio is not enough to keep insulin cool.

I’m sure I forgot a thousand things. Mostly be flexible and have fun. For a couple of years after my dx we stayed in areas with good infrastructure, now we are back to our adventurous selves. We still plan to retire to S Africa.

I’m not sure why you weren’t concerned before your child was dx. It’s the same for you as for a kid.

In addition to what has been mentioned I also highly recommend getting either TSA Pre-Check or Global Entry. In major US airports this will not only expedite your screening but in most cases you will be sent through a metal detector rather than AIS. Most pumps and CGM manufacturers advise you not to subject your equipment to AIS. I also take along the page from the user manual for my CGM and ask for manual screening of the receiver showing them the manual if the TSA personnel are obstinate.

It is also important to remember that many things like sensors and electronic devices should be kept in a normal temperature range and should not be placed in checked luggage. If you believe you can do a trip with carry-on but then are told that you have to gate check your bag, that can be a real problem. Not all planes have controlled temperatures in their hold and air temperature at 30,000 feet could be like -50 degF.

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I have never tried this, but I’ve heard that you are allowed extra carry-on luggage if that luggage contains medical supplies. Might be worth looking into if you have trouble fitting all medical supplies into one piece of carry-on luggage.

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This is basically what I do. I have a backpack in which I carry all my diabetes supplies and electronics. I carry all my electronics because electronics in checked baggage is not covered by carriers against loss, damage or theft. I will check my CPAP, but I don’t have much choice.

That works in the US (and southern African countries we’ve true it) but not in Europe. They don’t even want extra meds or valuables on board. The ADA has our back on this and it’s the law here they must allow our meds under the Americans With Disabilities Acr. Not so in Europe. I was referring to Wurope and European carriers - the rules don’t apply and it sucks. One of the agents said I should have a note from my doctor for “special treatment”. I wanted to slug her. Special treatment my a$$. None of them would allow the extra little bag (even with a note).

I thought I had it all worked out for our last flights. Nope - it was awful. Hopefully I can avoid Europe airports until someone finds a cure. Or bring my endo with me to “write a note”.

Completely frozen ice is allowed through security in U.S. and Europe. Strange but true!!

We’ve travelled with our T1 teen in England, Italy and Amsterdam with no issues in taking insulin or other diabetes supplies in our carry on bags. Heading to Spain next year. Europe hasn’t been a problem for us so far. We’ve also been to Japan and Tanzania. As others have said, don’t trust the hotel fridge (testing it with a glass of water is a great idea!). We always use Frio pouches. They aren’t designed to keep the insulin cold, but will keep it cool enough to keep it from roasting. We split her D supplies among the 3 of us, so we all have a little of everything. We do bring a ketone meter and a prescription of Zofran in case any stomach illness shows up. I have also brought a backup loaner pump with us just in case ours dies (because we all know that pumps choose to die at the worst possible moment!). We haven’t been too far off the grid with her D, but I wouldn’t hesitate to travel to far flung places, as long as I was extremely prepared. Travel insurance is an excellent idea and having a few phrases in the local language handy might be helpful as well.

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Splitting the supplies amongst two or more people in case one bag is forgotten or stolen is an excellent idea; I’ll be sure to do this the next time we travel.

I did this with a C-PAP back in July. I had my 21" suitcase and another bag about the same size and the small soft-side case with my C-PAP. I was told numerous times that I couldn’t take it (at the plane door) but when I said what it was, they let me go on and board (albeit, sometimes grudgingly). I also had the same response to the small bottles of apple juice I carried. The TSA agents just automatically said “You’ll have to throw this away” but when I said it was to treat hypoglycemia, I was allowed to take it. You just have to know the rules (bc sometimes the agents won’t even know – one of them had to go ask about the juice). And be prepared to insist, not in an overly aggressive way, but knowing what’s what goes a long way. I DID read a lot on the TSA website and even called them to ask questions. Hope that helps!

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I’ll add to what Geannie has just said: It can’t hurt to print up the exceptions to the TSA rules and have them ready to present at check-through. I’d also recommend prefacing any showing of the printed exceptions with something along the lines of “You know, I wasn’t even aware of these exceptions until I was diagnosed with diabetes.” Such a statement might go a long way towards lessening a TSA agent’s defensiveness. Then again, it may not. IMO, it’s worth a try.

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Ive been allowed to take An entire jar of Sunbutter on a flight after telling them I had it for severe food allergies (I also had a doctors note stating the same, which I didn’t use). It definitely pays to know any rules and exceptions in detail and come prepared to make things as smooth as possible. I was so nervous the first time I went through customs with literally a suitcase of food for a one-week trip. There are a lot of prohibit tied foods going through customs. But I had my doctors note, had gone through the rules in detail, and handed the customs agent a list of all the foods I’d packed with a short note at top stating why I’d packed so much food. Smoothest customs experience I’ve ever had!

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I fly to and from work multiple times a month. It’s become so routine for me that I don’t even think about it anymore. TSA has never, ever given me any kind of hard time whatsoever. I don’t even declare my insulin or the gel-ice packs I carry it with in a small cooler inside my carry-on. I just put my carry on on the belt. Just last week coming back from Hawaii was the very first time they’d even mentioned it-- I had filled up a gallon ziplock bag with ice from the hotel bc my gel packs were melted. By the time I was to the airport the ice in the bag was largely melted-- they asked to look in the cooler and asked if it would be OK to pour the excess water out of the bag I said sure, did so, and went on with my business. I’ve probably flown with my diabetes stuff in my carry-on, including an ice pack, well over 100 times and they’ve never said a word except that.

That’s another good travel tip-- while mini fridges are notorious for freezing things solid, I can absolutely guarantee that a small cooler with ice or ice gel packs in it never will (unless it’s below freezing temp outside the cooler for a long period of time… In which case you’d be worried about keeping it warm instead of cold anyway)

I do kinda the same thing with a hotel fridge. I keep my insulin in a frio or “fridge to go” until I have checked out the fridge in the hotel. I put a cup of water in it and check it before utilizing the fridge in the room. Once in a very upscale hotel, the water froze. Soooooo glad I had my system in place.