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DOCTOR'S COLUMN - DIABETICS AND TRAVEL.

Dr Gowri Sankar Specialist Internal Medicine Starcare Hospital

As any travel agent or stranded tourist will tell you, planning ahead is the key to a successful trip. And this is particularly true for people with diabetes A[degrees] a little forethought will take you a long way and help keep you healthy once you are there. Having diabetes should not be a limitation to long and short distance travel. It needs a bit of planning to avoid complications related to diabetes.

Preparation to travel:

Diabetics should carry medic alert/tag labels with a doctor's prescription to support themselves while travelling with insulin syringes, medicines, glucometer and lancets and passing through security, immigration and customs at airports or crossing borders. It is also worthwhile having a comprehensive insurance while going abroad which covers preA[degrees]existing illnesses. People with diabetes should choose a destination that has basic facilities to manage diabetic complications.

You should be relevantly immunised. Medications are better carried in your hand baggage to prevent the risk of loss. Insulin can be carried in preA[degrees]cooled vacuum flask/insulated cool bag. Patients on insulin pump may carry extra insulin pens in case of pump or other technical failure. Glucometer usage can be affected by extreme heights and temperatures. Carrying a spare meter is always worthwhile. Appropriate footwear for protecting your feet and medicines for motion sickness may help.

Visit your doctor weeks before you travel and update him about the itinerary and time zones and seek relevant tips about diabetes management during the trip.

Travelling by air:

Early checkA[degrees]in anticipating delays in security check makes your travel hassle free. If you have an insulin pump implanted, you should inform the security officer in advance and volunteer for a frisking to check the pump in a private area if possible.

Long flights and differing time zones:

Long flights need timing adjustment of food intake and insulin or medications usage according to the local time. Diabetic meals on board are usually sufficient for diabetics who are not on insulin, while insulin users can consume a vegetarian meal to avoid hypoglycemia as it contains a good quantity of carbohydrates which are lacking in diabetic meals served in the flight.

Also, you may have to carry short (glucose tablets/powder) and longA[degrees]acting carbohydrates (sandwich or biscuits) based foodstuff along with them to supplement the food served on board. Alcohol is best avoided as it may cause hypoglycemia (low sugars) and cause dehydration secondary to diuresis (excessive urination). Blood glucose should be monitored by glucometer often during transit and flight delays. While on board, glucose can be kept at higher levels to avoid hypoglycemia (low sugars). Aim at modest glucose control (10A[degrees]13mmol/ltr).

Time changes of less than four hours don't mandate any major changes in insulin dose and timing. Long flights flying westwards will lengthen the day and biphasic/long acting insulin needs to be given according to the destination local time with a topA[degrees]up with short acting insulin. For eastwards flights, the day length would be reduced so dose reduction of biphasic/long acting insulin is needed. A time shift of more than 12 hours needs an extra dose of insulin along with the above mentioned. For those only on oral medicines, no additional doses are required.

Travel by road:

Check your blood sugars at home just before travel and ideally every four hours later of travel. Stop after few hours of driving and stretch yourself. If you start feeling symptoms of hypoglycemia, immediately drive to the side, park, monitor the blood sugars and if low take a short acting carbohydrate like glucose tablet/powder/fruit juice or even a soft drink, followed by long acting carbs like a sandwich. Wait till all symptoms resolve and that your glucometer shows that sugars are in the normal range. Don't drive for more than 12 hours in a day or more than six hours in between meals. Carry adequate food supplies as you are not sure when you will reach the nearest restaurant or motel.

Travel by sea:

Similar guidelines apply to travel by sea. Disclose all medications and medical conditions to the cruise staff.

Travel on foot:

Camping and hiking are a very good recreation activity. Avoid going alone and if you are alone, inform your whereabouts and plans to someone and be in touch with them by phone. Updating the GPS coordinates and sharing your location is also an easy way to find you in case of emergency. Don't forget to bring the emergency and first aid kit, adequate food supplies and most importantly ample amount of water.

Insulin, administered in hot climates, is relatively rapidly absorbed and one should compensate for the rapid glucose reduction which occurs with increased food intake. Intercurrent infections should be handled by adequate hydration and mild increase of insulin dosage and checking the ketones often (sick day rules apply). It is advisable to carry a quickA[degrees]acting carbohydrate diet to combat hypoglycemia.

For more information on this topic, email your queries to Dr Gowri Sankar at health@apexmedia.co.om

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Publication:The Week (Muscat, Oman)
Article Type:Column
Date:Dec 12, 2013
Words:866
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