Australians love to travel. Currently, international travel is not an option, so more of us are exploring our backyard in Australia. This article discusses what you will need to include on your checklist when travelling Australia with diabetes.

Your trip starts with a visit with your credentialled diabetes educator and doctor. Topics you could discuss:

• Your sick day management plan (type 1) / sick day management plan (type 2) and what you will need in case of a sick day
• An updated list of your medications and how you are to use them
• A summary of your medical history in case of an emergency. If you have a My Health Record this will be digitally accessible to medical staff presuming internet access
• Extra prescriptions of your regular medications
• Any extra medications your doctor may think you may require, such as those for gastroenteritis
• Discuss how your planned activities may affect blood glucose levels and what to do about changes
• Any vaccinations, if you are not already up to date
• How and if you can access help for your health. Keep contact details of your regular health professionals with you in case you need other health professionals to consult with your team. You may also request a prescription for regular medication to be faxed to a local pharmacy. This is where cultivating good relationships with your diabetes health team pays off.

Things you may wish to consider before you leave:

Emergencies

• Consider your destination and the health services nearby. Where will you go in an emergency? In rural and remote areas calling 000 may not be an option. In this case, the Royal Flying Doctor’s service has a 24-hour emergency number 1300 69 7337
• Know what symptoms require you to seek medical attention

Food

• What are you going to eat? Are you going to be preparing your meals? If not, what options will be suitable for you? Beware of buffet breakfasts! The amount and quality of food you eat will directly affect your health. Make a plan or get some advice from your diabetes team

Exercise

• Reduced physical activity will also increase blood glucose levels and increase your risk of blood clots. Make a plan and schedule regular exercise. If you have an extended plane flight, train trip, or car trip ahead, schedule some movement breaks

Insurance

• Travel insurance on a domestic trip will generally cover you for flights, accommodation and rental cars when there is an incident – check the fine print before you go. Health incidents may be better addressed by Medicare and private health insurance. If you are traveling with an insulin pump you may wish to insure you pump for the journey or check if your house and contents insurance covers accidental damage away from home. Insulin pumps and some glucose monitoring equipment may be damaged by scanning security x-rays at airports – check with the manufacturer before flying

Medications

• Medications and glucose monitoring strips are temperature sensitive. Most oral medications will require temperatures below 30°C and to be kept out of direct sunlight and in a sealed container or foil packaging. Most medications can be packed by your pharmacy for the duration of your journey. This may be a good option if you take multiple medications. Don’t leave medications or strips in a hot car or hold luggage if you are flying
• The insulin you are currently using should be stored below 25°C. The temperature outside may be above this most of the time if you are heading north. Consider purchasing a travel pouch for insulin and cool storage containers for stored insulin – check out the Diabetes Shop here. Alternatively, an esky can be used with an ice block. Never place insulin directly onto an ice block – leave insulin in the packaging you get from the pharmacy and wrap it in a towel in the esky. If you are travelling with a fridge, the temperature must be above 2°C – never freezing. Insulin can freeze if you place it too close to the freezer section in a caravan fridge. Check out your fridge before you go as frozen insulin will not be effective when thawed.

What to pack to manage your diabetes:

• Your blood glucose meter and sufficient strips and a replacement battery. Most pharmacies in Australia are NDSS agents but may not have stock of the strips you require. Continuous glucose monitoring, Freestyle Libre, and insulin pump accessories will require ordering. It may take a few days before they arrive in the pharmacy. It is best to carry enough supplies for your trip
• If you live with type 1 diabetes don’t forget to pack a ketone monitor and strips. If you have an insulin pump, take injectable supplies and a plan in case of pump failure
• Emergency contacts, health summary, and any insurance policies, cards (NDSS, Medicare, and private health insurance)
• Your sick day management plan and hypo kit, plus a general first aid kit to treat minor ailments
• Enough medication for your trip and extra for just in case you are delayed returning home. Take prescriptions for your regular medications. You may require additional insulin for sick days

If you are driving with diabetes and are at risk of hypoglycemia, the rule is above 5 mmol/L to drive. The medications related to a risk of hypoglycaemia are sulfonylureas (Gliclazide, Glipizide, Glibenclamide, and Glimepiride) and all insulins. You will need to check glucose levels before driving and every two hours while driving. If you have treated a hypo, wait 30 minutes before you start driving again. This allows your body time to fully recover from the hypo. Always investigate the reason for your hypo and compensate.

It is always best to plan for the worst and enjoy the best. With pre-planning, you will have a safer and more enjoyable journey. Bon voyage!

by Donna Itzstein Pharmacist Credentialled Diabetes Educator and regular traveller