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Traveling With Diabetes. Blake Elkins Project Echo 4/26/13. Diabetes and Travel. 25.8 million patients with diabetes in the US Approximately 8% of the US population 69% of Americans traveled for leisure last year 22% of Americans traveled for business last year

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traveling with diabetes

Traveling With Diabetes

Blake Elkins

Project Echo

4/26/13

diabetes and travel
Diabetes and Travel
  • 25.8 million patients with diabetes in the US
    • Approximately 8% of the US population
  • 69% of Americans traveled for leisure last year
  • 22% of Americans traveled for business last year
  • Potentially annual US travelers with diabetes
    • 17 million leisure travelers
    • 5.6 million business travelers
diabetes and travel1
Diabetes and Travel
  • American Diabetes Association (ADA) and Canadian Diabetes Association (CDA) provide online travel recommendation that include:
    • See Your Doctor Before You Go
    • Prepare For An Emergency Abroad
    • How to Pack
    • How to deal with Issues during Air, Car, and Sea Travel
    • Issues with Insulin
    • Issues with Destination
  • However, few studies have examined patient knowledge and provider practice regarding traveling with diabetes
are patients obtaining advice prior to travel1
Are Patients Obtaining Advice Prior to Travel?
  • Are our patients obtaining travel advice?
    • 76% of patient’s have never been asked about travel by a provider
    • Only 31% of patients have ever asked providers for advice relating to their diabetes and travel

Unpublished Data

are patients obtaining advice prior to travel2
Are Patients Obtaining Advice Prior to Travel?
  • Only 28% of our patients on insulin have EVER asked advice regarding insulin during travel

Unpublished Data

diabetes and travel2
Diabetes and Travel

Table 1: Traveling with Diabetes Poses Challenges

diabetes and travel3
Diabetes and Travel
  • Travel can be potentially hazardous for patients with diabetes
  • Our findings revealed:
    • Providers are not routinely advising patients about travel
    • Patients do not routinely ask providers about travel
    • When patients do ask, they most commonly ask about insulin and blood glucose monitoring issues
    • Many patients do attempt to obtain advice from other sources besides providers
    • Patients do not routinely plan for medical emergencies prior to travel and indicate they would deal with the issues when they occur at their destination
discussion
Discussion
  • Currently travel recommendations directed towards patients are available from the American Diabetes Association and the Canadian diabetes association online

http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/when-you-travel.html

http://www.diabetes.ca/diabetes-and-you/living/guidelines/travel/

diabetes and travel4
Diabetes and Travel
  • SEE YOUR DOCTOR BEFORE YOU GO
    • Bring your travel companion with you
    • Visit should be 4 to 6 weeks prior to travel
    • Review sick day protocols
    • Immunizations
    • Obtain documentation
diabetes and travel5
Diabetes and Travel
  • PREPARE FOR AN EMERGENCY ABROAD
    • Find a physician in the area where you will be traveling
    • International Association for Medical Assistance to Travelers (IAMAT) www.iamat.org
    • If an emergency occurs and you can’t find an English speaking provider you can contact the American Consulate, American Express, or local medical schools for a list of doctors
    • Call your provider at home
    • Wear a MEDICAL ALERT ID
    • Learn common phrases such as “I have diabetes” and “sugar or orange juice, please” in the local language
    • Travel insurance
diabetes and travel6
Diabetes and Travel
  • PACKING TIPS
    • Double the medications and supplies
    • Divide them into separate bags (both to be carried on)
    • Keep a bag with supplies on you at all times
    • Make sure to bring
      • Twice the amount of insulin or oral medications you will need
      • Twice the blood and urine testing supplies with extra batteries for your glucose meter
      • Emergency medications for hypoglycemia, diarrhea, nausea, small cuts
      • DIABETIC ID
      • FOOD – snacks both simple and complex sugars, protein and fats
diabetes and travel7
Diabetes and Travel
  • AIR TRAVEL
    • Issues with security and supplies
    • Stressful environment with catching planes
    • Eating while in the Air
  • CAR TRAVEL
    • Check glucose prior to travel and regularly during
    • Pull over at first signs of hypoglycemia and do not restart till blood sugar is within safe range
    • Avoid driving in the time period between your insulin injection and the next meal
    • Limit yourself to 12 hours of driving daily or 6 hours between meals
    • Keep medication, meal, and snack times as regular as possible
    • Pack food in case of delayed meals
diabetes and travel8
Diabetes and Travel
  • SEA TRAVEL
    • Try not to overindulge
    • Keep active on the ship
  • GREAT OUTDOORS
    • GO WITH OTHERS
    • Bring all your medical supplies with you and teach others how to use glucagon kit
    • Avoid cuts, bruises, sunburns, blisters, or insect bites
    • Increase food or decrease insulin for increased activity
    • Keep hydrated
diabetes and travel9
Diabetes and Travel
  • Issues with Insulin
    • Storage
    • Some countries still may use U-40 or U-80 insulin
    • Crossing Time Zones
      • TALK WITH YOUR DOCTOR OR DIABETES EDUCATOR
        • Bring flight schedule and information on time zone changes
        • Make plan for travel in both directions
      • Eastward means shorter day and maybe less insulin
      • Westward means longer day and maybe more insulin
      • CHECK BLOOD SUGARS every 4-6 hours during travel
      • Less of an issue for patients on oral diabetic medications
pre mixed insulin
Pre-mixed insulin
  • Twice daily pre-mixed
    • Take usual insulin before departure at the normal time
    • Prior to departure obtain an insulin pen with rapid acting insulin
    • Check blood sugars every 4-6 hours
    • If blood sugar above 200mg/dl give a correction dose preferably with a meal
      • Continue this till the patient is in the new time zone and can give the second injection of pre-mixed insulin in the new time zone after arrival (if taken at 6pm at home you take the dose at 6pm in the new time zone)
    • Could also consider switching to basal bolus prior to travel
diabetes and travel10
Diabetes and Travel
  • DESTINATION
    • Check blood sugars more frequently
    • Plan meals and activities remembering you have to take your insulin
    • Keep medications with you
    • Keep snacks with you
    • Keep hydrated
    • With increased activity check blood sugars more frequently
    • Wear comfortable broken in shoes and never go barefoot
      • Check feet daily and obtain medical care at the first signs of infection of inflammation
diabetes and travel11
Diabetes and Travel
  • Converting Mmol/l to Mg/dl
diabetes and travel12
Diabetes and Travel
  • Continue taking insulin
  • Drink plenty of fluids
  • Test your blood sugar more often
  • Test for ketones
  • If unable to eat – then eat sick day foods
  • If vomiting seek medical attention