Having diabetes shouldn’t stop you travelling, but it does need careful planning 

Why do I need to plan?

It could be a road trip, a cruise or flying overseas – whatever your plans, your daily routine changes. Think about how this will affect your diabetes care, accessing supplies and protecting them from damage (including exposure to extremes of temperature).
Below are some considerations you might find helpful

What to pack wherever I travel and whichever insulin regimen I use

As well as all your standard travel gear, you need your diabetes supplies. Keep all medications in the original packaging.

 We recommend taking twice as much as you think you may need including:

• Blood glucose and blood ketones strips (and think about how you will clean your fingers when travelling)
• Insulin pen and pen needles.
• A spare blood glucose meter and lancet device
• Hypo treatment - consider what is available at your destination
• Snacks 
• Sharps container
• Wear medical ID and if you have a phone add the medical ID to your health app 
• Insulin carry bag – see safe storage of insulin (below)
• Medicare card
• Glucagon and sick day plan. Also carry insulin syringes for mini dose glucagon use
• For CGM/ FGM use: all your supplies. Sensors compatible with your transmitter may not be available overseas
• For insulin pump use: supplies of lines, cannulas, cartridges, batteries or charging cables 
• Alcohol wipes for pump line or CGM / FGM insertion 
• Contact details
  • How to get sick day advice while travelling. RCH patients have access to the “sick day service” (via RCH switchboard)
  • Medical device companies (CGM / FGM or insulin pump company details)

Safe storage of insulin and meters

Insulin companies recommend that unopened insulin is stored at 2-7 °C. If kept outside the fridge, and below 37 °C, it is usually stable for 1 month.

Insulin frozen or exposed to temperature above 37 °C should be discarded  

Before trusting a fridge when travelling, leave a small quantity of cold water on a saucer in it overnight. If it freezes, don’t use the fridge!

To protect from heat use an insulated bag with an ice block, separating the two with a pocket or cloth. Water cooled holders are another option  (e.g., FRIO bags)

Blood glucose meters should also be protected from extremes of temperature as this may affect their accuracy

Air travel and diabetes considerations

Flight letter

When flying you will need a flight letter, as this may be required at the security checkin.

Your treating diabetes team or GP are able to write one. A flight letter from RCH is prepared for our patients on request (email diabetes@rch.org.au). Please allow at least 3 weeks for this to be provided.

The letter should include:

• the diagnosis of diabetes
• a list of medications used
• a list of the diabetes supplies you will be carrying
• that you need access to all these items on board as they are required for diabetes care
• insulin delivery devices and CGM / FGM devices in use. Include that the companies recommend these are not exposed to x-rays (including luggage x-ray and total body scanner) so should not be removed from your body. Sensors and transmitters not worn should be in a clear plastic bag so you can request visual inspection
• should you be asked to go through the total body scanner you would need to remove your insulin pump or CGM (sensor and transmitter), so a pat down check is preferable and reasonable. 

Travel insurance

Smartraveller advises “if you can’t afford insurance, you can’t afford to travel”. Make sure your chosen insurance policy covers type 1 diabetes and your diabetes supplies (including insulin pumps if used)

Airport security and carrying diabetes supplies

Luggage stored in the cargo hold may be delayed, lost or exposed to extremes of temperature, so have your supplies (including flight letter) in your carry-on luggage.  If possible, divide supplies between 2 adults, in case a bag is lost or stolen. Make sure you have easy access to your meter, hypo food and insulin while seated.

More information on travelling with medications can be found on the Department of Health website 

Flying and CGM / FGM use

For further information on specific company advice, click the company links below 

Travelling with your Freestyle Libre®

Traveling with your Dexcom G6 - this is an American Video. The Australian support line is AMSL Australia 

Medtronic traveling with an insulin pump

Flying with an insulin pump

Air pressure changes and insulin delivery

Cabin air pressure changes during take-off and landing, and insulin, like other fluids, is affected by this. The pressure change can cause either bubbles in the line and reservoir causing less insulin delivery or increased pressure in the cartridge causing increased insulin delivery.

Some people disconnect and suspend their pump during take-off and landing and if bubbles are present, also check the reservoir before reconnecting. 

If using a Medtronic 640/670G with CGM, use ‘flight mode’ during the flight.

Date/Time in pump

Wait until you arrive at your destination before changing the time (and possibly date) in your pump. Make sure the am /pm is also correct!

Pump settings and reports

In case of line or pump failure, you will need to know your Pump Total Daily Dose (PTDD). Save a copy of your current pump settings and PTDD from your pump upload report.

Pump or line failure and you are unable to resite the cannula: 

If this occurs, you will need to revert to injected insulin.  See Pump Mangement for line failure 

If your pump has failed, contact your pump company regarding a replacement pump. Some companies have a travel loan program for overseas travel

Line/site failure with high BGLs +/- blood ketone: 

See Pump Management for hyperglycaemia

Medtronic travel loan insulin pump program: 

The Medtronic Travel Loan Program provides you with a spare pump to carry with you while you are away on holiday overseas or in remote locations where you are unable to receive a replacement pump should your pump fail.

Contact: australia.diabetes@medtronic.com. Medtronic cannot guarantee the availability of a specific model of the loan pump provided.

Medtronic ask to submit your application two weeks prior to the travel date but with the holidays approaching earlier than this to avoid delays.  

Common Questions about the Medtronic Travel Loan Program:

Q: Can I open the pump package up and input the device settings even if I don’t end up needing to use it?

A: Yes you may – safety first!

Q: How long do I have to return the pump after I return form my time away?

A: 14 days

Q: How long may I travel with the loan travel pump?

A: Up to 90 Days

International flight considerations

“What if” planning

Be prepared for "what if" situations including flight delays, missed connections and lost luggage. Always have your diabetes supplies with you.  

Vaccinations

Speak to your GP about vaccinations for overseas travel. Some need 2 doses a few weeks apart, so start planning early!

Sick day planning

Prepare your sick day plan including mini dose glucagon plan and a list of emergency contacts (GP, diabetes nurse educator and technical support numbers for insulin pumps or CGM / FGM companies). Sick day support for RCH patients is available via the RCH switchboard +613 9345 5522 - ask for the diabetes sick day service. 

Travel and food options

Avoid ordering the ‘diabetic friendly’ meal option in flight as these often are very low in carbohydrates. Wait until your meal arrives and when you can assess the carbohydrate content before injecting your insulin.

Do some homework before leaving home to learn about the local foods and carbohydrate content. There are many apps to help with this

Be mindful of the risk of gastroenteritis and find out if you should avoid the local tap water. 

Time zone changes and planning your insulin adjustments

With different time zone, you will need to adjust your insulin schedule. As well as carrying your flight letter, develop a flight plan for managing your insulin timing and doses during your flight.

Don’t change your time on your clock until you arrive at your destination. Give your insulin according to the time at your place of departure while in flight, See information below on working out a flight plan.  Always remember you need insulin in your body all the time. Any plan for changing the timing of your long acting insulin should be planned well before your fly. 

Multiple daily injections

See this guide to support you making a plan if using multiple daily injections. If you want a DNE to check your completed plan, email diabetes@rch.org.au (RCH patients only).   

Insulin pump use

You do not need a flight plan, but see flying with an insulin pump above 

Twice daily injections

A flight plan can be requested by emailing diabetes@rch.org.au, attaching your itinerary and current insulin doses.

Please note, given workload demands for the Diabetes Allied Health Team, allow at least 4 weeks for a reply for any requests for assistance with flight plans or flight letters. We are unable to accommodate last minute requests for help except in exceptional circumstances. 

Helpful Links

Diabetes Victoria - travelling with diabetes 

Department of Foreign Affairs and Trade

Smartraveller

Services Australia for information on reciprocal health care agreements