traveling with diabetes blake elkins project echo 4/26/13
TRANSCRIPT
Traveling With Diabetes
Blake ElkinsProject Echo
4/26/13
Diabetes and Travel
• 25.8 million patients with diabetes in the US– Approximately 8% of the US population
• 69% of Americans traveled for leisure last year• 22% of Americans traveled for business last
year• Potentially annual US travelers with diabetes– 17 million leisure travelers– 5.6 million business travelers
Diabetes and Travel
• American Diabetes Association (ADA) and Canadian Diabetes Association (CDA) provide online travel recommendation that include:– See Your Doctor Before You Go– Prepare For An Emergency Abroad– How to Pack– How to deal with Issues during Air, Car, and Sea Travel– Issues with Insulin– Issues with Destination
• However, few studies have examined patient knowledge and provider practice regarding traveling with diabetes
Are Patients Obtaining Advice Prior to Travel?
Are Patients Obtaining Advice Prior to Travel?
• Are our patients obtaining travel advice?– 76% of patient’s have
never been asked about travel by a provider
– Only 31% of patients have ever asked providers for advice relating to their diabetes and travel
Unpublished Data
Are Patients Obtaining Advice Prior to Travel?
28%
72%
Figure 3: Patients on Insulin who Asked for Advice Regard-
ing Insulin Dosing During Travel
Asked Did Not Ask
• Only 28% of our patients on insulin have EVER asked advice regarding insulin during travel
Unpublished Data
Are Patients Obtaining Advice Prior to Travel?
Unpublished Data
Diabetes and TravelTable 1: Traveling with Diabetes Poses Challenges
Potential problems associated with the Journey Potential problems associated with the Destination
Increased or decreased physical exertion while in transit
Increased activity
Insulin adjustment across time zones Exotic foods
Delays in meals Delayed or skipped meals
Issues with correcting hypoglycemia while in transit Increased insulin absorption in warm weather
Lost or depleted medications and supplies Lost or depleted medications and supplies
Insulin storage Insulin storage
Getting Sharps through Security Multiple issues with Altitude
Issues with Retinopathy and altitude Issues with feet
Diabetic feet Illness while on Vacation
Diabetes and Travel
• Travel can be potentially hazardous for patients with diabetes
• Our findings revealed:– Providers are not routinely advising patients about travel– Patients do not routinely ask providers about travel– When patients do ask, they most commonly ask about insulin and
blood glucose monitoring issues– Many patients do attempt to obtain advice from other sources
besides providers– Patients do not routinely plan for medical emergencies prior to
travel and indicate they would deal with the issues when they occur at their destination
Discussion
• Currently travel recommendations directed towards patients are available from the American Diabetes Association and the Canadian diabetes association online
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/when-you-travel.html
http://www.diabetes.ca/diabetes-and-you/living/guidelines/travel/
Diabetes and Travel
• SEE YOUR DOCTOR BEFORE YOU GO– Bring your travel companion with you– Visit should be 4 to 6 weeks prior to travel– Review sick day protocols– Immunizations– Obtain documentation
Diabetes and Travel
• PREPARE FOR AN EMERGENCY ABROAD– Find a physician in the area where you will be traveling– International Association for Medical Assistance to Travelers
(IAMAT) www.iamat.org– If an emergency occurs and you can’t find an English speaking
provider you can contact the American Consulate, American Express, or local medical schools for a list of doctors
– Call your provider at home– Wear a MEDICAL ALERT ID– Learn common phrases such as “I have diabetes” and “sugar or
orange juice, please” in the local language– Travel insurance
Diabetes and Travel
• PACKING TIPS– Double the medications and supplies– Divide them into separate bags (both to be carried on)– Keep a bag with supplies on you at all times– Make sure to bring
• Twice the amount of insulin or oral medications you will need• Twice the blood and urine testing supplies with extra batteries for
your glucose meter• Emergency medications for hypoglycemia, diarrhea, nausea, small
cuts• DIABETIC ID• FOOD – snacks both simple and complex sugars, protein and fats
Diabetes and Travel• AIR TRAVEL
– Issues with security and supplies– Stressful environment with catching planes– Eating while in the Air
• CAR TRAVEL– Check glucose prior to travel and regularly during– Pull over at first signs of hypoglycemia and do not restart till blood
sugar is within safe range– Avoid driving in the time period between your insulin injection and the
next meal– Limit yourself to 12 hours of driving daily or 6 hours between meals– Keep medication, meal, and snack times as regular as possible– Pack food in case of delayed meals
Diabetes and Travel
• SEA TRAVEL– Try not to overindulge– Keep active on the ship
• GREAT OUTDOORS– GO WITH OTHERS– Bring all your medical supplies with you and teach others
how to use glucagon kit– Avoid cuts, bruises, sunburns, blisters, or insect bites– Increase food or decrease insulin for increased activity– Keep hydrated
Diabetes and Travel
• Issues with Insulin– Storage– Some countries still may use U-40 or U-80 insulin– Crossing Time Zones
• TALK WITH YOUR DOCTOR OR DIABETES EDUCATOR – Bring flight schedule and information on time zone changes– Make plan for travel in both directions
• Eastward means shorter day and maybe less insulin• Westward means longer day and maybe more insulin• CHECK BLOOD SUGARS every 4-6 hours during travel• Less of an issue for patients on oral diabetic medications
VoyageMD.com
VoyageMD.com
VoyageMD.com
VoyageMD.com
VoyageMD.com
Pre-mixed insulin
• Twice daily pre-mixed– Take usual insulin before departure at the normal time– Prior to departure obtain an insulin pen with rapid acting
insulin– Check blood sugars every 4-6 hours– If blood sugar above 200mg/dl give a correction dose
preferably with a meal• Continue this till the patient is in the new time zone and can give
the second injection of pre-mixed insulin in the new time zone after arrival (if taken at 6pm at home you take the dose at 6pm in the new time zone)
– Could also consider switching to basal bolus prior to travel
VogageMD.com
Diabetes and Travel
• DESTINATION– Check blood sugars more frequently– Plan meals and activities remembering you have to take
your insulin– Keep medications with you– Keep snacks with you– Keep hydrated– With increased activity check blood sugars more frequently– Wear comfortable broken in shoes and never go barefoot
• Check feet daily and obtain medical care at the first signs of infection of inflammation
Diabetes and Travel
• Converting Mmol/l to Mg/dl
Diabetes and Travel
• Continue taking insulin• Drink plenty of fluids• Test your blood sugar
more often• Test for ketones• If unable to eat – then
eat sick day foods• If vomiting seek medical
attention
Diabetes and Travel
Questions?