Diabetes is a chronic disease that patients must learn to live throughout their entire lives. On an emotional level, this can mean patients go through different cyclic stages and may need support.

The diagnosis of a chronic disease implies an end to the patient’s previous health status. To adjust to their new medical condition, patients need to initiate a series of adaptive psychological mechanisms which entails passing through different stages: initial denial or shock, protest, anxiety, active negotiation and adaptation, “It would be better if I did not have diabetes, but I have to learn to live with it.” This adaptive process varies greatly between each person with diabetes and also between family members; those involved may experience it separately and at different times.

Regardless of these differences, patients with diabetes, given that they have a chronic illness, may undergo different psychological, family, social and also financial changes.

Therapeutic education programmes that integrate individual and group sessions (with other people with diabetes and their families) also provide an initial aid in this adaptive process. Even with this support, some people are unable to adapt psychologically and require specific professional help from a psychologist or psychiatrist. However, psychologists do not form part of the interdisciplinary teams that look after patients with diabetes in our national health system.

The latest guidelines published by the American Diabetes Association (ADA) stress that emotional well-being is an important part of diabetes care and self-management for patients and/or their families. Psychological and social problems can compromise the patient’s and/or family’s ability to complete daily diabetes treatment self-management tasks.

The ADA has prepared a series of standards regarding emotional aspects:

  • Psychosocial support must be patient-oriented in order to benefit everybody with diabetes; it must count on their collaboration and should aim to optimise health outcomes and patient quality of life.
  • Psychosocial screening, which may include: attitudes about the illness, expectations for treatment self-management and outcomes, mood, diabetes-related quality of life, available resources (financial, social and emotional), and psychiatric history.
  • Providers should consider assessment for symptoms such as distress, depression, anxiety, eating disorders and cognitive disorders using standardised and validated tools at periodic intervals. Including caregivers and family members in this assessment is recommended.
  • Consider screening older adults (aged ≥ 65 years) with diabetes for cognitive impairment and depression.

Associations for people with diabetes can also offer patients another type of support, by giving them the opportunity to meet other people in the same situation, by providing support in schools, offering legal advice, giving informative talks, demanding quality care, stimulating research into diabetes, etc. Ask for information about these associations in your reference centre.

A patient with diabetes can travel without any problems; they just need to plan their journey.

medications inside the bag

Take your medication and devices for controlling your diabetes.

Potato, carrot, peas

Take foods that can provide you with the necessary carbohydrates in the event of hypoglycaemia.

medical history paper

Medical record with your treatment and evolution of the diabetes.

Food pyramid

You can try new foods, but you must still control your diet, especially your carbohydrate intake.

Vaccination

Vaccinations. Vaccines are used to prevent infectious diseases, which are a common cause of high blood sugar levels (hyperglycaemia). Vaccines are not contraindicated in patients with diabetes. Patients should learn about vaccination requirements according to the country or countries of destination.

Comfortable shoes

Preferably choose footwear made of soft, flexible leather, it should be lined, have no internal stitching and adapt to the anatomical shape of your feet.

Insulin kit

It is advisable to take everything you need to carry with you from your own country, doubling or tripling the amount needed and sharing it among your travel companions.

Diet is an essential part of diabetes treatment. Having diabetes does not have to stop you from enjoying good cuisine. Travelling also implies trying out new foods and new cooking methods. There is no need to deprive yourself of this pleasure while also maintaining control over your diabetes.

Take care with fruit, juices and milk

The foods you must control the most are those rich in carbohydrates; note the amounts you eat at home before going travelling so you have a good mental image and can subsequently eat similar quantities. Use bread or fruit as back-ups if the meal has fewer carbohydrates than you usually eat or to improvise a meal under any conditions and anywhere.

piece of cake

If you eat a sweet dessert as well, then you obviously need to eliminate some carbohydrates from the total eaten in the meal. For example, if you try a slice of cake, you have to remove fruit and bread from that meal.

Glucometer measuring blood glucose levels

During the trip, it is crucial that you eat approximately your normal total intake of carbohydrates with each meal, even if you vary the type of food. Capillary blood glucose measurements will help you assess the results of these dietary changes.

The best option is to take everything you need to carry with you from home, doubling or tripling the amount, if necessary, and sharing it among your travel companions as a safety measure.

Insulin concentration

  • Types of insulin administered via cartridges (pens) have a concentration of 1/100 everywhere around the world, but insulin in vials may not have the same concentration. In some countries insulin in vials is still marketed in concentrations of 1/40. Obviously a syringe with a 1/40 concentration cannot be used to extract 1/100 insulins and vice versa, another reason why you should always carry 2–3 times more insulin than you require and, even better, share it between several travel companions and always carry in hand luggage.
  • X-ray scanners used at airport security controls will not alter the effects of your insulin.

Insulin storage conditions

  • Avoid exposing insulin to light and extreme temperatures, anything below 0 °C or above 30 °C. These factors could affect the effectiveness of the insulin. In some cases, you may need to use a cool-box or isothermal bag.
  • Once damaged by heat, rapid-acting insulin can take on a yellowish colour. NPH or slow-acting insulins may not mix correctly and the absorption retarding particles may stick to the glass vial.

Regulations for carrying insulin on airplanes

  • Medicinal products, including liquids such as insulin, are exempt from carry-on rules for liquids and can be carried in hand luggage for subsequent use during the flight.
  • Medicinal products must be individually identified at airport security controls, but they do not have to be carried inside a plastic bag.
  • Recommendations are to carry the corresponding prescription or medical report with the medicinal products.
  • It is also a good idea to get in touch with the airline because each has their own procedures regarding carrying these items inside airplanes. You can obtain more information at the company’s website.
travel, ariplane

The low temperatures in the airplane’s hold, where checked luggage is transported, can damage insulin and/or capillary blood glucose meters.

Boat

Travelling by boat can be very pleasant if you do not get seasick. If you do, it is better to avoid this means of transport or take motion sickness medicine before the journey or as soon as the first symptoms appear.
• If you take oral antidiabetics or insulin to treat your diabetes and seasickness causes you to vomit, it could lead to hypoglycaemia. Inform your travel companion or the boat’s crew about your diabetes so they may administer glucagon if required.
• If you vomit, measure your capillary blood glucose and decide whether you can wait the 15–30 minutes required to eat or drink and be sure of digesting some carbohydrate-rich foods: tea with sugar, fruit juice, Melba toast, etc. • However, if your capillary blood sugar level is less than 80 mg/dL, drink sugared water immediately in small sips and ensure somebody is present who can inject you with glucagon if necessary (loss of consciousness).
 

 

Train

Train journeys can be very long. Respect your medication and meal schedules to avoid losing control over your diabetes. Ensure you know the restaurant car’s opening and closing times.

Bus

Organised tours may not fit in with your meal schedule. Always remember to carry foods in your hand luggage for improvising a meal: Melba toast, biscuits, fruits, etc.

If you inject insulin, then besides following the general recommendations, and depending on the characteristics of the trip, you may previously need to discuss adapting your regimen with your healthcare team. Any changes made will relate to:

  • Your treatment regimen
  • The journey departure time and duration
  • The time difference based on the longitude of the destination country

In general, if you are following a multi-dose insulin regimen (rapid-acting insulin before meals and long-acting insulin once or twice a day), then it is better if you just inject rapid-acting insulin every 4–5 hours during the journey as its short-lived action makes it easier to manage and also provides greater flexibility in your diet.

When you reach the destination country, adjust the long-acting insulin according to your normal schedule.

  • If you travel west, the day is longer. For example, when it is 8 pm in Spain, it is 2 pm in New York. You will therefore need an extra dose of rapid-acting insulin in order to adjust your regimen to the destination country’s time zone.
  • If you travel east, the day is shorter. For instance, when it is 8 pm in Spain, it is 2 am in Bangkok. And so you will need to eliminate a dose of rapid-acting insulin in order to adjust to the destination country’s time zone.
  • Patients who use continuous subcutaneous insulin infusion systems will need to set the time on the pump to local time when they reach the destination country, and then reverse this adjustment when they return home.
Substantiated information by:
Enric EsmatjesEndocrinologist — Endocrinology DepartmentMargarida JansàNurse expert in Diabetes and Therapeutic Education — Endocrinology DepartmentDaría RocaNurse expert in Diabetes and Therapeutic Education — Endocrinology DepartmentMercè VidalNurse expert in Diabetes and Therapeutic Education — Endocrinology DepartmentIrene VinagreEndocrinologist — Endocrinology Department

Published: 20 February 2018
Updated: 20 February 2018

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