Before you leave, think about how you will manage your diabetes when abroad. You may wish to make an appointment with your diabetes team before you go.
Blood Glucose Control
People with diabetes usually aim for blood glucose between 4 - 7 (pre meal) or 9 mmol (post meal). But occasionally people are given different ranges by the doctor or nurse.
Hyperglycaemia (high blood glucose)
This can be caused by:
- Eating too much sugary or starchy food
- Not taking enough diabetic tablets or insulin
- Not exercising or using up as much energy as usual
- Stress or anxiety
- Illness or infection
- Poor injection technique or overuse of one site
- Taking some types of medication
- High altitude
- Menstrual cycle - usually before or during a period
Occasional "one-off" high results are expected especially when travelling and when your normal lifestyle has changed. If you have a high result, try and think of the reason for it. If you know the cause and your diabetes doctor or nurse have explained how to adjust your insulin doses, you can try adjusting to prevent the high occurring the next time you are in the same situation
Symptoms of hyperglycaemia are:
- Thirst and a dry mouth
- Passing urine frequently during the day and night
- Blurred vision
More concerning symptoms are:
- Abdominal pain
- Nausea and vomiting
These maybe caused by ketosis (especially in type 1 diabetes) or gastroenteritis. If you are unwell whilst abroad follow the appropriate sick day rules for type 1 and type 2 diabetes.
If you are travelling to places where it will be difficult to contact a doctor, we recommend that you discuss hyperglycaemia management and the risk of ketosis (type 1 diabetes), with your diabetes doctor or nurse before you leave. They will be able to give you advice about insulin doses adjustment and staying safe.
If you are prescribed insulin, never stop taking your insulin therapy.
Hypoglycaemia (low blood glucose)
This usually occurs when the glucose falls below 4mmol. Hypo's come on quickly.
The reasons include:
- Taking too much insulin or some tablets.
- Either missing out a meal, not eating enough, having a late meal or missing out a snack.
- Increased activity or exercising more than usual.
- Hot weather (causes insulin to be absorbed faster).
- High altitude
- Menstrual cycle - usually after a period.
- Injection sites, injecting into muscle can lead to increased rate of absorption. Avoid arms.
The symptoms of hypo's can vary depending on the individual. However people can usually recognise their own hypo symptoms. Hypo stages are mild, moderate and severe. Common symptoms and the treatment are listed below.
Mild hypo symptoms
- Feeling light-headed or faint
- Difficulty in concentrating
- Tingling of lips and tongue
You may experience these symptoms when you are not hypo, so if possible do a blood test to see what level you are at. If you cannot test, take glucose to be safe.
If you do not treat the hypo, your blood glucose may continue to drop. It is important to treat the hypo as soon as possible to avoid loss of hypo awareness.
- Mood changes - often irritability or aggression
- Visual disturbances
- Inappropriate behaviour (rudeness, laughter)
It is important that your fellow travellers understand how to deal with hypos, as by this stage you will be confused and will need help. They should treat the hypo immediately.
In a severe hypo you would be unconscious or very drowsy, so it is dangerous to give you something to drink. You may appear to be having a fit. For more information check the Hypoglycaemia Education Leaflet.
Always carry some form of glucose with you, especially in remote areas where there are maybe no shops.
If you are carrying Dextrosol in humid conditions, once the packet is opened the tablets will become hard and impossible to eat. Once opened you may have to carry them in an airtight container or plastic bag.
This is the most common problem encountered by travellers. It can be caused by stress, over indulgence in rich food or alcohol, or contact from contaminated food or water.
The risk of diarrhoea also depends on the public health systems (local standards of hygiene and how safely food and drink is prepared) in countries visited.
If you do become ill it can cause problems with hyperglycaemia requiring insulin adjustment (see hyperglycaemia section). Safe Eating and Drinking
- Tap water (even when cleaning teeth) and when frozen (ice cubes),
- unpasteurised milk and dairy products, ice cream,
- raw or undercooked meat or poultry or seafood, salad and
- raw vegetables, ready-peeled fruit, food kept warm for a long time.
- Wash your hands often.
- Drink bottled water and check the seal is intact.
- It is safe to drink fizzy drinks, tea and coffee, beer and wine, fresh coconut milk.
- In less developed countries, to make local water safe to drink you can: boil it (but this may be impractical) or use water-purifying tablets.
- If travelling to a remote or less developed country, before you leave see your G.P and ask for a supply of antibiotics. Avoid buying them locally as you don't know what you will be given and the side effects.
- Maintain your fluid intake as you can become dehydrated. Drink small amounts often. Avoid milk in hot drinks.
- Have small, frequent, bland snacks i.e. bread, rice, biscuits, crackers.
- If you have severe diarrhoea you will have excess fluid loss. Start taking Oral Rehydration Therapy, which you can buy in pharmacies before you leave.
- Check your blood glucose before each meal in case of hyperglycaemia. For treatment sick day rules for type 1 and type 2 diabetes.
- Seek medical attention if: you develop a fever and high temperature, stools contain blood or mucous, you experience a sudden onset of very watery diarrhoea and cannot drink enough to compensate, if it lasts longer than 1 week.
Vomiting and Diarrhoea may be caused by Gastroenteritis, but vomiting alone may be caused by raised ketones as a result of hyperglycaemia (particularly in type 1 diabetes). People with type 1 diabetes should know how and when to check for ketones, how to deal with raised ketones and when to seek medical help.
High Altitude and Effects on Blood Glucose
If you are travelling to places with a high altitude, be aware that it could affect your blood glucose.
The symptoms of altitude sickness include:
- Dry Cough - may be blood stained
- Loss of appetite
- Nausea and vomiting
It is important to regularly check your blood glucose. Personal experiences of travellers have reported hyperglycaemia (or high blood glucose).
- If you are inactive due to tiredness this may cause hyperglycaemia.
- If you have loss of appetite you may decide to reduce your usual insulin dose to allow you to eat less. However, most travel guides will advise you to take regular high carbohydrate meals, snacks or drinks to give you more energy.
- If you are nauseated or vomiting:
If you use an insulin pen, make sure it is working properly. Always do an air shot of 2 - 4 units prior to dialling your dose. If you find you need to do a few air shots before getting a squirt of insulin, check that when you dial up your dose you still get insulin coming out. This sometimes doesn't happen due to the air pressure.
If you are unsure about the pen working accurately, change onto insulin syringes, whilst in high altitudes. You can draw insulin out of a cartridge with a syringe, but remember not to inject air into it before drawing it out.
Drink more fluids. In high altitudes the air is dry and you loose moisture when you breathe which could cause dehydration if you are breathing quicker.
If you are travelling in the Andes, drink Coca tea (Mate de Coca). However, watch the amount of sugar added to it.
Avoid alcohol and sedatives.
- Try taking glucose drinks i.e. fizzy drinks (not sugar-free), fruit juice, milk or milk shakes.
- Remember not to stop your insulin, you may even need to increase your doses if your blood glucose is high.
- Check your blood glucose at least before each meal.
- If you have blood glucose of 17mmol or more for 2 tests in a row, or if you are vomiting, check your urine or blood for ketones.
- Don't exercise.
- If you have a trace to small amount of ketones you will need to increase your insulin. However if you are unsure, contact a doctor.
- If you have moderate to large amounts of ketones and are vomiting we strongly recommend that you see a doctor immediately or as soon as possible.
- If you are unable to contact a doctor refer to sick day rules for type 1 and type 2 diabetes.
- It is important to increase your fluid intake and drink plenty of water, to try and prevent you becoming dehydrated.
- If your ketone levels are rising symptoms include: usual hyperglycaemia symptoms i.e. tiredness, thirst, frequently passing urine, blurred vision and also nausea and vomiting, abdominal pain, breathlessness.
If you become pregnant when away contact your diabetes centre immediately to inform them and get advice.
- Start taking Folic Acid 5mg daily.
- It is extremely important to have perfect blood glucose control to protect your baby. Check your blood glucose at least before each meal. Aim for Before Breakfast 3.5-5.5mmol, Before Meals under 7mmol.
- You are more at risk of hypoglycaemia during certain stages of the pregnancy.
- Make arrangements to get home. It is important to see your diabetes team as soon as possible as it is important to control your blood glucose in the early stages when the baby is developing.
Other Points to Note:
- Take condoms with you. Don't trust foreign ones that don't have the kite mark/quality mark sign on them.
- If you wear contact lenses take plenty of cleaning solution with you. You don't want to be at risk of getting an eye infection.
- If travelling to less developed countries, take your own Sterile Injection Kit, available from pharmacies. This would be used if you were admitted to hospital.
- All infections can cause hyperglycaemia.
If you are going on a trekking holiday or if you are concerned about your feet, make an appointment to see a State Registered Podiatrist before you leave. They will give you advice on prevention and treatment of problems that may occur.
- Break new shoes in before you leave. Wear shoes that don't hurt.
- Wash and inspect feet (for cuts, blisters) daily.
- Don't walk barefooted - especially on a beach.
- If feet become dry apply moisturiser or hand cream.
- Take toenail cutters, blister plasters, sterile dry dressings, tape, and antiseptic spray.
- If you get any wounds or injuries they may take longer to heal, especially if your blood glucose readings are running higher.
- Never use sharp instruments or corn plasters on your feet.
- Do not burst blisters. Keep them clean, dry, and covered. Try not to let them rub against footwear.
- If you have a cut, clean it regularly with saline or if you have none use salty boiled (but cooled) water. Apply a sterile dressing.
- Signs of infection are: increased redness of the skin, pain/throbbing from the wound, discharge. You should seek medical attention. However, if you are unable to do so, start taking antibiotics if you have them. Keep the wound clean. Keep your blood glucose well controlled.