Holiday advice

Whether you have decided to take a holiday in the United Kingdom or are going aboard, the following guide should help to make the best preparations you can before heading off.

Holidays both at home and abroad take a bit of planning so we have included a list of things you need to do before travelling.

What should I do before we leave?

The Sheffield Children’s hospital diabetes team office can provide you a range of country-specific information leaflets for travellers which can be provided to you, these give useful information such as:

• which vaccinations may be needed
• what medical services are available
• whether you can obtain your medication whilst abroad in an emergency

Please call our office on 0114 271 7320.

For more information, please visit Diabetes UK resource on travelling with diabetes.

If you are travelling to a country where yo will need vaccinations, make sure you arrange these in plenty of time. Some vaccinations could have a temporary effect on your diabetes control. Ask your GP or diabetes team for advice on how to manage your diabetes should this occur.

Make sure you are correctly insured and that your insurance covers for pre-existing medical conditions. you must declare your diabetes before you go otherwise your medical insurance policy may be cancelled by the provider without paying out any claims. Most insurance companies will cover your diabetes once declared and the cost to cover this is usually minimal. Check the Diabetes UK website for further information on insurance. Ensure you have your pump fully insured for use away from home as you will be responsible for replacing it should it be lost or stolen.

You will need to carry your EHIC (European Health Insurance Card) with you in case treatment is required at a hospital. This allows you to get state healthcare at a reduced cost or sometimes for free. If you do not have an EHIC card then you can apply online or alternatively call 0300 3301350. Your EHIC card does not cover you for all expenses incurred whilst hospitalised abroad so do not assume that you will be okay without insurance.

If you are travelling abroad then you should contact the diabetes office for a letter to cover you carrying your insulin pens, pumps, pods and so on through airport security.

Make sure you have ordered enough medical supplies to cover your stay.

At the airport

Airport security has been increased in recent years meaning people with diabetes need to plan ahead in order to avoid running into problems before boarding.

Medication and equipment which you require for the duration of your flight should be carried in hand luggage providing you support its use by documentation from a relevant qualified medical professional. Insulin for the duration of your stay should be carried in your hand luggage as it can be degraded due to the freezing temperatures in the aircraft hold.

If you are on an insulin pump then you should explain to the security staff that you are attached to an insulin pump with a cannula attached to your body which is difficult to remove.

The pump should not be put through either the X-ray machine or the full body scanner.

Should security insist that you go through the X-ray or scanner, then detach your pump from the cannula and hand it to security. They will then be able to check the pump without having to put it through the machines. If you are allowed to leave your pump on then you should expect a ‘pat down’ by the security staff which should be witnessed by an adult in your party.

You will not be allowed to carry drinks for hypo treatment through the security area so be prepared to purchase something once you are through if required. It is advised to carry glucose tablets as a hypo treatment.

If you are on a pump which uses Bluetooth connectivity then you must remember to switch the Bluetooth connectivity off when you board the aircraft as this may interfere with the aircrafts communications and navigation systems. Do not forget to turn it back on again when you arrive at your destination.

How does the weather affect my diabetes control?

In hot weather the absorption rate of your insulin can be greatly increased meaning that you could be at risk of hypo. You will need to test more regularly to ensure that you are not dropping low and adjust your insulin accordingly. Remember to drink lots of fluids and do not ignore hypo symptoms such as ‘sweating and lethargy’ as just being because of the heat, it could actually be a hypo which will need to be treated.

Take into account that you may be more active than usual and also your diet may differ from normal, you may need to consider reducing your background insulin doses with this in mind.

Pump users should not remove their pump for more than an hour and will need to give a catch up dose when reconnected.

The time difference between countries may need to be taken in to account in regards to adjusting your insulin or injection times. Generally if the time difference is less than 4 hours you should not need to make adjustments to your injections but you can call the diabetes team in advance of your holiday for advice about injection times and insulin reduction if required.

Your blood glucose meter can be affected with extremes in temperature so that it can become unreliable. It is suggested that you carry a set of control solution with you so that you can quality control your meter regularly to make sure it is working as it should be. False readings may cause you to treat a hypo or hyper which is not a true reading and in turn this may lead you to be unwell. Try to keep your meter and test strips as near to normal room temperature as you can, keep them in the shade out of direct sunlight.

Insulin can be damaged by extremes of temperature. If the insulin gets too hot it can become cloudy and may also have a brownish colour if exposed to direct sunlight. Do not use your insulin if it looks in any way different to usual. You should ideally need to store insulin in a fridge in your accommodation but do not freeze it. There are also very good products such as small cool bags which keep insulin cool for carrying round with you and these are available from pharmacies such as Boots or Lloyds or via Diabetes UK

What to take with you

• Customs letter for airport security
• double amount of insulin required in case of emergency (including both fast acting and background insulin cartridges for your pens in case of pump failure). This must not go in the hold area of the aircraft, keep in hand luggage
• insulin pens (plus spares, spares can be packed in your suitcase)
• pen needles
• meter control solution
• glucose and ketone meter (plus spare) and batteries
• finger pricker (change of needle and spare set)
• blood and ketone test strips (plus spare bottles)
• sharps bin
• pump (plus pens in case of fault) and batteries
• pump handset (plus spare meter) and batteries
• spare cannulas or pods (pump therapy only)
• adhesive remover
• glucose tablets
• glucogel
• GlucoGen hypokit – orange box (to go in hand luggage)
• sick day rules (leaflet and contact numbers)

If you become unwell whilst on holiday then you will need to follow your sick day rules and keep hydrated, try to eat if you can. If you have a severe hypo and cannot keep your blood sugars up stop your pump immediately.

Emergency supplies

If you need to obtain an emergency supply of insulin then you can get this directly from a pharmacy as well as extra supplies for your blood glucose meter.

It is advisable if you are on a pump to carry plenty of spare cannulas or pods and so on with you as these will not be readily available over the counter. You will also need to have insulin pens available with both quick and background insulins.

Glucose tablets for hypo treatments are available from pharmacies and in some European countries from their supermarkets. Full-sugar coke is also readily available.

What to do in an emergency

If you feel unwell or are vomiting:

• check your blood sugar
• test your urine or blood for ketones
• follow sick day rules
• in cases of severe hypo or if you cannot keep your blood sugars up (stop the pump immediately)

If you have been following the sick days rules but still have ketones and they are not reducing then you should contact the local emergency services and request an ambulance. This number can usually be given by your hotel or camp site manager and you would find that they will usually make the call for you.

It would be a good idea for you to find out about the local area where you are staying. Find the nearest GP surgery and take a note of their emergency contact number and opening hours. You could also find and ask where the nearest pharmacy and hospital are situated. Illnesses can happen in the middle of the night and there may be no-one around to help at that time. Before you go print off a resort map from the internet showing doctors, hospitals and pharmacies.

Make sure you take all your insulin, pens, pump supplies etc with you as you may be able to still use them whilst in hospital.