A Little Extra Planning Can Assure a Safe and Fun Vacation
By Mark Moran
Reviewed By Michael Smith
On a trekking expedition in Europe, a young man with diabetic neuropathy -- nerve damage in legs, feet, and hands related to diabetes -- develops ulcers on his feet while hiking through wet farmland. Moisture contaminated with bacteria is absorbed through the ulcers, causing an acute infection.
The result: a shortened vacation, five days in a hospital in Europe, and several weeks on antibiotics at home.
"It was the last kind of trip he should have signed up for," says travel medicine expert Winkler Weinberg, MD, director of the International Travel Medicine Clinic, which serves Kaiser Permanente members in Atlanta.
Weinberg says the case is an extreme example of the way a chronic condition like diabetes can wreak havoc on vacation fun when the proper precautions are not taken.
With summer rapidly approaching, Americans are planning their trips to the mountains, ocean, and foreign shores. But for individuals with chronic conditions such as diabetes, a little extra planning should be anticipated to make sure vacations are safe and healthy.
"If you have diabetes, there isn't anyplace you can't go," says Paula Yutzy, RN, a certified diabetes educator and director of diabetes education at Diabetes Center at Mercy Medical Center in Baltimore. "It should not stop you if you are prepared."
Whether traveling to Switzerland or a nearby seashore, patients with diabetes are advised to bring a sugar source. "They should have with them some form of sugar to treat insulin reactions -- peanut butter, a juice box, or glucose tablets," Weinberg says.
And what about those long car rides, cramped in the car? "If patients with diabetes are driving long distances, they need to stop at rest stops and get up and walk," Yutzy tells WebMD. "If they are sitting for a long time it can contribute to poor circulation in their legs."
Endocrinologist David Bell, MD, suggests taking an aspirin for its blood-thinning properties before a long car or plane ride. "As long as the patient does not have allergic or other adverse reactions to aspirin, it can help prevent blood clots in the legs," says Bell, who is professor of medicine at the University of Alabama School of Medicine.
Bring extra food, too. "People may think they are going to stop at the next rest stop, but if they have a flat tire, they may not make it there," Yutzy advises. "You have to have emergency food in the car so that you can avoid a low blood sugar reaction."
Individuals who travel with insulin should keep it in a cooler -- or at least be very sure not to let it get hot. Leaving insulin on a dashboard in the hot sun can be disastrous. "Anything over 86 degrees will destroy it," Yutzy says.
Yutzy and Bell both advise wearing a medical alert bracelet and carrying extra supplies: Those glass bottles of insulin can drop and break. And travelers who are flying should be sure to carry supplies on the plane; checking them with baggage can be a big mistake. "You don't want to be in Portland, Oregon, when your baggage and your supplies are in Portland, Maine," Yutzy says.
Traveling overseas may involve an entirely different level of preparation and planning, particularly if people with diabetes are traveling to Third World countries. Yutzy advises checking with the U.S. State Department to find English-speaking doctors at any travel destination.
Yutzy and Bell also stress that needles and syringes can raise the eyebrows of customs officials in some countries. Documentation that the supplies are necessary to treat diabetes can save a lot of grief. "People need a signed letter from their doctor, on letterhead," Bell advises.
Also, traveling across time zones can complicate things for patients who are on a regular insulin schedule. "What I usually advise people is to treat their diabetes as if they were on American time until they get to Europe [or wherever they're going]," Bell tells WebMD. "Once they get there, they can change over to European time. And when they come back, stay on European time until they get home."
But Bell says that in the "nitty gritty" of travel, people are not apt to eat regularly. "So I tell them they have to check their glucose multiple times," he cautions. "If they are running low they need to take some sugar, and if they are running high they need to take some insulin to stay on schedule."
What else do you need to know about when the car or plane ride is over and you've reached your destination?
Experts say patients experiencing neuropathy -- like the patient described by Weinberg -- need to be cautious about ambitious adventures, especially hiking. And Bell says a walk across the blazing sands of a summertime beach can be hazardous for patients who have lost feeling in their feet.
Similarly, patients who have eye complications stemming from diabetes should think twice about scuba diving. And any water sports can be made safer by using the "buddy system," Yutzy and Bell say.
For the traveler whose diabetes is well controlled and without complications, vacations can be as adventurous or relaxing as the next person's. "People with diabetes climb mountains and hike the Appalachian Trail," Yutzy tells WebMD. "The key is making sure you know how to take care of yourself."
Originally published June 26, 2000.
Medically updated Dec. 3, 2003.
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