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Traveling With Diabetes

Traveling With Diabetes. Blake Elkins Project 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

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Traveling With Diabetes

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  1. Traveling With Diabetes Blake Elkins Project Echo 4/26/13

  2. 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

  3. 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

  4. Are Patients Obtaining Advice Prior to Travel?

  5. 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travel by a provider • Only 31% of patients have ever asked providers for advice relating to their diabetes and travel Unpublished Data

  6. Are Patients Obtaining Advice Prior to Travel? • Only 28% of our patients on insulin have EVER asked advice regarding insulin during travel Unpublished Data

  7. Are Patients Obtaining Advice Prior to Travel? Unpublished Data

  8. Diabetes and Travel Table 1: Traveling with Diabetes Poses Challenges

  9. 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

  10. 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/

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. VoyageMD.com

  18. VoyageMD.com

  19. VoyageMD.com

  20. VoyageMD.com

  21. VoyageMD.com

  22. 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

  23. VogageMD.com

  24. 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

  25. Diabetes and Travel • Converting Mmol/l to Mg/dl

  26. 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

  27. Diabetes and Travel

  28. Questions?

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