VOLUME 10 NUMBER 1 • MARCH 2013
33
SA JOURNAL OF DIABETES & VASCULAR DISEASE
PATIENTS AS PARTNERS
a small risk of suitcases going astray; therefore these essential items
should be kept close at hand.
Patients should be advised to check with airlines before their journey
regarding travelling with medicines and equipment in hand luggage, par-
ticularly as airlines have tightened up procedures in recent years. People
with diabetes using insulin generally need a letter from their GP to be able
to take insulin pens and needles onto an aircraft.
GLYCAEMIC CONTROL ON HOLIDAY
Most people away from home change their lifestyle temporarily. Eating
habits may change to allow one or two more treats than usual, and ca-
tering arrangements are likely to be different. Levels of activity may also
be different away from home – some people will be more active, and
some less so; therefore people with diabetes should consider these is-
sues in relation to their glycaemic control. Insulin or oral hypoglycaemic
agents might need some adjustment to compensate, and patients will
need to be advised accordingly. Even a change in the weather can make
a difference. Insulin is absorbed faster in hot weather, which could lead
to unexpected hypoglycaemia, and patients need to be aware that their
insulin dose should be reduced as necessary.
ADJUSTMENTS FOR DIFFERENT TIME ZONES
Patients might need help in adjusting the times of insulin injections to fit
in with the time difference of their holiday destination compared to home.
This should be carefully planned in advance to ensure the patient fully
understands what to do, and when. Changes might need to begin a few
days before travelling to ensure an efficient and gentle transition to the
new time zone.
BASAL-BOLUS ALTERATIONS
Short- or rapid-acting insulin injections are fairly straightforward to
manage, as they act quickly when food is eaten, so, generally speak-
ing, no food means no insulin. More frequent blood glucose testing will
be needed to prevent hypoglycaemia. Long-acting in-
sulin analogues are designed to be taken at roughly
the same time each day, within a two-hour window.
So, by pushing the injection on an hour or taking it
an hour sooner than usual, and continuing to alter the
time gradually over the few days preceding the trip,
the injection can be moved to fit in with the expected
holiday time zone.
ALTERING AN INSULIN MIX
Insulin mixes are made up of intermediate-acting insu-
lin lasting about 16 hours and a short- or rapid-acting
insulin, which acts on the meal about to be eaten.
Moving the timing of these injections will depend on the patient’s itiner-
ary and should be considered accordingly. Alterations can probably be
left until the day of travel and, as long as it is remembered that the
intermediate insulin lasts for 16 hours, then changes can be thought
through logically.
A patient can safely have a snack to prevent hypoglycaemia and move
an injection forward as long as it is not more than 16 hours since the last
one, and, of course, the later injection needs to correspond with a meal.
For example, a patient taking a night-time flight could have their morning
injection with breakfast as usual, and lunch as normal, then a snack late
afternoon, delaying the second injection until the next meal, later in the
evening, perhaps at the airport before the flight.
DRIVING AND INSULIN
The risk of hypoglycaemia while driving has to be taken very seriously. By
law, people with diabetes must inform the Driver and Vehicle Licensing
Agency (DVLA) in certain circumstances. Fortunately, medical conditions
account for a relatively small percentage of road traffic accidents.
Going on holiday: points to remember
• Consider necessary holiday vaccinations and malaria prophylaxis well in
advance.
• Follow safe food and water advice.
• Take enough medication to cover the trip.
• Take any necessary equipment, glucometer, etc.
• Consider aspirin therapy, as appropriate.
• Ensure travel insurance is adequate, and take your European Health.
Insurance Card (EHIC) if appropriate. The EHIC (formally known as
the E111) entitles most UK residents to reciprocal healthcare when
temporarily visiting a country in the European Union.
• Pack snacks, as appropriate, for the journey.
• Follow DVT prevention advice.
• Consider the effect of changes in diet and exercise levels on diabetes
control.
• Plan changes to insulin regimens in advance to fit in with different time
zones.
