Although travel could pose problems for diabetic Debbie Nuzzo, she's able to control the disease even thousands of miles from home.
"I have learned over the years the different things to do," says Nuzzo, 52, of Stamford, Conn., who took a two-week European cruise this summer.
Difficulties diabetics face when traveling include proper insulin management, which is affected by changing time zones; circulation problems in the feet during long car or plane trips; blood sugar levels affected by varied meal times; and problems replacing lost medication because insulin concentrations abroad differ from those in the United States.
Diabetes occurs when the body's blood sugar (glucose) is too high because of insufficient levels of insulin. Without enough insulin, which helps transform food into energy, glucose remains in the blood at potentially harmful levels, requiring daily insulin injections. Health risks from continuously high blood sugar levels include nerve injury and blindness, as well as kidney and blood-vessel damage, which increase the risk of heart attack and stroke.
Because blood sugar levels are affected by factors such as diet, activity, stress and medication, diabetics must check sugar levels throughout the day, especially when traveling.
Norwalk, Conn., endocrinologist Dr. Sam Engel says diabetes management depends on one's insulin program. Because of time and meal variables while traveling, he says, "(diabetics) may need to take an extra injection or reduce their dosage or change the type they are using for a shorter-acting or longer-acting insulin."
Nuzzo used to inject herself with an insulin-filled syringe, but five years ago she began using a battery-operated insulin pump worn on her belt. Life has become much easier, she says. This small piece of equipment, which resembles a pager or cell phone, delivers the exact amount of insulin required to control her blood sugar levels.
After testing her blood sugar and punching in the numbers on the pump, Nuzzo receives her insulin through a thin plastic tube with a needle at the end, inserted under her skin. When traveling, she takes along extra insulin and other necessary supplies.
In the unlikely case the pump fails, Nuzzo also takes a supplementary supply of insulin (different from that used for the pump) and syringes. If the pump fails, she can order a pump that she will receive within 24 hours "no matter where I am."
"Overpacking is a very good thing to do," says Nancy Ryan, diabetes educator at Greenwich Hospital in Greenwich, Conn. She suggests that diabetics pack at least twice the amount of insulin and supplies they need. Because insulin can lose its effectiveness in drastic temperature changes, she suggests packing it in carry-on luggage rather than exposing it to the extreme cold of a plane's luggage hold.
When diabetics are traveling by car, biking or backpacking, Ryan recommends putting the insulin into an insulated bag or cool pack.
"It's always a good idea to have a couple of letters from the doctor," says Stamford Hospital endocrinologist Dr. Antonio Pantaleo. The first letter should explain the traveler's need for insulin administered by syringe or pump and include a list of medications and allergies. The second letter should include a prescription for insulin and other medications, in case of emergency.
Airports do not restrict syringes, provided they are accompanied by insulin supplies, Ryan says. The insulin must be in the original box marked with a prescription label and must be shown to airport security.
As to administering your insulin when visiting different time zones, have your doctor set up a schedule. Another concern is diet, and Pantaleo advises diabetics to "practice what they do at home, avoiding ice cream, desserts and soda. Even if they're on vacation, it's not a good idea to deviate from that."
Late suppers, customary in Europe, don't allow foods to be digested before bedtime or permit an after-dinner walk to work off your food.
Diabetic airline passengers also have been affected by dramatically reduced food service on planes.
"Diabetics should always carry food with them, just in case their blood sugar goes down," Pantaleo says. Also, he suggests calling the airline in advance to check if it serves meals. If it does, the traveler should order a special meal low in sugar and fat.