Traveling with Type 1 Diabetes: Tips from ACTUAL Travelers with T1D

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Not that any of you are particularly invested, but my grandmother wants to visit her family in Georgia. She and her siblings are getting older, so I understand – and encourage it! But my grandmother hasn’t been back to Georgia since she ran away to California as a young woman. In fact…my grandmother hasn’t been ANYWHERE since she settled in Southern California over seventy years ago. She hasn’t even been on a plane. So her recent desire to hop across the country is going to be a major milestone for her. While she has a lot of worries and hesitations about traveling, one of her concerns: she has diabetes. Unfortunately, I couldn’t provide any advice for her, but I wrangled up some experts in the field of traveling with type 1 diabetes.

The experts: well…travelers with type 1 diabetes. They know the ends and outs of traveling with type 1 diabetes, from what snacks to pack to what to do when you run out of insulin. All from first-hand experience.

That said, they ARE NOT medical professionals, so for any information pertaining to your health and physical wellbeing, please consult with your physician. But for travel tips, WE GOT CHU! Alright, enough chatter, time to get the party started!

Let’s Meet Our Travelers!

Disha

Hi, I am Disha, which means “Direction” in Hindi. I associate myself with seeking freedom, opportunities to enjoy life, going to new places and experiencing new things. I am 27 year old! Most of which I lived in Mumbai, India (25 years) and later moved to the UK. I have been living in London ever since.! Ohh, I am Type 1 Diabetic, since I was 5. And of course, I am a travel addict. I have been to over 20 countries since I started traveling in 2017, while working full-time. When I am not spending my free time on travel websites, I like to cook and make new cocktails (kind of a self-proclaimed Mixologist)

Mel

My name is Mel Stephenson-Gray and I’m from Wales in the United Kingdom. Outside of loving to travel and having new adventures, I’m also an athlete and coach, with a passion for food and nutrition. I also happen to have type 1 diabetes, which I was diagnosed with 18 and a half years ago.

Waiiit…what IS Type 1 Diabetes?

In the most simple of terms, for those of you unfamiliar with the diabetes realm: Type 1 diabetes is an auto-immune, chronic illness where your body’s defense system attacks the insulin-producing cells in the pancreas. The body is unable to produce insulin, which is the hormone that allows your body to use sugar (glucose) from carbohydrates in the food for energy or energy storage. Of course, this is the most basiccc explanation, and there are exceptions, outliers, and usual conditions. Make sure to check in with your physician to get the scoop on the specifics of your personal diagnosis.

Do you need to consult your doctor before travel?

Mel: I do consult with my Diabetes specialist team before I travel. I get a letter from them to let people (airport security) know that I’ll be traveling with a medical condition and additional supplies. I also contact my GP and pharmacy ahead of traveling to order enough supplies to cover the entire length of the trip. Make sure you give yourself enough time to ensure your supplies arrive on time!

Disha: Yes. Especially if it is the first time you are traveling or if there has been a change in your medication. Carry your diabetes ID and that letter from your GP. Both of these should say you have diabetes and the medication you need to treat and what equipment you might be carrying. 

Also, check-in with your doctor to ask if any vaccinations are required for your destination, I typically go at least six weeks before for vaccinations. Never skip vaccinations! As you know, diabetics can potentially weaken your immune systems so outbreaks, flu strains, and other colds can affect us harder than others.

You must also discuss with your doctor if you have planned activities that could impact your blood sugars and what to do about it. Buttt, besides these scenarios, a seasoned traveler with T1D can embark on their adventures as usual without consulting the doctor.

Do you need to bring a medical note for medications?

Mel: I do carry a medical note for all of my medications and diabetes supplies, as detailed above. I also carry a recent prescription as further evidence of which one I am currently carrying. Not related to the doctor’s note, but jot down some useful phrases, such as “I have diabetes” and “where is the nearest pharmacy?” if you are going to a country where English is not a spoken language!

Disha: Yes. The note or letter from your endocrinologist should clearly state that you are a type 1 diabetic and will be taking insulin vials and/or pens, needles, test strips, glucose tablets and juice for hypoglycemia (hypos) treatment, glucagon for severe hypos, hypo snacks, ketone test meter and strips, insulin pump, CGM sensors, etc with you. You know, ALL THAT FUN STUFF. Make sure you are carrying the prescription on your person and the medication should have your name on it.

If you are using an insulin pump and/or CGM, the letter should state that under no circumstances should you be put through whole-body scanners or any X-ray machine, as the x-ray can interfere with the pump causing pump failure.

It’s also important for people and their doctors to be well versed with airport security guidelines. Consider incorporating those guidelines into the text of their travel letter.

Should you arrive at the airport any earlier than normal?

Mel: I like to arrive at the airport at the earliest point that the airline recommends. It can sometimes take a little longer to get through security when wearing a medical device. Especially at busy airports. Arriving with plenty of time also gives me the opportunity to hydrate and get food if needed. In the UK, we now have the hidden disability sunflower lanyards, which I’ve found incredibly helpful in many airports. They let airport security and staff know that I might need a little more time, patience, and understanding. Last year in the USA, the Seattle airport was the first to adopt this voluntary program as well!

Disha: Not really. But if it’s a new airline or a new airport, it doesn’t hurt to arrive 15-20 mins earlier than usual (for you) as maybe some airlines might ask you to fill additional paperwork for your medical equipment. It also may take longer to manually scan your devices or explain your equipment to an officer with no prior experience with diabetes devices.

These situations are very few and far between for me, but 30 minutes is nothing if it means getting a good start to your vacation.

Are you allowed to take insulin in a carryon?

Disha: Insulin MUST be carried in a carry on/hand luggage. Your checked luggage will be exposed to extreme temperatures in the plane’s cargo section, which can render the insulin useless. Also, there is a chance that the checked luggage could get misplaced, which could leave you without your life-saving diabetes supplies. People with type 1 diabetes are allowed to take more than the standard limit of 3.4 ounces of liquid per item through security. You can take as much insulin and supplies as you need, provided you have a prescription for the supplies and a note from the doctor.

Mel: I carry my supplies in a separate bag, with items that need to remain cool, such as insulin in a Frio cool bag. The insulin does briefly need to be put into a clear plastic bag, as do all liquids, for going through security. 

Have you ever had any trouble getting through airport security? 

Disha: Ahh…anyone at any time can have hiccups with airport security. While each airport is different, here are some general tips to help people traveling with type 1 diabetes get through airport security.

• Tell the security screening officer that you have diabetes and have ‘robotic’ parts attached to you. You can go through the body scanner machine (not the x-ray scanner) with your pump on, or choose a private pat-down/feel-up.  Even if you go through the screening device, chances are it would beep and you may be asked to touch the pump and then have your hand-tested for explosive residue.
• It is not recommended to remove your insulin pump before body scanning. You must show the doctor’s letter ask or ask to speak to a passenger support specialist, a TSA officer who’s trained to assist people with health conditions. This usually doesn’t happen as airport staff members are becoming more aware of insulin pumps.
• Make sure to double-check that you have all your medicines and devices after the security! There have been many cases where people forget to pick up their pump, PDM, or insulin. Please don’t make that mistake.

Do any of the x-ray or scanners in TSA damage pumps?

Disha: Insulin pumps are designed to withstand common electromagnetic interference. You can continue to wear your insulin pump or continuous glucose monitor (CGM) while going through common security systems such as an airport metal detector. It will not harm the device or trigger an alarm. But make sure that you do not send the devices through the x-ray machine.

Most tubed pumps use direct current motor technology and strong magnetic fields. An x-ray can re-magnetize the portion of the motor that regulates insulin delivery.

Similarly, pumps should also not be exposed to luggage X-ray machines. However, Omnipod and its PDM isn’t affected by X-ray exposure and hence safe to be worn during security checks. 

What are must-pack items for a carryon? 

Mel: In addition to my diabetes supplies, I also carry food with me. Mostly snacks for the trip! There have been situations whereby we’ve been delayed on the tarmac for hours and the airline crew was unable to start serving/ selling food. It can be a really tricky situation when you have diabetes, so it’s best to carry your own snacks. I also carry fast-acting glucose hypo supplies, just in case.

Disha: We often joke in our community that diabetics cannot be light packers. There is some truth to that. We often have to compromise on space by leaving out clothes and shoes because of the enormous quantity of diabetes supplies we have to carry. You can find a full list of everything you should pack here (both carry-on AND checked luggage!), but here are some general guidelines:

Traveling with Type 1 Diabetes: Packing Tips

• Carry multiple insulin pens and pump supplies in your cabin bag and backpack! If you are traveling with someone, consider stashing some in their bag so you have multiple backups in case yours gets lost or stolen!
• Whatever you do, DONT put your insulin in your checked bag.
• Most airlines will let you carry an extra bag (small handbag) for medical supplies, although you should inform them in advance. You might be able to squeeze some extra shirts or light pieces of clothing inside as well!
• Pack twice as much medicine as you think you’ll need. TRUST ME.
• Carry the medication in the same packaging as you receive them. If you need to swap out the packaging for whatever reason, ask your pharmacist to print extra labels to attach to the new medication bottle.
• If you are on a pump and you think you need a backup pump during your trip, reach out to your pump manufacturer. They can enroll you in a Travel Loaner Program. It is really helpful and puts your mind at ease, especially if it’s your first time traveling!

Do you have any favorite pumps that make traveling easier?

Mel: In the UK we tend to have 4-year contracts for our insulin pumps. So we don’t get to change them when we go abroad. I’m fortunate that my pump company offers a loaner pump for me to travel with. I prefer traveling with an insulin pump because it enables me to easily keep track of my glucose levels with continuous glucose monitoring. It also allows for easy and quick adjustments, which can be incredibly useful in a new environment.

For example, on a trip to Morocco last year, I was doing the Diabetes UK 1 million steps challenge. I needed to make adjustments for my insulin with all of the extra walking. In addition, you are able to change time zones easily at the click of a button on the pump.

Disha: There are essentially two types of insulin pumps available in the market – A tubed pump and a tubeless one. 

For me, the major benefit of having an insulin pump is the flexibility to eat in food markets while traveling. Before, I had to plan my meals beforehand, calculate the intended carbs, and give myself insulin so as to avoid multiple injections. But with the flexible insulin delivery, I can now enjoy street food, markets, and spontaneous snacking better.

Pro tip – A general rule of thumb before choosing an insulin pump: check if the pump is globally manufactured and distributed! My friend’s pump failed on day three in Ghana. Day three out of a MONTH LONG trip throughout Africa. Sounds like a nightmare, right? Well. Due to the global reach of her pump’s manufacturer, she was able to get a new pump in 36 hours!

Does travel ever make your blood sugar levels unpredictable? 

Disha: It most definitely does. One thing about blood sugars is that there are 100 different factors affecting it. Liiiike stress, altitude, change of atmospheric pressure, food, exhaustion, sleep quality, dehydration, etc. And if one solution is working for me today, that doesn’t guarantee it will work for me tomorrow. So it’s kind of a trial and error situation. Having said that, technology in type 1 diabetes is advancing every 6 months and it is making “typical” activities such as exercise, socializing, and traveling with type 1 diabetes increasingly easier to manage.

Mel: Travel does add an additional challenge when managing blood glucose levels and diabetes. Whether that’s walking long distances in airports, changing time zones, not having regular meal times, or eating new foods with unknown carbohydrate contents. Heck, even the excitement and emotions of being in a new environment can have an impact on your blood glucose levels. Not to mention the challenges that different climates adds to the mix! Traveling with type 1 diabetes is never dull, that is for sure!

For more insider tips on managing your T1D on an airplane, Disha spills more secrets in my “Traveling with Type 1 Diabetes: Airplane Edition” post!

How do you deal with switching timezones?

Mel: I carry my insulin in a Frio cooling wallet and set a timer or reminder on my phone. This allows me to keep track of when the insulin wallet needs to be re-energized. However, I always ensure that my insulin is the first thing that I unpack and put into the fridge when I arrive in a new place. It is EXTREMELYYY to forget this, especially when you’re in an exciting new city and there’s plenty to explore. But, it won’t be any fun if your insulin spoils and you get sick. So. Just set a reminder.

Disha: This is tricky. When traveling east to west, the day is lengthened. Some doctors will advise you to take an extra meal and cover it with extra insulin. When traveling west to east, the day is shortened and the amount of insulin and carbohydrate may need to be reduced. Make sure to discuss this with your doctor before your trip! They can help you judge what you may need depending on your specific body.

If the time zone change is less than 4 hours, then there probably won’t be any major change required in the insulin regimen. 

Timezones are inherently annoying

Disha: Coping with timezone changes varies from person to person. Some people try to stick to the schedule of the departure country, and try to slowly transition after arriving at the destination. Others do the opposite and leave out their long-acting insulin altogether and rely on short-acting injections until they are back on the 24-hour clock in your country of arrival. Many people try three short-acting injections during the day, followed by a medium or long-acting injection in the evening. This regime gives a great deal of flexibility.

So, again, it is important to discuss this with your doctor to find a regime that works best for you.

Personal note: The important thing to remember is that “running a bit high” for up to 24 hours is unlikely to cause you any harm. At least in my experience. So don’t stress if you can’t get it right the first time.

Is travel insurance more expensive for Type 1 diabetics?

Mel: I buy travel insurance for every single trip I take, declaring that I have Type 1 Diabetes. Even if I’m just going abroad for a day or two, just in case. It used to be really expensive to get insurance with my T1D. But now, I use the comparison websites to check which is the best deal. I have noticed that the costs for cover have come down dramatically in recent years!

Disha: Having a chronic illness can really bump the price up for travel insurance, especially if you have any complications. Unfortunately, this is one added cost you should not avoid. There are a lot of factors that can make you sick while traveling with Type 1 Diabetes. And trust me, you don’t want the stress of paying those enormous bills while being sick – and in another country. 

And yes, people with pre-existing illnesses do typically have to shell out extra bucks for the travel insurance. But here are some tips on how to be smart about it:

Traveling with Type 1 Diabetes: Choosing Travel Insurance

• Check if your bank or credit card already covers travel insurance. Some banks and cards are sweet like that, but make sure you tell them about any medical conditions. They might not be as sweet after that. But better to know in advance!
• If you are not as lucky, then make sure to compare, compare, compare! Look over websites, compare quotes, and shortlist the insurers that fit your criteria – cancellation, excess, cover, defaqto rating, etc. There are several websites in the UK like GoCompare, ComparetheMarket or even Diabetes UK.
• Once you have a list, call them and try to negotiate the price. Hinting that you are considering two insurers and asking if they could offer you a deal generally helps. Hint hint.
• Next, you should buy travel insurance ASAP since it will also cover any flight cancellations that you have to make due to illness. Even before the trip begins!
• Always declare all your pre-existing conditions and complications or your claim can be rejected later. No fun.
• I have also noticed that with pre-existing conditions, buying an annual policy may be prohibitively expensive. Get quotes for both single-trip and annual cover, and work out what will be most cost-effective for you.

Any recommended snacks that you love to bring on your trips?

Disha: Protein bars, nuts, and fruits are my go-to snacks. Now that I am on a Tandem pump + Dexcom G6 which suspends lows, I need fewer snacks to treat my hypos. So, I am always on the lookout for 10 gm carbs worth snacks, enough to satiate me after a hypo but not much to spike me crazy. Honestly, choose whatever snacks you like, just make sure you know the carb content. It can be hard to find snacks abroad in a pinch, much less know their carb content if its a different language!

Mel: I take snacks with me that won’t melt, especially if I’m going to be going somewhere warm. It can be really challenging to carb count a food that is all stuck together! 

Do you need to watch what you eat abroad?

Mel: Because I follow a gluten-free diet, I do have to be very careful when eating out while traveling. I always look up the term “gluten-free” in the local language of the country I’m visiting. I also always research restaurants and places to eat in advance that are both clean and appealing, with locally sourced food.

As much as we all love spontaneity, always check to make sure food is thoroughly cooked and be especially vigilant of sanitation practices. If you’re eating street food, try to go for vendors with gloves (if they are handling the food with their hands, especially if they are also taking cards/money. Also, if you can, choose busier street carts – the food is more likely to be fresher! If may seem like a lot to watch out for, but food poisoning (or even a stomach bug) is a real damper when you are traveling with Type 1 Diabetes. However, I do still enjoy tasting local cuisine, as that’s all part of the enjoyment and adventure of going on holiday! 

Disha: Contrary to the common perception that diabetics cannot eat sugar or carbs, we can! We can eat churros, ice-cream, pizza, and everything. The caveat – we need to be extra careful to match the amount of insulin to the number of carbs. Guestimate is the key in such situations. I have to definitely watch what I am eating because I need to know how many carbs are in the dish, or if it is high in fat. Both will affect insulin absorption and determine the number of units of insulin needed.

I try to google a particular dish before visiting if I have never heard of it before! If it’s a popular dish, there are usually nutritional values available online. Otherwise, I do what I know best – Guestimate, take insulin, and hope it’s not too off, haha!

Do you have trouble traveling to warm or hot destinations? What about cold destinations?

Mel: Warm destinations can be more difficult to navigate, as insulin can spoil quickly in the heat.

Traveling with Type 1 Diabetes: Tips for Hot Climates

• In hot climates, the biggest threat is the sun so wear clothes that cover and protect your skin! Easy, breezy, light-colored clothing, and try not to expose your insulin pump to direct sunlight. Aim to sit in the shade and put your pump in a cooling wallet while swimming. 
• If going out for the day, keep the majority of your insulin in the fridge at your lodging. Just take one vial out with at a time, just in case you need to do a set change for my pump. Keep the extra vial in a cooling wallet!
• Drink plenty of water, even if you’re not thirsty, to avoid dehydration. Try to avoid alcohol and caffeine, especially in the peak degrees, as they can further dehydrate. 
• Amp up your sun protection. Make sure you wear high factor sunscreen as sunburn can raise your blood sugar levels. For sunscreen options that are vegan, reef-safe AND won’t leave a white residue on your skin, check out this sunscreen post for recommendations!
• Use sunglasses that have a UV400 label to make sure they protect your eyes.
• Ditch thy uncomfortable chappals. Diabetics need to take care of their feet and when you add hot climates, you gotta be extra careful. Don’t go barefoot and protect them from the sun with socks or sunscreen.
• Be careful of misleading test results because the extremes of temperature may affect the accuracy of your meter!

Traveling with Type 1 Diabetes: Tips for Cold Climates

• Take precautions when out in the cold by wearing extra layers of clothing, gloves, and thermal wear, etc. Keep your feet warm because there is no messing around with feet and frostbite when you are a diabetic!
• Your body may absorb insulin more slowly in cold weather, then suddenly speed up once you warm up (like stepping inside of a building after being outside). This can lead to erratic sugars. 
• Make sure you keep your insulin at the correct temperature because insulin starts to freeze at around -3 °C or 26°F rendering it useless. Frio bags can be used in cold temperatures to keep insulin safe. You can also use MedAngel smart thermometer to measure if the insulin is safe to use.
• Hypos can be more dangerous in cold conditions since they interfere with your body’s attempts to stay warm and increase the risk of hypothermia. So make sure you test more often and don’t rely on feeling the symptoms. In cold weather, it can get confused with normal body shivering.
• Cold weather can also affect other diabetic equipment like insulin pumps, blood testing monitors, CGMs, FGMs. It is recommended to check with the manufacturing companies if their devices can withstand extreme temperatures.
• One trick is to wrap the devices and batteries in scarfs or gloves to contain the heat and remove, use and put them back in after use. Or, keep your insulin close to your body!

Have you ever run out of insulin or supplies while on vacation?

Disha: This happened once when I was working in a different city in India. I forgot all my insulin supplies at home. Fortunately, in India, you don’t need a prescription to purchase insulin! So I just went to a pharmacy and bought it. If this happens to you, you have some options. Most countries will sell you insulin only with a prescription, but you can still try to explain the situation to the pharmacist. Show them the doctor’s letter stating that you are Type 1 Diabetic on insulin. This option has worked for many people I know. 

You should be aware, however, that insulin brands vary in each country. They may not stock your exact insulin. The insulin strengths can also vary in different countries, so you must check if the insulin is the same strength as you normally inject in your home country. If not, then you need to convert and match the insulin units. There is a risk of hypo, so it is ideal to have someone double-check your math.

In case this doesn’t work, you can always post about your situation online in the local diabetes social media groups. Almost always there is at least one other diabetic that will help you out. The Diabetes community online is powerful!

Have you ever had to visit the hospital, pharmacy, or a doctor abroad?

Disha: Ohh Yes. Last year, I went to Belgium for my birthday. That day in July was the hottest day in Europe, and I suffered a heat stroke. My symptoms started late at night and I suffered from stomach cramps and vomited through the night. I decided to visit the hospital and told them about my diabetes. I had to wait for a while to be seen but after some tests, they said I was dehydrated and I was put on I.V. They also managed my blood sugars and I was discharged in the evening.

I didn’t have to pay anything at that point because of the EHIC (European Health Insurance card) as UK was still a part of the European Union at that time. The card ensures that you have easy access to healthcare in that country, but later I ended up paying 200 euros for the treatment. An expensive lesson learned on dehydration, lol.

What advice would you give to people who are “too hard on themselves” about their diabetes? 

Mel: Diabetes is not an easy condition to manage and it often requires that we reflect on our management in order to make adjustments to improve our methods. But with this reflection can come over-analysis where we can be too hard on ourselves, which can also be exhausting. 

In a way, this is where travel can be a real positive. As managing diabetes away from home brings its own challenges, doing so can also build confidence. Traveling with Type 1 Diabetes can help promote skills in organization and planning. Plus, it gives us a break from our regular daily routine. However, despite being on holiday, Diabetes is still there and needs to be taken care of. But traveling with Type 1 Diabetes has been a liberating and empowering experience for me! It’s been brilliant traveling all over the world and not letting T1D hold me back! 

Disha: I know Type 1 Diabetes is shitty. No one WANTS it. It can be stubborn, it needs a lot of attention, and comes with stress, pain, and bruises. I feel ya. But you have to also remember that because of T1D, you now know how mentally and physically strong you are. This 24/7 responsibility fell on your shoulders out of nowhere and you managed to pick up the pieces together over time.

You, my friend, are a freaking champ!

So, you can do anything and everything in life that you fancy – be it sports, swimming, diving, hiking, cycling and yes, even traveling. It’s only a matter of having the right knowledge and a bit of guidance. Just give it a shot, I promise you will find a way for your passion and your condition to co-exist.

What does travel mean to you?

Disha: Travel is the fuel that drives me. Personally, it’s about knowing the world, meeting people, experiencing cultures, eating delicious food, and finding unexpected surprises along the way. With diabetes, travel can be intimidating. I have had moments where I had wished ‘Man! If only I was normal, I wouldn’t have missed a beautiful sunset because of a nasty hypo’

But those issues are clearly not enough for me to give up on my passion. Please don’t give up on something that you love because you have a long-standing illness. With the technology and support available, you can do anything anyone else can (well, except make your own insulin – lol).

Traveling with Type 1 Diabetes has made me resilient. It has made me confident because I now know my body and symptoms better than ever. I am motivated to try different activities, which I was previously afraid to try. Diabetes has connected me to so many Diabuddies from different continents!

Mel: Travel to me means freedom. It means exploration and adventure. It reinvigorates my soul! But it isn’t all just fun and games. Travel also means self-awareness and self-development, which can be really helpful when managing diabetes. Travel reminds me that if I can manage my condition when away from my usual routine, support network, and home comforts, then I’m stronger than I realize.

Conclusion:

YOOO!! This post was PACKED to the brim with advice and personal experiences! If you’re interested in learning more about traveling with a chronic illness and disabilities, I also have the following posts to check out!

• Chronic Condition Travel
• Traveling with a Wheelchair

Thank you both Disha and Mel for all of your tips and tricks for traveling with Type 1 Diabetes! You can follow them at their respective social channels below!

Mel

instagram: @lifesportdiabetes

website

Disha

instagram: @travelwithat1d

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