TRAVEL AND HOLIDAYS
Comprehensive medical insurance
This is absolutely essential. Medical treatment may be extremely expensive in some countries.
A diabetic, like any other person, may have to travel for business, profession, social duties, vacation or pleasure. During travel, he/she is away from the usual doctor and problems about diet, blood testing and insulin injections may arise. However, these problems need not deter a diabetic from traveling, if diabetes is well controlled.
The vacation should be planned well in advance.
Doctor's Letter
A diabetic should carry with him/her, a letter from the doctor giving details of his/her condition and prescription of medicines with generic names. Brand names of drugs often vary from country to country. Such a letter is very valuable if the diabetic falls ill during travel. Besides, such a letter affords an explanation of syringes in the luggage.
Diet
A diabetic diet consists of foods like milk, eggs, fish, meat, bread or chapatis, pulses, vegetables of a low or moderate carbohydrate content and fruits. There should not be any difficulty in obtaining these foods in restaurants or hotels. A well trained diabetic should be able to judge the quantity of suitable foods . Obese diabetics should cut down fats to minimum. For example one can take the usual allowance of chapatis or rotis but avoid purls or parathas. Dishes of unknown composition, sweets, puddings, and fruits with sugar, should be avoided. Clear soups, and tomato juice are safe and plain fruit is allowed as dessert.
Sometimes, there may be very little time for lunch. In such a case, a diabetic can have a quick lunch of sandwiches, milk and fruit. A diabetic should carry a simple source of carbohydrate like biscuits, sandwiches and fruit.
A diabetic may not be able to have the usual meal due to motion sickness. In that case, one should take the usual carbohydrate allowance in liquid form. But food should never be omitted completely.
Insulin
A disposable syringe, a small bottle containing an antiseptic and cotton can be carried in a compact plastic case. It is wise to have extra syringes on prolonged trips. Spirit swabs packed in foil are available and are very convenient. The insulin bottle, syringe, etc. should be carried in a handbag which will always be with the diabetic rather than in a suitcase which may be kept away during travel. Disposable or non disposable insulin pens are very convenient during travel.
While purchasing a fresh insulin bottle or a syringe, one must ensure that the insulin is of the same strength which the diabetic uses and the syringe corresponds with this insulin strength. One should not inject U 40 insulin with a U 100 syringe.
While traveling in a hot country, insulin bottles should be kept in a wide mouthed vacuum flask which has been cooled overnight in a refrigerator or in an insulated cool bag. Insulin bottles can be protected from heat by keeping them in the centre of a suitcase containing clothes. Insulin should not be injected unless the meal is in sight. A diabetic, as already mentioned, should carry a handy supply of carbohydrates, like biscuits, bread slices, a fruit, candy or sugar, so that there is no risk of hypoglycaemia, if the meals are not served on tune. When diabetes is severe, half the usual dose of morning insulin should be injected, followed by a carbohydrate containing snack, if the regular breakfast is going to be delayed by several hours. Total omission of insulin is dangerous in a type 1 diabetic, especially when the disease is severe.
Oral Drugs for Diabetes
Besides an ample stock of usual medicines, antidiarrhoea medicines should be taken.
Air Travel
Find out the meal time and the kind of meal which will be served. A meal suitable for diabetics is often served on the plane, if the air line is intimated in advance. A well trained diabetic should be able to select suitable foods from the meals which are served. On long distance flights, the air line should be notified so that food is available at appropriate intervals.
Traveling east shortens the day and traveling west lengthens the day. In general, time changes of less than 4 hours do not require insulin adjustments. A change of insulin dose is required when there is more than one time zone difference. The insulin dose is increased or decreased, in proportion to the time gained or lost, respectively. For example, on a longer day, as in flying west, the total insulin dose is increased by fifteen per cent if four hours, are gained. For adjustments of insulin dose, according to time zones see Appendix 8.
If more than one insulin injection is being taken, the increase or decrease in insulin dose is done for the later insulin dose; the first insulin dose need not be altered. Insulin flows fast into the syringe at high altitudes.
Meticulous control of blood glucose is not advisable during air travel, Mild to moderate hyperglycaemia for a few hours does not matter.
Oral drugs do not need much adjustment due to change in time zones. If a short-acting drug, for example, tolbutamide is taken, one extra dose is required for a longer day or night. For a shorter day, one should switch to the new timing. With a long-acting drug like chlorpropamide, generally no change is necessary.
Blood glucose monitoring
This is very useful for adjusting the dose of insulin during travel.
Motion Sickness
Those prone to motion sickness should take antivomiting tablets well in advance.
Identification Card
An identification card should be carried during travel. Without such a card, a diabetic taking insulin injections may be accused of being a drug addict.
Vaccination and Inoculation
These may give rise to fever and body ache and should be taken well in advance.
Customs and Excise
Insulin, oral drugs and accessories for treating diabetics need not be declared.
On Arrival
The meal plan and the insulin dose should be readjusted according to new activities.
PRISON
Management of diabetes usually fares badly during imprisonment. Diabetic diet, blood glucose monitoring, regular exercise and insulin therapy are often not available in prison. Prison medical staff is usually not well versed with management of diabetes. Food may not be given during prolonged interrogation, giving rise to hypoglycaemia, which may be mistaken for intoxication. Intercurrent illnesses may not be recognised and treated promptly.
Some diabetics may deliberatedly withhold insulin to produce ketoacidosis, in order to get into a hospital.
In some diabetics, control of diabetes may improve due to regular life, withdrawal of alcohol and weight loss.
Cost of Treatment
Medical consultations, periodic investigations and treatment of a lifelong disease involve considerable expense. Every diabetic should make a provision for his/her treatment in the household budget. Treatment should not be neglected because of the expenses, for, in the long run, an uncontrolled and neglected diabetes results in much more expenses, disability and loss of work days. Personal hygiene and prevention of complications of diabetes are very important. The most common cause of prolonged stay of a diabetic in hospital is a foot problem, which can often be prevented by proper care.
The charges for investigations vary from laboratory to laboratory. The price of the same drug marketed by different companies, also varies.
Diabetes clinics at the Municipal or the Government hospitals provide treatment of diabetes, free or at nominal charges. Persons covered by the Central Government Health Scheme or the Employee's State Insurance Scheme can get the drugs and have investigations done through these schemes, without an additional contribution. Many Diabetic Associations run laboratories, where investigations are carried out at moderate charges and supply drugs at concessional rates.