Recommendations for Counseling Traveling Patients with Diabetes

MAY 23, 2019
Lourdes Cross, PharmD, BCACP, CDE, and Neil Vasavada, PharmD Candidate
Patients with diabetes may be concerned about difficulties with managing their health while traveling. In 1 survey, up to 1/3 of individuals reported that guidance from a health care professional would help reduce their fears.1

Health care professionals, including pharmacists, should discuss with patients should their travel plans before going on a trip to ensure that all necessary supplies—medications, glucose test strips, lancets, etc.—are enough to cover the duration of the trip.

In addition, prevention of acute complications, management of travel-related issues, and need for immunizations should be reviewed with a health care professional.

The CDC and American Diabetes Association (ADA) suggest the following for traveling with diabetes.2–6


Packing Supplies

Recommended items to take on a trip include:

Maintenance
  • Diabetes medications/insulin pump
  • Syringes/needles
  • Lancing device and needles
  • Glucometer and test strips
  • Urine ketone test strips
  • Cotton swabs
  • Alcohol swabs
  • Band-aids
  • Sharps container
  • Glucose log sheet
  • Transport bag with ice/cooling gel pack
Emergency Supplies
  • Glucose tablets/hard candies
  • Glucagon emergency kit
  • Medical identification
  • Health insurance cards
Snacks
  • Juice
  • Regular soda
  • Cheese and crackers
  • Peanut butter
  • Fruit

According to the ADA, best practice is to pack at least twice as much medications and glucose testing supplies as normally needed to minimize complications due to travel delays or lost luggage.3 Many manufacturers of insulin pumps will provide a loaner for international travel.

The CDC recommends carrying medications in the pharmacy bottles they came in or asking the dispensing pharmacist to print extra labels that can attach to plastic storage bags.2 Although not required by law, a physician letter describing the patient’s medical conditions, medication regimen, and medical necessity to bring supplies can expedite the screening process.

It is also important to educate the patient on the importance of preparing for emergency situations.

Hypoglycemia occurs in up to 10% of patients taking insulin during travel or in the first 24 hours after arrival.1 Patients should consider packing supplies that can treat hypoglycemia, such as glucose tablets, hard candies that contain simple sugars, and a glucagon kit.

Traveling with healthy snacks, such as crackers, cheese, peanut butter, fruit, juice box, is ideal to manage hypoglycemia.3 Patients should be encouraged to wear medical identification accessories to alert others of their health condition in the event of an emergency. The ADA also has a medical alert card available on their website that provides law enforcement officers and other first responders with critical information.7


Storage
A container with an ice or cooling gel pack should be used to store insulin and other supplies that need to be kept at lower temperatures. Once in use, most insulin pens should be stored at room temperature at <86°F (<30°C). One exception is insulin glulisine, which must be kept at 77°F.8 Patients should be reminded to not leave supplies in a hot vehicle or in direct sunlight.

When flying, travelers are allowed to bring all medical supplies on a plane in a carry-on bag, according to the Transportation Security Administration (TSA).9 It is not recommended to check in medical supplies, because fluctuating temperatures and improper handling of luggage may cause damage. People with diabetes are exempt from the 3-1-1 Liquid Rule, which means that medications, fast-acting carbohydrates like juice, and cooling gel packs in excess of 3.4 ounces or 100 milliliters may be packed in a carry-on bag and are not required to be placed in a plastic zip-top bag. Guidelines for flying with diabetes medications and supplies can change at any time, so it is always important to check with the TSA for current recommendations.

For those that are traveling across time zones, a phone alarm can be helpful to remind patients when to take their medications. The day shortens when traveling from west to east and lengthens when traveling from east to west, which can increase the risk of hypoglycemia or hyperglycemia if a patient does not monitor glucose closely and modify insulin administration appropriately. It may be necessary to provide guidance on medication adjustments to account for travel duration and differences in time zones.


Conclusion
Pharmacists and other health care professionals can provide education on self-management skills and adequate travel preparation for individuals with diabetes. Recommendations may help maintain glucose control and lower health risks. Travel advice for patients is important to alleviate stress, improve wellbeing, and increase confidence in planning for future trips.­­

 
Lourdes Cross, PharmD, BCACP, CDE, is an assistant professor at Sullivan University College of Pharmacy and Health Sciences, and a clinical pharmacist at the University of Louisville Hospital in Louisville, Kentucky.

Neil Vasavada is a PharmD Candidate at Sullivan University College of Pharmacy and Health Sciences.



References
  1. Burnett JCD. Long- and short-haul travel by air: Issues for people with diabetes on insulin. J Travel Med. 2006;13(5):255-260.
  2. U.S. Centers for Disease Control and Prevention. 21 Tips for traveling with diabetes. https://www.cdc.gov/diabetes/library/features/traveling-with-diabetes.html. Accessed May 16, 2019.
  3. American Diabetes Association. When you travel. http://www.diabetes.org/living-with-diabetes/treatment-and-care/when-you-travel.html. Accessed May 16, 2019.
  4. Bettes TN, McKenas DK. Medical advice for commercial air travelers. Am Fam Physician. 1999;60(3):801-810.
  5. Lumber T, Strainic PA. Have insulin, will travel: planning ahead will make traveling with insulin smooth sailing. Diabetes Forecast. 2005;58(8):50-54.
  6. Boerner H. Tips to trip by: the art and science of traveling with diabetes. Diabetes Forecast. 2008;61(5):42-45.
  7. American Diabetes Association. Know your rights. http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/law-enforcement/know-your-rights.html. Accessed May 20, 2019.
  8. Pearson TL. Practical aspects of insulin pen devices. J Diabetes Sci Technol. 2010;4(3):522-531.
  9. Burns B. TSA travel tips: travelers with diabetes or other medical conditions. https://www.tsa.gov/blog/2014/04/01/tsa-travel-tips-travelers-diabetes-or-other-medical-conditions. Accessed May 16, 2019.


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