Diabetics must manage disease while traveling

Although travel could pose problems for diabetic Debbie Nuzzo, she’s able to control the disease even when thousands of miles from home.

“I have learned over the years the different things to do,” says Nuzzo, 52, of Stamford, Conn., who recently returned from a two-week European cruise.

Difficulties diabetics face when traveling include maintaining proper insulin management affected by changing time zones; circulation or foot problems on long car or plane trips; blood sugar levels affected by varied meal times; and problems replacing lost medication, as insulin concentrations abroad differ from those in the United States.

Diabetes occurs when the body’s blood sugar (glucose) is too high because of insufficient insulin levels. Without enough insulin, which helps transform food into energy, glucose remains in the blood at potentially harmful levels, requiring daily insulin injections.

Since blood sugar levels are affected by factors such as diet, activity, stress and medication, diabetics must check sugar levels throughout the day, especially when traveling.

Norwalk Hospital endocrinologist Dr. Sam Engel says diabetes management depends on one’s insulin program. Because of time and meal variables while traveling, he says: “(Diabetics) may need to take an extra injection or reduce their dosage or change the type they are using for a shorter-acting or longer-acting insulin.”

Nuzzo used to inject herself with an insulin-filled syringe, but five years ago she began using a battery-operated insulin pump worn on her belt. Life has become much easier with the pump, she says. This small piece of equipment, which resembles a pager or cell phone, delivers the exact amount of insulin required to control her blood sugar levels.

After testing her blood sugar and punching in the numbers on the pump, Nuzzo receives her insulin through a thin plastic tube with a needle at the end that is inserted under her skin. When traveling, she brings along extra insulin and other necessary supplies.

In the unlikely case the pump fails, Nuzzo also brings a supplementary supply of insulin (different from that used for the pump) and syringes. If the pump fails, she can order a new pump that she will receive within 24 hours “no matter where I am.”

For diabetics, “Overpacking is a very good thing to do,” says Nancy Ryan, diabetes educator at Greenwich Hospital in Greenwich, Conn.

Ryan suggests diabetics bring at least twice the amount of needed insulin and supplies. As insulin can lose its effectiveness in drastic temperature changes, she suggests packing it in carry-on luggage rather than expose it to the extreme cold of a plane’s luggage hold. When traveling by car, biking or backpacking, she recommends putting it into an insulated bag or cool pack.

“It’s always a good idea to have a couple of letters from the doctor,” says Stamford Hospital endocrinologist Dr. Antonio Pantaleo. The first letter should explain the traveler’s need for insulin administered by syringe or pump, including a list of medications and allergies. The second letter should include a prescription for insulin and other medications, in case of emergency.

Airports do not restrict syringes, provided they are accompanied by insulin supplies, Ryan says. The insulin must be in the original box marked with a prescription label and must be shown to airport security.

As to when to administer your insulin when visiting different time zones, have your doctor set up a schedule.

Another concern is diet. Pantaleo advises diabetics to “practice what they do at home, avoiding ice cream, desserts and soda. Even if they’re on vacation, it’s not a good idea to deviate from that.”

While Nuzzo thinks European countries have become “a little more sugar-free friendly,” many foods in Europe are richer and are often covered by heavy sauces. “I have to be more careful with what and how I eat,” she says.

Also, late suppers, customary in Europe, don’t allow foods to be digested before bed or allow time for an after-dinner walk to work off your food.

Diabetic airline passengers have been affected by dramatically reduced food service on planes. “Diabetics should always carry food with them, just in case their blood sugar goes down,” Pantaleo says.

Also, he suggests calling the airline in advance to check if it serves meals. If it does, the traveler should order a special meal low in sugar and fat.