Travelling with children can be daunting but even more so if they have diabetes. However, like everyone, planning is essential before travelling by land, sea or air.

Things to consider when travelling with children who have diabetes
Prior to the trip, schedule an appointment with your child’s diabetes team as you will need to bring a letter on medical stationary stating that he/she has diabetes and they use pens/pumps/meters. Your diabetes nurse can revise such things as sick day management and discuss things to consider when in a hot climate, travelling through time zones etc.

Bring a written prescription with generic terms of medication your child is taking in case your child’s medication is lost or stolen or you need to visit a doctor when abroad. Photocopy all relevant important documentation and give a copy to your travelling companion or keep a copy in separate luggage you are bringing.
Remember to always bring spare insulin (and spare pen devices), at least 2-3 times the normal amount you think your child would require during the same timeframe. Carry any medication in its original packaging obtained from the pharmacy.

If your child is using an insulin pump, ask your diabetes team if it is possible to get a spare holiday pump. Carry emergency contact numbers for the company that supplies the pump to access technical advice over the phone if necessary. Also, get advice from your diabetes nurse about what to do with your child’s pump if they are in the water or in the sun for long periods.

If you are unable to get a holiday spare pump

• Ensure you have adequate spare supplies you may need plus backup insulin and insulin pens. It is essential that you bring your child’s long-acting insulin in the unlikely event of pump failure.

• Know what to do in the event of pump failure, and how to revert back to multiple daily injections of insulin. Know your child’s basal rates and carbohydrate ratio etc. Prior to departure ask your diabetes nurse for written instructions on what to do in the event of pump failure.

• Carry emergency contact numbers for the company that supplies the pump so they can arrange a replacement pump ASAP or to give you technical advice over the phone.

• Changing your child’s normal routine may upset their diabetes control and the only sure way to keep on top of that is by checking their blood sugar levels more frequently. As frequent testing will be necessary you will need at least double the normal amount of glucose testing strips for the same timeframe plus a spare glucose meter.

• Don’t forget to bring ketone testing supplies also.

• Always split the supplies into two bags and if possible, give one set to a travelling companion in the event your luggage gets lost.

• Check on the basic forms of carbohydrates eaten in the countries that you are visiting. While away, it should be possible to select familiar food such as rice, pasta, bread, biscuits and fruit. You may need to schedule an appointment with your child’s dietician to discuss the carbohydrate content of some of the basic foreign foods you may come across while away. Plan ahead, try to make reservations in restaurants to avoid long delays and carry plenty of snacks for when you are delayed.

• Extra excitement and a hotter climate can increase your child’s risk of a hypo so always carry quick-acting carbohydrates so you can treat your child’s hypo symptoms as necessary. Ensure to pack glucagon hypokits and refresh your memory on how to use them in the case of an emergency.

• Day trips: Carry a bag pack with all water, snacks, hypo treatment etc. If you and your family are travelling to water parks or amusement parks it may be possible for you to get a ‘fast pass so you can avoid long queues.

Vaccinations
For information on what countries may need vaccines see Tropical Medical Bureau www.tmb.ie. They can provide you with detailed information on vaccines, malaria prevention and the latest health news tailored to your family’s travel plans. It is important to note that there are no special restrictions for vaccinations due to diabetes. Furthermore, it is more important for a person with diabetes to actually get the recommended vaccinations since illness will mean more difficult consequences associated with diabetes control. No precautions will give absolute protection, so, if your child develops a fever, or feels ill while travelling or for up to three months on return, seek medical assistance immediately.

Tips to avoid ‘holiday tummy’ with your child:

• Ensure they avoid tap water, even when brushing their teeth.
• Avoid ice cubes in unclean environments.
• Be cautious of milk, cream and mayonnaise (including anything that might have these products in it for example coleslaw).
• Ensure juices are diluted with reputable water supplies.
• Be vigilant when feeding your child from cold buffets- remember that anything that needed washing will have been washed in cold tap water.
• Avoid shellfish for example sushi, salads and raw food.

Water Intake
Hot weather, high blood sugars, extra activity and insufficient fluid intake increase your child’s risk of dehydration. Carry plenty of bottled water to ensure your child stays hydrated in a hot climate. Dehydration may cause your child’s insulin to be absorbed slower leading to high blood sugars. Drinking bottled water from a reputable company with the seal intact is the best way to keep hydrated. You may need to discuss with your child’s diabetes team issues regarding insulin absorption, sites, exercise and temperature prior to travelling.

NB – paying the extra cost for air conditioning may be beneficial to help prevent nighttime glucose fluctuations.

Footcare

• To avoid accidental injury ensure your child does not walk in his/her bare feet; there may be broken glass or shells in the sand etc.
• Ensure any footwear that they are wearing is broken in prior to departure to avoid blisters etc.
• If a cut/blister develops wash the area and cover it with a sterile dressing, observe for any signs of infection such as redness, discharge, heat or pain.
• Ensure sun cream is applied to you child’s feet.
• A person with diabetes may be at increased risk of infection especially if blood sugar levels are high. It is advisable to attend a doctor if there are signs of infection present.

Final Tips

• It is a good idea to have a few phrases in the local language, for example, My son/daughter has diabetes, please give me something sweet, and please call a doctor.
• Your child should always have some identification on them stating they have diabetes. There are bracelets and medals available through Diabetes Ireland and at most pharmacies.
• For longer vacations – Have the contact details for the Irish Consulate of the area you are visiting.
• Have the contact details for the national diabetes association of the country you visit – see www.idf.org
• Put local emergency contact numbers on your phone for easy access if needed.
• And finally, remember that blood glucose is measured in mmol/L in Ireland but in mg/dl in many other countries for example in the United States. So if you need to contact a healthcare professional abroad, the conversion rate is 1mmol/L= 18mg/dl.

Travel Insurance
You are advised to obtain full health insurance for your child with comprehensive cover. Check what insurance covers your child has or will need and the geographical area of cover. Read all the small print in the policy so that you know what will be covered and what will not. Make sure your policy will cover your child in the case of an A&E diabetes-related matter while abroad.

Remember that ordinary holiday insurance booked through your travel agent may not cover your child’s diabetes as it may be considered a pre-existing condition. Check with the travel agent about the extra premium required ensuring coverage of your child’s condition.

Contact ERM on 01 8454361 for information on a comprehensive travel insurance scheme through Diabetes Ireland. If you have private Irish health cover, speak to your provider about their travel insurance. Carry the contact details of your travel insurance medical division with your passport.

If you are an EU citizen and need medical assistance while in another EU country, you need to bring a European Health Insurance Card. For more details, see https://www2.hse.ie/services/ehic/ehic.htm

Travelling by Air
Most insulin pump manufacturers recommend that you do not expose your pump to x-ray equipment. Request a “walk through” or hand wand inspection. It is important to have some kind of identification on your person showing that you have diabetes. More often than not it will not be required as the airport security has become well accustomed to recognising insulin and medical equipment on the monitors over recent years. However, if you experience difficulties boarding a plane, have the matter referred to the airport police. Regulations state that vital medical equipment can be held as hand luggage within the passenger’s view on all flights.

Keep insulin supplies in your hand luggage, as there is a danger of freezing in the airline luggage containers at high altitudes.

Please note: If your trip involves crossing time zones, talk to your diabetes team about the necessity to adjust your child’s insulin or change the time on their insulin pump.

While travelling by air, people with a medical conditions, including diabetes, are not permitted to use any exit seat. The main reason stated by relevant authorities is that passengers with diabetes should have access to their medications, blood testing equipment and extra snack supplies throughout the flight so be careful when booking your and your child’s airline seats.

Generally, meals supplied to passengers on planes are fine for people with diabetes. However, long-haul flights or flights greater than two hours in duration may supply diet-specific meals with confirmation reservations needed 24 hours before departure. Although these diabetic meals may be available they usually contain limited carbohydrates. Make sure that you have adequate carbohydrates packed in your hand luggage to cover all eventualities in case they do not serve food in-flight or your child does not eat it. Do not put your food supplies in the overhead compartments so that you have access to it when you need them.

Travelling by land
When travelling by land, remember that closed vehicles parked in direct sunlight can get very hot, so it may be more appropriate to pack all your child’s diabetes supplies in a cooler bag in the boot. If your child suffers from travel sickness, medication, which is available without a prescription, may be purchased. Travel sickness can mask the symptoms of hypoglycaemia or hyperglycaemia therefore, frequent blood glucose testing is essential. Vomiting can cause hypoglycaemia and dehydration so plan ahead and try to avoid these unnecessary risks. If your child does feel sick, they should continue to take their insulin and take carbohydrates in a liquid form. Follow the Sick Day Rules/Management guidelines as advised by your diabetes team and seek medical assistance if not responding.

Diabetes and Altitude
Up to 7000 feet above sea level, it is unlikely that you need to be concerned with altitude levels affecting your child’s blood glucose levels. Most meters are guaranteed for reliable readings up to 16,000 feet and within a temperature range of 18-30 degrees centigrade. Outside these ranges, meters can give incorrect high or low readings, or even stop working completely. Check your child’s meter manufacturer about the height and temperature ranges of your meter. Keep meters close to the body for optimum temperature operation.

Diabetes and Hot weather  (>25 degrees C) 
It is important that your child’s insulin supplies are kept at the correct temperature. In a hot climate, it is a good idea to request a room with a fridge or to bring your own cool box or a ‘frio’ bag. ‘Frio’ bags are activated by cold water and are reusable every 48 hours. If a fridge is not available or you do not have a cooler box, keep the insulin in the coolest and darkest part of the room and if warm, cover it with a cold wet cloth. In normal conditions, it is acceptable to carry a preloaded insulin pen on your person to use during the day. However, in extreme sunshine, you may need to bring a cool box or ‘frio’ bag with you during the day.

Diabetes and Cold weather (<3 degrees C)
In cold climates, insulin should not be allowed to freeze. In freezing conditions, keep your child’s insulin or pen injector in the inner pocket of your clothing or bag. You must examine the insulin for crystals and discard the insulin if any are found. Even if it looks okay, you should test blood glucose levels more frequently and if they appear abnormal, discard the insulin as it may be damaged or ineffective. Keeping the needle on your insulin pen, when exposed to temperature changes between injections leaves an open passage to the insulin, allowing insulin to leak out and/or air to leak in when exposed to extreme temperatures.

If you are travelling to an area that is likely to experience very extreme temperatures, check with your child’s meters manufacturers about limits on the reliability of their machine.

For more tips on travelling with diabetes check out our travel section.