Traveling with diabetes

• Use diabetes as an excuse to overpack. Traveling for a week? That equals six pairs of shoes and two weeks of diabetes supplies. Take double the testing supplies, medications, low blood sugar treatments, pump accessories and other medical items you think you'll need. And if you use a pump, pack as if you expect for it to quit working on the first day. If you're flying, keep everything in your carry on so you don't have to worry about your supplies arriving in Auckland while you deplane in Oakland. Driving? Use an insulated bag so supplies don’t overheat in the trunk while you're out exploring.
• Embrace your new time zone. But first, talk to a member of your healthcare team about how to manage your blood sugar as you cross time zones—especially if you use insulin. Depending upon how far you go, the direction of travel and how long you'll be visiting, your healthcare provider may want you to alter your therapy and check your blood glucose more frequently. Jet lag can also affect how your body uses insulin, how you eat and how well you can do math, so try to pay close attention to your numbers.
• Import your own snacks. Planes don't always leave or serve meals on time. Roadside dining may not offer great options. Cruise ships make it easy to go overboard with food and drink. A few (or few dozen) snack, nut, fruit, etc. bars with predictable carb counts (and effects) can come in very handy. And make sure you have a fast-acting carb source to treat a low.
• Between the selfies, keep a closer eye on your blood sugar. Walking an extra 20,000 steps a day, lingering meals later at night, new foods or a disrupted sleep schedule can impact your blood glucose levels in unpredictable ways. Why be surprised when you can simply test?
• Overshare. Tell airport security, your travel companions, your hosts and anyone else who needs to know that you have diabetes. Let people know what a low looks like for you. A note from your doctor can also be helpful for explaining the extra syringes, infusion sets, medications and a container of used sharps in your bag.

Sure, there's a lot to consider. But getting away is worth the extra planning.

A few smart steps now can help you avoid any surprises in the airport and in the air.

Diabetes and airport security

Navigating the security rules can be pretty taxing, although a quick look at the Transportation Security Administration site will fill you in on the latest.

The TSA rules make it clear that you can bring diabetes-related supplies, equipment and medications through the security checkpoint, although they will need to be X-rayed or hand inspected.^1,2,3

• Insulin and preloaded dispensing items such as syringes or pens
• Unlimited unused syringes when accompanied by insulin or another injectable medication
• Lancets, meters and all other testing supplies
• Insulin pump and supplies
• Glucagon kit
• Ketone test strips
• Used syringes, if they're in a hard-surface disposal container
• Juice, gel icing tubes or other items needed to treat or prevent hypoglycemia
• Freezer or gel packs
• Any other related medication, equipment and supplies

Explain to the security officer that you're carrying diabetes supplies so they can be properly screened. And if you're wearing a pump or continuous glucose monitor, check with the manufacturer. You may be able to go through the metal detector without disconnecting, and you can always ask for a pat-down and visual inspection instead.⁴ The TSA site asks that you inform the officer conducting the screening about your insulin pump or CGM.³

Your medically necessary liquids can be in containers larger than 3.4 ounces, and don't have to be put in a zip-top bag, but you are asked to remove them from your hand luggage to declare them.^1,2

How to manage diabetes in the air

A few tips to keep you feeling your best.

• Bring plenty of snacks—for the airport and on the plane (e.g glucose tablets, gels, or candy to relieve symptoms of hypoglycemia and snacks such as breakfast bars, crackers, or trail mix for missed or delayed meals). You never know when a flight may be delayed. What's more, many flights offer no more than in-flight beverage service, so you never know when you'll have to provide your own meal.⁵
• If there is an on-board meal, wait until your meal is placed in front of you before taking any pre-meal insulin.⁵
• While flying, keep your watch set to your home time zone until the morning after you arrive, so you can stick to your regular medication schedule, or the one you and your doctor agreed to before the trip.⁵
• Let the flight attendant know you have diabetes, especially if you're traveling alone.
• Airplane cabins are pressurized. Before using a syringe in flight, remove and replace the plunger to allow pressure equalization.⁵
• Check your blood sugar often, to make sure the excitement, time zones, or changes in activity and eating aren't throwing off your control.⁵

Chances are, you already have hard candy or fast-acting glucose hidden in strategic places around your home, office and car in case of a blood sugar low. If not, here's your cue to do so. You can also set yourself up to be prepared by using this short checklist of items that can be kept in your on-the-go bag and stay well stocked at home for use at a moment's notice.

• A nutritious, fairly substantial snack. Individually wrapped granola bars, dried fruit and nuts, or crackers with peanut butter or cheese can provide much-needed carbohydrates in a pinch.
• A double batch of testing supplies and medications. If you're going to be away from home, bring along everything you need—and then some. Alcohol swabs or moist towelettes are handy for cleaning up a fingertip, as well as about a thousand other uses.
• Sun, rain and bug protection. It's a good idea to keep items like these near the front door, so you don't have to hunt them down whenever you need them. If you're going to be outdoors, slather on the sunscreen and spritz with bug spray, even if you don't think you'll need them. Why take the risk?
• A well-charged phone and medical ID. You never know when an emergency will occur—that's what makes them emergencies. Get in the habit of keeping your battery juiced and your ID on you. It won't do anyone any good lying in a drawer.

¹American Diabetes Association. What can I bring with me? Available at: https://www2.diabetes.org/tools-support/know-your-rights/what-can-i-bring-with-me-on-plane. Accessed November 28, 2023.

²Travel Security Administration. Special procedures: disabilities and medical: medications. Available at: https://www.tsa.gov/travel/special-procedures. Accessed November 28, 2023.

³Travel Security Administration. Special procedures: disabilities and medical: external medical devices. Available at: https://www.tsa.gov/travel/special-procedures. Accessed November 28, 2023.

⁴American Diabetes Association. Fact sheet—air travel and diabetes. Available at: http://main.diabetes.org/dorg/PDFs/Advocacy/Discrimination/air-travel-an.... Accessed November 28, 2023.

⁵Flying With Diabetes. Clinical Diabetes 1 April 2003; 21 (2): 86. Available at: https://doi.org/10.2337/diaclin.21.2.86. Accessed November 28, 2023.