Brief travelling checklist
Make sure travel plans include management of diabetes.
Talk with your diabetes team about how best to manage diabetes during travel, and what to do if your child becomes unwell while travelling.
Get a letter for airport security from your diabetes team or GP so you can carry diabetes supplies.
Make sure you take enough diabetes supplies for the whole trip - double the supplies you would usually need.
Make a record of your total daily basal insulin, carb ratios and correction factors from your pump. Or, you can print out the Tandem Source or Glooko reports.
Then, in case of pump failure, you can switch to Lantus and rapid acting insulin via injections.
You might find the following action and management plans helpful.
Creating A Safe Environment For Children With Diabetes At School
How travel can affect children with diabetes
Changes in your daily routine, food, climate, physical activity and time zones can affect diabetes. They can cause glucose levels to rise or fall unexpectedly. It's important to remember this when travelling and to check glucose levels regularly. This will allow you to quickly identify any changes in your child’s condition and help you manage problems if they happen.
Preparing to travel with your child
When travelling, it's important to think about the following:
- length of journey
- the chance of delays
- timing of insulin
- difference in time zones
- availability of carbohydrate food
- changes in type of foods
- access to medical services and diabetes supplies
- care of insulin and diabetes equipment
- customs regulations in different countries
- changes in activity levels
- changes in medicine and sleep routines
- prevention and management of sickness away from home
- carrying a letter to authorise carrying diabetes supplies through customs and security check
- carrying a copy of your pump rates
- medical identification
- arranging travel insurance
Planning before travel
Meet with the diabetes team
It's a good idea to make contact with your diabetes team before travel. This is especially important for overseas trips. They can help you review glucose levels and give you advice about insulin dose adjustments, documents and printouts.
Insulin adjustments
Specific insulin adjustments for flights crossing time zones
You may need specific insulin adjustments for your child for flights crossing time zones. These adjustments need to take into account:
- the length of the flight
- the time zone changes - how many hours difference between home and your destination
- timing of meals, snacks and stopovers
- usual pattern of insulin doses
- time of arrival at destination and plans for that day (for example, sleeping or being active)
When using insulin injections, you don't need to make significant adjustments for travel with less than a 2 hour time shift (for example, Pacific Islands or Australia).
When using an insulin pump, you simply change the time on your pump to the local time when you arrive at your destination. If there are multiple destinations, change the time at arrival at each destination.
Decreased activity
If travelling for long periods of time (for example, in a car or aeroplane), your child may need more insulin to keep glucose levels in target range. Ask your diabetes team about this.
Increased activity
If travel is for sport (for example for tournaments or active adventures), make a plan with your diabetes team for possible reduced insulin due to increased activity.
Documents and plans
Sick day plan
Travelling can increase the risk of illness, such as:
- Infections, like colds
- gastroenteritis from eating unfamiliar foods
It will be helpful to have a plan for managing sickness. Your diabetes team can help you with this.
Managing Children With Diabetes When They Get Sick
Clinic letter
Take a copy of a recent clinic letter as this summarises medical information about your child in case you need to get medical advice away from home.
Letter for airport security
For overseas trips and domestic flights, ask for a letter stating that you will be carrying diabetes supplies. These will include insulin and syringes, as well as fluid and food for hypoglycaemia treatment. Having this letter will avoid any problems at customs or security inspections.
A written record of basal rates and ratios
If your child needs to come off the pump for any reason during the trip, you’ll need a written record of basal rates and ratios. Have a backup plan for this situation.
Supplies you will need
Make sure you have enough supplies when travelling with diabetes. Carry your diabetes supplies in your hand luggage. Try and pack key supplies in 2 separate bags in case of lost bags.
- insulin (pack double what you think you need)
- GlucaGenTM
- syringes
- insulin pens
- blood glucose meter (plus a spare meter) and spare batteries – even if using a CGM
- blood glucose test strips
- ketone test strips
- continuous glucose monitor (CGM) sensors (check expiry dates)
- medical identification stating that your child has diabetes
- insulin pump supplies (check expiry dates)
- hypokit including non-juice box options
- extra food for the flight and transit
In case your child needs to come off the pump, take a spare insulin pen or syringe, and some long acting insulin.
Lithium batteries are not allowed in your checked luggage. But it's OK to have one in your child’s pump and a spare, in its packaging, in your hand luggage.
Other medicines to consider taking with you
If you are travelling to parts of the world where risk of infection is high, and medical care is limited, talk to a health professional (such as your GP) about whether to take:
- anti-diarrhoea medicine
- anti-nausea medicine
- broad spectrum antibiotics
- electrolyte hydration packets
- anti-fungal cream
Take enough supplies of other regular medicines for any other conditions your child has.
Travelling to hot climates and keeping insulin cool
If you're travelling to hot climates, plan to keep the insulin and other supplies cool. You can buy travel bags with a gel pack (for example, ‘frio’ packs).
Vaccinations if travelling to other countries
Make sure your child is up-to-date with vaccinations and has any special vaccinations they need for travel to particular countries. Allow at least 2 months for this in case your child needs special vaccinations. Your health professional can give you advice about this.
Health professionals advise that tamariki and rangatahi with diabetes are up-to-date with their vaccinations.
Travel insurance
Get travel insurance well in advance. The insurer will usually need information from your doctor, so you’ll need to allow enough time for this process.
Before the flight
12 hours before the flight
Change the pump cartridge, line, site and battery to prevent having to manage a possible infusion set or cartridge change during the flight.
At the airport - general security requirements
Get to security points early. Make sure you have easy access to your diabetes supplies when going through security.
Liquids in carry-on bag - no more than 100 millilitres
When flying internationally, the quantity of liquids, aerosols and gels are restricted to containers that can carry no more than 100 millilitres in volume. Passengers can carry other supplies in their checked bags as usual.
Exemption for essential medicines like insulin - these can be more than 100 millilitres
There is an exemption for essential medicines, medical devices, baby products and dietary supplements in liquid, aerosol or gel form greater than 100 millilitres. This exemption includes insulin and related supplies, liquid medicines, dietary supplements and foods in liquid form and gel (‘frio’) packs for keeping insulin cool.
Have the letter authorising you to carry the exempt items onboard with you. Make sure it's easy to find.
What to do with containers you carry on-board in hand luggage
You need to put any containers you carry onboard in hand luggage in a resealable transparent plastic bag. The bag needs to be no larger than 1 litre in volume (no larger than 20 centimetres by 20 centimetres in size). Present it separately at the security screening point.
Diabetes supplies - in hand luggage
Divide essential diabetes equipment between 2 separate hand luggage bags in case one is lost. Don't pack supplies in your luggage in the cargo hold. They may be exposed to extreme temperatures or get lost at the airport. Make sure you have enough supplies for the whole flight.
Security scanning
Tell security screeners that you are wearing an insulin pump and cannot remove your CGM. If required, show your medical letter. Also, your spare CGM sensors cannot go through the airport carry-on luggage x-ray machine.
The pump is designed to withstand common electromagnetic interference. As a result, you can safely carry it through metal detectors. But it cannot be exposed to any form of x-rays. This includes airline luggage x-ray machines and full body scanners.
DON’T put the following through machines that use x-rays, including airline luggage x-ray machines and full-body scanners:
- insulin pumps (including spare or loan pumps)
- CGM
Metal detectors and hand wands are safe. Ask airport security staff to physically check you and your luggage before using the x-ray equipment. Security staff must respond to such a request under government agency regulations. If travelling internationally, your insulin pump may be swabbed for explosives.
If you go through the full-body scanner, you must disconnect and remove both your insulin pump, sensor, and transmitter. To avoid removing your devices, you should request an alternative screening process that does not use x-ray. It's best to ask the security agent for an alternative screening method and ask to go through a standard metal detector - with your child wearing their pump.
Keep the insulin pump or CGM on you at all times. Don’t let anyone take the pump away from you.
Security scanners will not damage blood glucose meters and insulin.
Check the guidance developed by the New Zealand Aviation Security Service in collaboration with Diabetes New Zealand. The advice applies to security screening at New Zealand airports.
See the booklet (PDF, 1.31 MB)
Check with the manufacturer of your child's pump or CGM for more specific advice.
On the plane
Supplies
Take supplies of easy-to-eat carbohydrate for treating hypoglycaemia. Also, take enough extra carbohydrate in case of delayed meals during the flight, or delays between flights. Make sure your child keeps hydrated during the flight.
Keep your insulin supplies and hypo snacks close to you during the flight, not in the overhead compartment. That way, you have snacks on hand in case of hypoglycaemia or delayed meals or snacks.
Food on the plane
Ask the airline or travel agent about approximate meal times on the flight, and whether extra snacks are available.
It's best not to ask for a 'diabetic diet' as this is often low in carbohydrate and not the type of food tamariki like. Ask for a children's meal or normal meal and if there is not enough carbohydrate, have your own food available.
Devices
You can keep your receiver on before take-off, in flight and after landing.
The airlines ask that you put your smart device in 'airplane mode'. You can do this, but keep your bluetooth on. That means you can receive sensor glucose information on your smart device.
Cabin air pressure can change during take-off and landing. Talk to your diabetes team about suspending or disconnecting the pump during take-off and landing.
At your destination
Change the time on the pump to local time on arrival
Wait until you arrive at your destination before changing the time in your pump, and the date if appropriate.
First, make sure to select the correct am or pm.
Travelling to hot climates and keeping insulin cool
If you are travelling to hot climates, plan to keep the insulin and other supplies cool. You can buy travel bags with a gel pack (for example ‘frio’ packs).
Taking care with food and hygiene to avoid sickness
Like all travellers in overseas countries, be extremely careful with food hygiene. In countries where water supplies and general hygiene is suspect:
drink only bottled water
avoid ice cubes
avoid salads
avoid street food sellers and market stalls
If need to get diabetes advice or supplies in another country
Ask your doctor about suitable diabetes services at your destination. Your diabetes team can give you contact names, addresses and phone numbers for most parts of the world.
Make sure you have the contact phone and email address of your usual diabetes team in case you or others need to contact them about your child.
Important things to remember
- never stop insulin on flights
- do extra glucose checking
- keep one watch on local departure time and one on destination time
- set an alarm or arrange for someone to wake you to avoid oversleeping on the plane or after arrival
Be prepared to give extra doses of rapid insulin
Be prepared to give extra doses of rapid insulin whenever glucose levels are above the target range. Higher glucose levels are more likely during flights because of inactivity. You can usually give corrections 3 hourly. Check with your diabetes team.
Be prepared for hypos
Be prepared for unexpected hypos.
Carry plenty of extra carbohydrate.
Low glucose levels may happen if:
there is an overlap of long-acting insulin doses due to time zone changes or
if your child eats less food because of sleeping more than usual
Helpful links and resources
Check out the travel checklist at the Diabetes New Zealand website.
Travelling with type 1 diabetes can be fun and safe - and with a little preparation, you’ll have peace of mind that you’ll be able to tackle any eventuality that arises.
Acknowledgements
The content on this page has been approved by the Clinical Network for Children and Young People with Diabetes, Paediatric Society of New Zealand | Te Kāhui Mātai Arotamariki o Aotearoa.
