Travelling and driving with type 2 diabetes

If you’re living with diabetes, here’s my first tip: Focus on the first part of the phrase. You are living! Diabetes will alter your life, yes, but your condition is something you are managing – not the other way around.

Travel is, for many people, a significant part of life. Whether you’re simply commuting to work or flying abroad to explore the most remote parts of the world, being able to get from A to B is essential.

Being mobile and independent allows us to do everything from solving the simplest problems to pursuing the greatest meaning. In other words, this is an important matter – almost as important as getting your meal plan right and having access to medicine and healthcare services.

Let’s start with the basics. When you travel – whether by air, sea or land – you expose your whole self to environments where the conditions for your wellbeing are unknown or unpredictable. In these situations, you will be less able to come to your own assistance when your body needs it.

But with a little preparation, you can anticipate most of the challenges that are likely to come your way – and focus on the joy of travelling instead of the risk. We will do a deeper dive into this in the following sections.

Here is a tip which applies whether you are insulin dependent or not: When you travel, make sure to check your glucose levels regularly with a glucose meter – say, every 2 or 3 hours. Depending on the trend of your glucose levels, your monitoring may tell you it is time for injecting insulin or having a snack with fast-acting carbohydrates.

Getting used to checking your glucose levels regularly works sort of like an insurance policy! When you invest in taking full control, the payoff is increased freedom to make (and keep) plans, be spontaneous and have fun. It takes a little time and commitment, but it pays off.

Few things give people a stronger sense of freedom than getting behind the wheel of a car and taking off. You may need the car to commute to work in the morning, go out for groceries or get out of town for the weekend. Many people also operate a car or truck as part of their work.

Here is my tip: When you take your car – no matter where – pack with forethought. Depending on what you keep your car stocked with, you can turn your diabetic symptoms into little more than a blip in your glucose levels, and avoid hypoglycaemia.

A little information about hypoglycaemia: Symptoms of hypoglycaemia tend to occur when glucose levels drop below 70 milligrams per deciliter of blood (3.9mmol/L). Common hypoglycaemic symptoms include:

• Feeling sleepy
• Going pale
• Feeling dizzy
• Hunger
• Shaking
• Feeling anxious
• Sweating
• Grumpiness
• Irregular heartbeat

It goes without saying that you need to be completely in control of your body when you drive a car, so hypoglycaemia is something to avoid.

Before taking off, be sure to stock up on:

• Extra medication
• Bottles of water
• Fast-acting carbs such as
  • Glucose tablets or drinks
  • Full-sugar soft drinks
  • Sweets
  • White bread
  • Cookies

Here, “fast-acting carbs” refer to foods that cause a rapid increase in your blood sugar levels. On the Glycaemic Index, which runs from 0 to 100, these foods occupy the 70-100 interval.

A couple extra tips: Check your blood glucose levels immediately before you get behind the wheel, and keep checking them every two hours during the course of your journey.

And lastly, reference the list above and pay attention to the symptoms you experience when your blood sugar levels drop. In the future, you’ll have increased awareness of how your body reacts, and you may be able to catch your glucose levels dropping at an earlier point in time.

Needless to say, if symptoms of hypoglycaemia occur while you’re behind the wheel, pull over to a safe spot and don’t continue your journey until your blood sugar is regulated.

Here’s another tip: The longer your journey and the farther away you go, the more you need to plan ahead. Write a checklist and include everything you might need in order to navigate every part of the journey. Regardless of your health, modern air travel can put stress on the body. This should be taken into consideration when you prepare for your trip.

Always board a flight with medication in your hand luggage – preferably a little more than you strictly need. If you are insulin dependent, ask your doctor beforehand to write a letter alerting the airline staff to your need to carry insulin, syringes and other supplies. Bring both your doctor’s letter and your prescriptions. Also, make sure that your pill bottles and insulin vials bear legible pharmacy labeling. These things will put you in a much stronger position if you are asked to explain your need to bring medical items onto a flight.

When you embark on a flight to a different time zone, log the time and place you take your medication so as to not be thrown off by the change in local time. Having your day either “shortened” or “lengthened” by travel across time zones can destabilise your metabolism. It is therefore your job to soften this impact and adapt as precisely as possible to the new schedule and regimen. And logging your time precisely is central to that end.

If possible, mention your trip to your doctor at least one month before you leave. That way, he or she can help you plan for any changes you may have to make to your insulin regimen.

Here are a few extra tips if you are insulin dependent. Keep your insulin cool and pack it in an insulated bag to minimise the effect of extreme changes in temperature. Refreezable ice gel packs or a frozen or refrigerated bottle can also be used to keep your insulin cool. Make sure to place a thin hand towel between the cooling device and the medication so as to not expose your insulin directly to freezing temperatures, as these will alter its effectiveness.

Note that being diagnosed with diabetes raises the risk of blood clots, also called deep vein thrombosis (DVT). And whether diabetic or not, flights of 4 hours or more have been associated with an increased risk of DVT. To address that risk during a flight, I suggest that you:

• Exercise your feet, calves and ankles, even while seated
• Walk up and down the aisle once 2-3 hours
• Wear travel socks, support socks or stockings
• Drink plenty of water
• Avoid alcohol and caffeine
• Sit with your legs uncrossed

These tips may help lower the risk of DVT during air travel.

Being diagnosed with diabetes does not mean you cannot travel the world. If you are visiting a culture where customs and attitudes deviate from your home culture, you may run into surprising and unforeseen reactions to your diabetes. The local population may, for example, think medical injections in public are an unusual and triggering occurrence. What has become routine and second nature to you may be a little shocking or disagreeable to another.

Besides being discrete and thoughtful towards your surroundings, do as much research ahead of time as possible:

• Take the time to find out something about the food culture at your destination. What do the locals like to eat? What might be difficult to find in supermarkets and restaurants? When you know the nutritional facts about the common foods and delicacies, you can immerse yourself more fully in the culture.

• If the country you’re visiting uses different units of measure (for example, they use grams but you’re used to ounces), make a little overview of the differences and keep it in your pocket at all times. Convert the most common portion-size measures to the local system – for quick reference when you’re deciding what to put on your plate.

• Food labels vary around the world. Use Google or another search engine to find images of food labels from where you’re going. And practise using them so that you will save time when you encounter them on your journey.

• Consult an online dictionary and find the local words for glucose, diabetes, blood sugar level, hypo- and hyperglycaemia, insulin and other related terms.

• Lastly, your research should focus on sanitary conditions and the availability of medicine and health professionals at your destination.

Enjoy your trip and stay!

In principle, there is no activity you need to give up on completely when you’re diagnosed with diabetes. But it is crucial to develop a good sense of your own metabolic and emotional reactions to the things you either enjoy or have to do in your life.

If you are newly diagnosed, try to assume that you know nothing about yourself and have everything to learn. The less you take for granted about your body here and now, the more you will learn in the next minute – and the quicker you will adapt to living with diabetes.

This applies to travel-related activities, too. When you travel, you open yourself up to the world. In order to stay as safe as possible, you are required to take certain precautions. I suggest keeping a close watch on your blood sugar and general wellbeing. By planning ahead and learning from experience, you put yourself in the best possible position to take care of yourself and have a great time wherever you are.

Every diagnosis can lead to the worry that you will be unable to pursue the things you love, the things that add meaning to your life. I am here to tell you that while living with diabetes, you can still tap into nearly all your favourite activities – you simply need to be smart and careful about it. Start by taking the relevant precautions, planning ahead, doing your homework and enjoying everything in moderation.