Diabetes and Travelling: You Can Still See the World

Chapter 53 · Vihang Rahul Vasa

One of the most common worries after a diabetes diagnosis is: can I still travel? The answer is a resounding yes. Millions of people living with diabetes travel the world every day: short trips, long holidays, and even trans-Atlantic flights. You just need a little extra planning, for your medicines, your testing, and what to do if something goes wrong, and this chapter is that plan.

Before You Fly

• Diabetes medicines and supplies, insulin pen, glucometer, continuous glucose monitor (CGM) sensors, test strips, lancets, and basic medication, can generally be carried in cabin baggage, but rules vary: check the requirements of your airline, departure and transit security authorities, and destination country before you travel. It is sensible to carry a doctor’s advice or prescription confirming your condition and the medicines you carry, to avoid any questions at security.

• A practical tip for the CGM: put on a fresh sensor the day before you travel. A sensor already on your arm does not go through the X-ray belt, and a fresh one will see you through a trip of up to its full life, usually around two weeks for current sensors, so you may not need to carry or buy a spare abroad, where your model may not be sold. For longer trips, carry the spares in your hand baggage and ask for a hand check at security (see Chapter 16).

• Pack little more medication than you think you will need. Carry enough to cover your entire trip plus a few extra days, in case of delays or unexpected extensions.

• Always carry all your diabetes and other essential medicines only in your hand luggage: never in your check-in luggage. There are two critical reasons for this: first, the cargo hold temperature can damage insulin and other sensitive medications; and second, if the airline loses or misplaces your checked baggage, you will lose all your medication at your destination, and it will be extremely difficult to coordinate with local doctors and pharmacies during a short trip, especially in a foreign country where your prescriptions may not be recognised.

• As an additional safety measure, some travellers keep a spare set of non-temperature-sensitive medicines in check-in luggage as a backup: your primary supply always stays in hand luggage. If you do this, mark the spare set clearly as “Extra medicine for personal use: Not for sale” and accompany it with your doctor’s note and prescription advising you to carry extra medicines for your medical condition.

• Never carry medicines in commercial quantities. Carry only what you need for personal use during the trip. Your medicines must always be accompanied by your doctor’s prescription, a medical letter confirming your condition, and any other evidence that these medicines are essential for your survival. This protects you from unnecessary questioning at customs and security checkpoints, both at departure and at your destination.

Managing Time Zones and Medication

This is the question every traveller with diabetes asks: if I am on a trans-Atlantic or long-haul flight of 6 to 8 hours or more, crossing multiple time zones, what time do I take my medicine? One common approach is to keep your watch on your home time zone for the duration of the flight and take your medication at your usual home time. Once you land and settle in at your destination, gradually transition to local time over one to two days, adjusting your medication schedule accordingly. But medication timing across time zones is drug-specific, particularly for insulin, and must be individualised with your treating clinician before departure; they can advise exact timing adjustments based on your medication type and dosage.

During the Flight

• Inform the cabin crew about your diabetes at the start of the flight. Do not hesitate: cabin crew are generally trained in basic first aid and can assist passengers with medical needs, though the level of medical support varies by airline, and the inflight crew combined together typically speaks several languages. They will keep a quiet, reassuring eye on you throughout the journey.

• The cabin air on a pressurised aircraft is extremely dry. This can dehydrate you faster than normal, and dehydration can affect your plasma glucose (blood sugar) levels. Drink plenty of water throughout the flight: far more than you normally would. Avoid tea, coffee, and especially alcohol, as these dehydrate you further.

• Strictly avoid alcohol on a long-haul flight if you have diabetes. The combination of altitude, dehydration, reduced cabin pressure, and alcohol can cause unpredictable plasma glucose (blood sugar) swings and increase the risk of hypoglycaemia (a low plasma glucose, or blood sugar, episode): this is not the place to take that chance.

• If you have varicose veins along with diabetes, or other circulation issues, your risk of deep vein thrombosis (DVT) during long flights may be elevated: speak to your doctor before flying. For all long-haul travellers, regardless of risk, simple precautions help: get up and walk the aisle every hour or two, do simple seated leg and ankle exercises, wear comfortable loose clothing, stay hydrated, and consider wearing compression stockings if your doctor recommends them.

• Check your plasma glucose (blood sugar) more frequently during the flight than you would on the ground. The combination of altered meal timing, reduced activity, cabin pressure, and time zone changes can cause unexpected fluctuations.

What Actually Happens If You Fall Ill in the Air

I asked an airline pilot friend, who preferred not to be named, one plain question: if a passenger with diabetes goes into a low or a high at about 38,000 feet, cruising altitude, what happens? His answer, from the flight deck, is worth knowing before you ever need it. The crew treats it as they would any medical emergency, in a fixed order: first they page the cabin for a doctor: one may or may not be on board; second, they contact a ground-based medical advisory service by satellite phone, where an emergency physician talks the crew through the case in real time; third, if immediate care on the ground is needed, the captain may divert to the nearest suitable airport, depending on the passenger’s condition and what the flight can safely do; and throughout, the crew stabilises and comforts the passenger. That is the system; it is not a reason to fly unprepared: the passenger who knows what a low looks like and carries sugar is still the first line of help.

Two lessons follow. The first: you are not alone up there: the system exists, and it works. The second: everything in that chain moves faster if the crew already knows. Tell them at boarding that you live with diabetes (as this chapter has already asked), keep your medicine list and SOAP (Subjective, Objective, Assessment, Plan) report (Chapter 14) in your hand baggage, and make sure the person beside you knows what a low looks like (Chapter 25).

And can a person with diabetes fly a plane? Honest answer: it depends on the country and on the treatment. Aviation authorities have moved a long way: several countries now allow pilots with well-controlled diabetes, including some on insulin, to hold a commercial licence under strict monitoring protocols, while others still do not. These rules differ from country to country, change over time, and airlines may add rules of their own, so nothing here should be read as the position today. If aviation is your profession or your dream, the answer comes from an aviation medical examiner.

(References for this section, in-flight medical emergencies and aviation medical rules for pilots with diabetes, are listed in Appendix B.)

Diabetes-Friendly Meals on Flights and at Airports

Many airlines are conscious of passengers’ varied dietary needs and may offer options such as a diabetes-friendly meal. If your airline offers this, you can usually select it when you book your flight. If you are booking online, look for the meal preference option on the airline’s portal; if you are booking through a travel agent, inform them of your dietary requirement at the time of booking. Do this in advance: it ensures you receive a meal that is balanced and appropriate for your condition, without having to worry about what is being served, or remaining hungry because the standard meal did not suit you.

At airports, you will find that most food stores, lounges, and restaurants now serve diabetes-friendly options. Look for grilled proteins, salads, nuts, and fresh fruits. Avoid the temptation of airport fast food, sodas, colas, energy drinks, sugary drinks, and pastries: they are everywhere, but they are not your friends.

General Travel Tips

• Always carry your medicine list, your one-page SOAP report (Chapter 14), your doctor’s contact details, and your emergency contact information: both in your phone and as a printed copy in your wallet.

• If you are travelling to a different country, research the local emergency number and identify the nearest hospital to your accommodation before you arrive.

• Wear a medical identification bracelet or carry a medical ID card that states you have diabetes. In a medical emergency abroad, where language may be a barrier, this small piece of identification can save your life.

• Protect your insulin and medication from extreme heat and cold. Use an insulated medical travel pouch for insulin, if needed.

• Most importantly: do not let diabetes stop you from travelling. Plan a little, prepare well, and go see the world. You have every right to enjoy it.

Illustration: Vihang sailing off Marseille.

Sailing off Marseille, June 2013: four friends, four countries: the author (India), Parth (USA), Marcel Griessmann (France), and Andrew (Poland). Different languages, one shared joy.

Illustration: Chapter 53 illustrated summary. Travel with a care plan: keep medicines and supplies in hand luggage, protect them from heat and cold, and carry the prescription, doctor's letter, SOAP report and contacts.

Chapter 53 Travel with a care plan: keep medicines and supplies in hand luggage, protect them from heat and cold, and carry the prescription, doctor's letter, SOAP report and contacts. Plan medicine timing with the doctor, check airline and destination rules, inform crew, monitor regularly, drink water and move gently.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.