Pediatric Diabetes Resources

• It is better to be well-prepared when traveling with diabetes than to find out that you don’t have what you need. Make an electronic checklist (see a sample below) of all the necessary diabetes supplies you can follow when packing. Your needs will vary depending on what type of travel you are doing, (camping, Disney, foreign countries, flying, driving, cruise, the beach, etc.).
• Do your homework on where you are traveling and plan ahead.
• How remote will you be? How active or sedentary? How stable is your diabetes? How long will you be gone? What resources are along the way or at your destination?
• Are there any language issues where you are going? Do you need to have information translated? How will you tell someone you are diabetic and need sugar in their language?
• Check with TSA regarding any new travel updates or requirements for traveling at www.tsa.gov.
• Have a diabetes check-up before your planned trip to discuss the specifics of your travel and to modify your treatment regimen, if needed.
• Obtain a letter of explanation from your health care provider regarding your diabetes. Keep it with you to explain why you need to have your supplies with you at all times, as well as any drug or food allergies you have. Our clinic can do this for you.
• Obtain copies of all your prescriptions - just in case. Have your pharmacy’s phone number.
• Be sure all immunizations and vaccines are up to date with your primary care provider.
• Have an idea of where to seek medical care where you are going, (for example, local hospitals or medical schools). If in a foreign country, where is the American consulate office?
• Carry your health insurance information with you. If traveling abroad, check into traveler’s insurance and coverage of existing conditions. Know what is covered.
• Be aware of time zone changes where you are going. If the time change is more than 2-3 hours, you may need to make adjustments to your insulin dosing. Going east is a shorter day, possibly requiring less insulin. Going west is a longer day, possibly requiring more insulin. Change your meters and pump time to the local time zone when you arrive (and remember to change it back when you come home).

Packing

• In general, pack double the amount of supplies you think you will need; it is better to have extra than to run out and have none.
• Carry your medicines and supplies in your carry-on instead of checking it in your luggage. For the supplies that aren’t affected by extreme temperature, consider splitting them up into half in your carry-on and half in your luggage.
• Have some form of sharps disposal available. The BD Safe-Cliptm needle clipper and storage device or small sharps container are available. Many airports have sharps disposal boxes in the restrooms.
• Be sure to include all other medications you may be taking. Having an anti-nausea medication like Zofran can be a lifesaver in the event of a vomiting illness (by prescription only). Include enough insulin for an extra week; back-up vials or pens in case of breakage or loss; and don’t forget a supply of pen needles and syringes.
• Store Insulin so it is protected from extreme heat or cold. It is stable from 36 to 80 degrees Fahrenheit. You may use a Frio pack or other insulated bag to maintain the temperature. Insulin out of the refrigerator is stable at room temperature for several weeks.
• Your blood glucose meter is crucial to managing diabetes. Having enough test strips, lancets, batteries for the meter, and even a back-up meter is important. More testing is important during travel due to more variables (different foods, activity, climate and schedule).
• Insulin Pump supplies (if applicable) include everything from reservoirs/cartridges, alcohol or IV prep pads, infusion sets, set inserter, to a pump battery. A good rule is to take one pump infusion set for each day you’ll be gone. Remember, you still need to bring Lantus and syringes along for back-up in case the pump fails. Know how to convert the dosing from pump to injections before you leave. Depending on your travel plans, some pump companies offer a "loaner" back-up pump that you can take along just in case. Contact your pump company.
• If wearing a Continuous Glucose Monitor (CGM), you’ll need your charging device or cord, extra sensors and alcohol wipes. It is a good idea to reference your CGM in your travel letter as well, and a have copy of your CGM prescription.
• Check the expiration dates on all the supplies you are taking.
• Be sure to pack appropriate foot-wear that is comfortable. Never go barefoot.

Flying

• Give yourself extra time at the airport, anticipating that you will be stopped, searched and possibly questioned about your diabetes supplies.
• Your liquids (insulin, etc) must be in a zip-lock bag that you must declare and put through the x-ray device. Tell the TSA agent that you have diabetes supplies in your bag. If your bag is searched, remind them that there is breakable medication and to be careful.
• Be sure your medicines have the appropriate prescription and labels on them. Your prescriptions must match the name on the ticket.
• Your insulin pump and CGM can go through the walk-through metal detector, but should not go through the x-ray conveyor belt device or body scanner. Tell the security officer that you cannot remove the pump because it is inserted with a catheter under the skin. You will be subject to a pat-down or wand. Check with your pump or CGM manufacturer about specific recommendations on getting through security.
• Always carry extra hypoglycemia treatments and substantial carb snacks with you when traveling; be prepared for delays or periods of time where food may not be accessible. Use non-liquid hypoglycemia treatments when flying (due to security restrictions), such as skittles, raisins, glucose tabs, jelly beans; they also weigh less. Sports gels (available at sporting goods stores) are another easy-to-transport option..
• Keep your diabetes supplies under the seat in front of you to avoid having to get into the overhead bin, or not being able to access them during take-off and landing.
• Be aware that meals and food can be limited on flights, so having extra snacks is helpful in the event of delays or being stranded.
• If drawing insulin from a vial in flight, don’t inject air into the vial as the cabin is pressurized and this will make drawing your insulin difficult due to the vacuum created.
• If wearing a pump or CGM, setting the alarms to vibrate may be helpful, as it can be difficult to hear the alarms in a pressurized cabin during flight.

During your trip

• Try to follow your normal daily schedule at your destination (including medications, meals, snacks, activity and sleep), although this is sometimes difficult.
• Increase the frequency of blood glucose monitoring. Set an alarm and test your glucose in the middle of the night to monitor for hypoglycemia.
• If traveling with someone, ask if they will carry a bag of necessary back-up supplies for you, in case your bag gets lost or stolen, or if your luggage doesn’t arrive.
• Stop at regular intervals to check your blood glucose and have a snack if needed. Pace yourself.
• Keep insulin stored at a safe temperature. Don’t store it in the glove compartment or trunk of the car. Backpacks can get quite hot in direct sunlight.
• Insulin used in the United States is most commonly U-100 (meaning 100 units in 1 mL) strength. In foreign countries, insulin may come as U-40 or U-80 strength. If you need to use this insulin, you must buy new syringes to match the new insulin to avoid a mistake in your insulin dose. If you use U-100 syringes for U-40 or U-80 insulin, you will take much less insulin than your correct dose. If you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin.
• If your child with diabetes (no matter the age) is traveling with a group or other family, it is important to identify an adult who can be trained about diabetes and what to do in an emergency. Having a communication plan is important to avoid scenarios which could ruin an otherwise fun time. If phone contact is available, check in with your child at least each night to review the blood sugars and help them make insulin adjustments, such as reduced Lantus/Levemir or lowered temporary basal rate on the pump. Be sure they have a “go-bag,” or day pack with the necessary supplies when they are out and about.
• Watch out for situations that can make diabetes more challenging, such as traveler’s diarrhea, sun exposure, altitude sickness and dehydration. Don’t drink tap water or ice cubes in foreign countries.
• Keep some notes or a log about what worked and what didn’t work during your travels - things that you would do differently next time.

Hopefully, planning ahead will make your travels more enjoyable

Expect some challenges with diabetes, adapt the best you can, and make some fun memories.

Travel Check List

This list is comprehensive, but not all-inclusive. You will have to decide what applies to your needs, or identify if there are other items or needs not listed here.

□ Back-pack to carry supplies for day trips
□ Back-up plan in case of insulin pump failure, conversion to injections
□ Extra batteries/charger for pump, meter, CGM
□ Backup external battery pack
□ Blood glucose meter X 2
□ Camel-water pack to stay hydrated on hiking or long day trips
□ CGM supplies (if applicable): charging unit/cord, extra sensors, alcohol wipes, adhesive options
□ Communication plan with supervising parent or adult of your child
□ Copy of all travel documents, letters, prescriptions in a place separate from supplies
□ Diabetes healthcare provider’s contact information
□ First-aid kit, antibiotic ointment, basic dressings
□ Frio bag or insulated bag for insulin storage
□ Glucagon X 2
□ Hand sanitizer
□ Head-lamp or small flashlight
□ Hypoglycemia treatment (skittles, glucose tabs, jelly beans)
□ Lancet device X 2, and lancets
□ Letter of explanation re: diabetes
□ Log book
□ Long-acting insulin vials or pens
□ Medical Alert ID bracelet or necklace
□ Medical insurance information
□ Money for hypoglycemia treatments; in the right currency
□ Other medications such as Tylenol, ibuprofen, Zofran
□ Pharmacy label on all medications (name must match travel ticket name)
□ Pump supplies (reservoirs, infusion sets, tubing, inserters, nickel, IV prep pads, tape & dressings)
□ Rapid-acting insulin vials or pens
□ Sharps disposal method (recommend BD Safe-Clip Needle Clipping and Storage Device)
□ Sick-day management plan
□ Snack variety (carb and non-carb options)
□ Test strips (enough for 12 tests/day)
□ Travel insurance coverage (if applicable)
□ U-100 Syringes or pen needles
□ Urine or blood ketostix
□ Walkie-talkie radio or cell phone (in some situations, i.e, hiking, Disney Land)
□ Watch or small travel alarm clock
□ Zip-lock bags or dry-bag to protect items from water exposure

• Bring a list of questions
• Bring all your blood glucose meters for download.
• Always keep the accurate date and time in all your diabetes devices.
• Upload your insulin pump and/or continuous glucose monitor at home. Review your data before your visit. If you are not able to upload, keeping written records for 1-2 weeks prior to your appointment can be very helpful.
• Attempt to get annual labs drawn before your appointment.
• Update your provider with any major stressors, health events, life changes, or upcoming challenges, as these may affect diabetes management.
• Consider bringing someone for support. A parent, friend or guardian.
• Make sure your school or camp forms are up to date.
• Have an updated list of all your medications, even any non-diabetic medications you may take.

When you are sick, your diabetes is significantly affected. Having a sick day plan in place is important to avoid getting into danger with diabetic ketoacidosis (DAK)—a potentially life-threatening condition. Do not assume your illness is just caused by the flu. DKA and flu symptoms are very similar (tiredness, nausea, vomiting, abdominal pain, body aches, high blood sugars and increased thirst/urination/hunger).

When you are sick, “THINK:”

Test your blood sugars every two to three hours.

Hydrate. Drink one cup of water every hour. Fluids flush the ketones out of your body. If you cannot keep fluids down, call the clinic 509-474-2880, for a prescription of Zofran.

Insulin. Correct high blood sugar levels every three hours based on your ketone correction. Do not stop taking your daily Lantus if you are on multiple daily injections. If you have a pump, change your pump site immediately.

Nutrition. If blood sugars are trending low, consider sugar-containing electrolytes (Gatorade) If blood sugars are high, consider sugar-free containing electrolytes (G2/Power-aid Zero).

K are a result of fat breakdown due to not enough insulin in your body. Extra insulin is required. Check ketones every three hours until negative.

Helpful hints

• If blood sugar reads = “HI” use the BG of 600 to correct
• Low carb or carb-free fluids: Crystal Light, sugar-free popsicles, sugar-free jello, broth.