Having diabetes should not limit most people from traveling, yet a certain amount of education can help prevent diabetes-associated complications. Following a regular and routine lifestyle of sleep, exercise, caloric intake, and medication dosage best regulates diabetes. Adjusting to time zone changes, unregulated meals, and irregular sleep-wake cycles are some of the many challenges diabetics face due to the unpredictable nature of traveling. Furthermore, since many diabetics, suffer an impeded ability to heal infections, we offer advice about how to prevent and manage minor, common infections and when to seek medical attention.
Traveling with Medicines
Most medicines that regulate blood sugar are available in Mexican pharmacies without a prescription. There may be differences in the strength and preparation of insulin(s), so always confirm the dosage/concentration prior to use. Insulin users should always use caution in matching syringes with insulin concentrations (i.e. use U40 syringes with U40 insulin) to avoid over- or under-dosing complications.
Always pack two to three times more medicine than you think you will need. Take separate supplies stored in waterproof packages. Assume that you will lose your luggage, so keep one supply with you at all times and keep the other(s) in your luggage. Similarly, if you take a day trip away from your base city, always remember to take a second supply of insulin or oral medication in case of loss or breakage. Remember to take adequate supplies of syringes, lancets, and glucometer supplies (test strips and extra batteries). Insulin in a vial will keep for about one month at room temperature. A popular alternative to carrying and using vials and inject-able syringes is the disposable Insulin Pen. Many remain effective for 7 to 14 days at room temperature. The newer basal insulin preparations last 28 to 42 days, without refrigeration. These are distinct advantages for the frequent traveler with diabetes and we recommend discussing these alternatives with your physician
Medical Travel Tips
If you are traveling across multiple time zones, remember to keep your watch on home time until you arrive in Mexico. Jet lag can interfere with your internal “gauge,” and we always advise that you use insulin according to schedule and meals and not based on how you feel. Remember to make frequent glucose checks as you adjust to your new surroundings and time zone.
When traveling to a foreign country, syringes and medications may raise suspicion among local authorities. Always carry documentation of your diabetes and form of medical therapy.
It is important that diabetic travelers be aware of the signs, symptoms, and causes of hyper- and hypoglycemia. You may exercise and walk more during a vacation, which can induce low blood sugar. Taking your medication on schedule and skipping meals is another sure recipe for developing hypoglycemia. It is wise to carry small snacks with you to combat low blood sugar.
Physiologic stresses such as infection, dehydration, and diarrhea can cause high blood sugar. If you notice an unexplained or persistent elevation in blood sugar that is not typical, this may be an indication that something serious is going on in your body and you should visit a doctor. It may be useful to take additional insulin or medication during a bout of high blood sugar.
Preventing and Treating Common Infections
The standards of treatment for the complications associated with diabetes are based on prevention. Aside from controlling blood sugar through proper diet, exercise, and medication, the diabetic traveler should self-monitor for signs of illness or infection. In diabetics even the most minor scratch, if left untreated, can result in a severe infection. Educated, aware, and relatively healthy diabetics should be able to self-manage minor infections without the guidance of a physician. We advise such diabetic travelers to take antibiotic ointments and pills with them in the event of simple bacterial infections or in some instances for prevention. Less self-reliant or less healthy people should seek medical care more readily. Your home-based primary care physician can provide you additional advice and education and, if necessary, a list of antibiotics you should take under certain circumstances.
We provide these helpful guidelines for certain common conditions:
Upper Respiratory Tract Infections (URI)
Most URIs are viral and do not require medication. However certain people are at an increased risk of developing bacterial pneumonia and are therefore candidates for preventive antibiotics. People with COPD, other lung disease(s), heavy smokers, alcoholics, and elderly or debilitated travelers should take special care. Ask your physician if he or she feels it would be prudent to take antibiotics with you in case you develop a URI.
Skin and Soft Tissue Infections
Diabetics are at particular risk for developing skin and soft tissue infections from even minor cuts and scratches. The most notable area of infection is the foot, where nerve damage from long- term diabetes may have eliminated the sensations of heat, cold, and pain. This makes it difficult to detect cuts, sores, or even a penetrating nail. Also, many long-term diabetics have developed poor circulation making it difficult to heal even minor wounds. It is imperative that diabetics check their feet daily for cuts, scrapes, or embedded objects. It is also imperative for diabetics to wear shoes or other protective covering on their feet at all times (even on the beach). Younger diabetics without a history of wound healing problems can self-treat minor cuts and scratches according to standard wound care procedures. Older or unhealthy diabetics or diabetics with a penetrating or deep wounds should consult a physician. All diabetics should carry a wound care kit on any trip where medical attention might be difficult or inconvenient to attain.
Urinary Tract Infections (UTI)
A diabetic with a common bladder infection has an increased risk of developing a serious kidney infection (Pyelonephritis).
Diabetes can complicate diagnosis and treatment in emergency medical situations. All physicians and health-care facilities listed in Mexico: Health and Safety Travel Guide are equipped for and skilled at managing complicated diabetic care.
Robert H. Page, MD and Curtis P. Page, MD are authors of the MEXICO: Health and Safety Travel Guide.