Life with Diabetes

Travelling with Diabetes

Travelling with type 1 diabetes is entirely possible – you just need to plan ahead and be prepared to ensure your trip goes as smoothly as possible. Here, are a few things to consider:

Before you go

Schedule a visit to your healthcare team ahead of your trip
Discuss your travel plans and how this may affect your diabetes management for example a change in insulin requirements as a result of new foods and different physical activity day-to-day, or even how different time zones need to be considered
Carry medical ID or documentation
In case you need medical assistance whilst you are travelling, having the appropriate medical identification may help to expedite your care. For example, bringing a letter from your doctor which states you have type 1 diabetes and carrying your National Diabetes Services Scheme (NDSS) card can be useful in identifying you have type 1 diabetes in an emergency situation. Also consider other forms of ID which may be beneficial like wearing a medical bracelet or necklace¹
Plan ahead with travel insurance
If travelling internationally, consider healthcare in other countries and arrange travel insurance accordingly. Make sure the cover includes pre-existing conditions like type 1 diabetes¹ as well as illness or injury which may result from pre-existing conditions
Consider what medical technology could best help you manage your glucose levels whilst travelling
- For example, Continuous Glucose Monitoring (CGM) can be very useful when travelling as it provides continual glucose information every 5 minutes, meaning you can see your glucose levels^* in real-time as you go about your trip.² In particular, Dexcom G6 CGM has a number of features like customisable alerts and alarms, and Dexcom Share which allows for remote sharing of glucose levels with family, friends or carers anywhere in the world, offering more peace of mind for the individual/group travelling and their loved ones back home^{^}
- Another example of medical technology which could assist whilst away is insulin pump therapy, such as the t:slim X2^™ insulin pump. Insulin pumps like the t:slim X2 continuously deliver a small amount of short-acting insulin to keep glucose levels steady, as well as additional insulin on demand (for example around mealtimes); providing great flexibility when travelling as there’s no need to stick to ‘normal’ snack or mealtimes. Further, in the case of the t:slim X2 insulin pump, the Control-IQ^™ technology feature uses a predictive algorithm to keep an individual’s glucose within the target range.^# When needed, Control-IQ automatically delivers additional insulin if levels are too high, or suspends insulin delivery when glucose levels are too low, offering more convenience and automated assistance, so you can focus more on your holiday

Packing

Packing supplies
If using a CGM like Dexcom G6 or an insulin pump like the t:slim X2 insulin pump, pack extra supplies! NHS recommend packing three times the amount of supplies you think you will need, in case of an emergency.³ Additionally, make sure you have a back-up plan organised (e.g. insulin pens, blood glucose meter) in case of an emergency
Storing supplies
Refer to your device’s User Guide for more information on how your device should be stored. In the case of Dexcom G6, sensors should be stored at temperatures between 2 and 30 degrees Celsius, and the transmitter between 0 and 45 degrees Celsius.² And for the t:slim X2 insulin pump, Tandem Diabetes Care recommend the pump should be kept between 5 and 37 degrees Celsius⁴

Packing supplies for flying
If flying, Diabetes Australia suggest splitting your medical supplies in at least 2 bags, so even if a bag gets lost or damaged in transit, you will still have some supplies⁵

During your trip

Airport Security
If flying, consider airport security. Firstly, medical devices like Dexcom G6 and t:slim X2 insulin pump should not go through Advanced Imaging Technology (AIT) body scanners or x-ray machines - instead ask for a full body pat-down, hand-wanding, walk-through metal detector, or visual inspection as you are wearing/carrying a medical device.^2,4 The airport security officer may ask for proof of diagnosis, in which case make sure you have the letter from your doctor in a handy spot! And as a result, allow extra time going through security to ensure you don’t have to rush to catch your flight
Carrying medical supplies whilst travelling
Make sure you carry your medical supplies in accordance to their optimal temperature ranges – this may mean taking a cooler pack or small esky. If driving, remember to take your insulin and other supplies out as soon as you reach your destination
BYO snacks
Sometimes there are delays or unexpected moments, so try to plan ahead with your meals and snacks too wherever possible.² If flying, taking some snacks with you in your carry-on luggage may prevent an emergency later on if your glucose levels are dropping
Don’t Drive Under 5
If driving, make sure you’re fit to drive. Diabetes Australia advocate for “Don’t Drive Under 5” (that is, 5 mmol/L).^6,7 Furthermore, Austroads suggest that not delaying or skipping normal mealtimes can also assist in managing glucose levels, as well as stopping every two hours to consider if you need a snack break.⁸ Austroads have more information available in their Assessing fitness to drive document here

Some useful links:

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Nutrition and Type 1 Diabetes

Consuming a healthy diet is essential for anyone, whether they live with diabetes or not. However, for individuals living with type 1 diabetes who need to manually correct their glucose levels, nutrition plays a key role in finding that balance, to maintain glucose levels within range. It’s important to understand the main nutrients which give us energy – carbohydrates, proteins and fats - how the body absorbs these nutrients, and how they affect BGLs.⁹ This is something we’ll delve into a little more now.

There are three main nutrient groups which give us energy:

Carbohydrates - Whether starches or sugars, Carbohydrates have the biggest impact on glucose levels.⁹ They can be categorised into different groups based on their Glycaemic Index (GI), that is how quickly or slowly they affect glucose levels. High-GI foods breakdown into glucose quickly, resulting in a higher and faster rise in levels after eating¹⁰, and examples include processed fast foods, chips, cakes, white rice and bread. Whereas low-GI foods breakdown into glucose over a longer period of time, resulting in a smaller and slower rise in levels¹⁰, which includes most fruits, dairy foods and green vegetables. Knowing the nutritional value in the food you are eating is beneficial so that you can adjust your insulin requirements accordingly – and this is where carbohydrate counting comes into play!

Carbohydrate counting, which is essentially matching insulin to the amount of carbohydrates you eat and drink¹¹, is crucial to do to maintain your glucose levels within your desired target range. You can find out the number of grams of carbohydrates by reading the nutritional label pre-packaged foods. Then, by taking into account your insulin to carb ratio, you can estimate how much insulin is needed to account for that particular food. The best way to get started with carbohydrate counting is by speaking to your diabetes educator – they may also put you in touch with a dietitian or nutritionist who can help you get started tracking your carbohydrate intake. However, keep an eye out for training courses or events too – for example, the NDSS has a Carbohydrate Counting online program, which you may find helpful in starting out with Carbohydrate counting. For more information, see https://www.ndss.com.au/services/support-programs/carb-counting-online/
Proteins and Fats – Proteins breakdown into amino acids and fats breakdown into fatty acids, not glucose – so their direct effect on glucose levels is minimal compared to carbohydrates however they shouldn’t be overlooked. Proteins are key nutrients that can help the body grow and repair⁹ – and many protein foods such as milk and yoghurt also contain carbohydrates. On the other hand, fats are an essential nutritional group as well, providing the body with stored energy and insulation. It’s also important to consider that a meal high in protein and fat can change how quickly the body can absorb carbohydrates.¹²

There’s obviously a bit to think about with nutrition, so we’ve compiled some general factors to consider below:

Ask your healthcare professional to find out more about nutrition! A dietitian or nutritionist will be able to answers your questions about food, managing glucose levels around mealtimes and how nutrients are absorbed by the body
Consistency is key! Life can get busy, however it’s essential that everyone feeds their body the nutrition it requires. For people living with type 1 diabetes however, skipping a meal is not ideal as this can cause blood glucose values to fluctuate¹³
Carbohydrate counting can be an effective tool for managing insulin requirements. To get started, check in with your healthcare team to see if your local diabetes clinic hosts or can recommend a training course to get you started!
Continuous glucose monitors like Dexcom G6 can be helpful in identifying any changes in your glucose levels following mealtimes or snacks

Ultimately, some people living with diabetes may choose to eat a specific diet to help keep their BGLs within range, however there’s no ‘standard’ diet to follow for people living with type 1 diabetes. Before implementing a new diet regime, it’s important to consult a dietitian or nutritionist to ensure that you are getting all the nutrients you need.

Helpful links:

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Exercise and Type 1 Diabetes

It’s important to recognise that exercise can significantly impact glucose levels, causing levels to increase or decrease. This is because exercise causes your muscles to use more glucose.¹⁴ It is vital that individuals living with diabetes consider what type of exercise they will be doing and at what intensity, for how long and how this may affect their glucose levels so that they can adjust their management accordingly.

Many exercise factors can affect glucose levels such as the type of exercise performed. For example, many people participating in aerobic sports and exercise like swimming, road cycling and marathons will notice a reduction in their glucose levels.¹⁵ Whereas anaerobic exercise and sports like weightlifting, boxing and sprinting tend to increase glucose levels in the body.¹⁵When it comes to mixed activities or team sports like AFL, soccer, netball and basketball – as these have elements of aerobic and anaerobic physical activity, typically their effect on glucose levels is a little different. Individuals living with type 1 diabetes may generally experience relatively stable glucose levels throughout the game or activity but then a drop in the hours after the exercise.¹⁵It’s important to note that every body reacts slightly different to exercise, and so it’s crucial that individuals talk to their healthcare team about how their body may respond to physical activity and what necessary precautions they need to take prior to exercising.

Other factors to consider when exercising:

Insulin – Insulin requirements may need to be tweaked prior, during and after exercise, as the body is more sensitive to insulin so it’s important to consider what management strategy will work best for you. For example, some insulin pumps like the t:slim X2 insulin pump with Control-IQ technology can automatically adjust your insulin requirements during exercise. To figure out what would work best for you and your needs, your healthcare team can assist in creating a tailored insulin plan for you
Diet – It’s important to consider how different nutrients affect glucose levels. Carbohydrates (starches or sugars) for example, are thought to have the most direct impact on glucose levels.¹⁵ Additionally, the body also absorbs nutrients differently prior to, during and after exercise – so this much be accounted for in the management plan. If you want more information, it may also be beneficial to meet with a dietitian to find out more about how certain nutrients can affect your body

Ultimately, it’s important that you chat to your healthcare team prior to starting a new exercise regime, however here are some additional tips to think about:

Always carry fast-acting carbohydrates - additional carbohydrates may be needed during or after exercise to prevent or treat a low glucose event (‘hypo’)¹⁶
Consider your glucose levels before exercising. Remember that vigorous anaerobic activities can further elevate BGLs whereas aerobic exercise will most likely result in a drop in your levels¹⁵, so it’s vital individuals plan ahead. Continuous glucose monitoring devices like Dexcom G6 can be helpful in identifying any changes in your glucose levels before, during or after exercise. CGMs like Dexcom G6 have additional features that help you keep track of your glucose levels whilst exercising like customisable alerts and alarms, or for viewing retrospective glucose readings to find patterns and insights – the Dexcom Clarity† program can be useful too!
Check your glucose levels before and right after exercising – and in the hours that follow¹⁷to prevent delayed low glucose events. Furthermore, consider finishing your exercise activity a few hours before bedtime
When testing how your body responds to different sport and exercise activities, keep a record of the activity and how your glucose level responds¹⁸

Other helpful resources:

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ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE. Read the warnings available on amsldiabetes.com.au/resources before purchasing. Consult your healthcare professional to see which product is right for you.

*Readings from Dexcom G6 can be viewed on one medical device (e.g. the t:slim X2 insulin pump or Dexcom Receiver) and one personal device (e.g. a compatible mobile phone). To view a list of compatible smart devices, visit www.dexcom.com/dexcom-international-compatibility
^{^}Followers must separately download the Dexcom Follow App to view shared glucose information. A stable internet connection is needed to enable this Dexcom Share feature
#Control-IQ technology is not a substitute for active self-management of your diabetes. Dexcom G6 is required for this feature, and is sold separately
†The web-based Dexcom Clarity software is intended for use by both home users and healthcare professionals to assist people with diabetes in the review, analysis, and evaluation of historical CGM data to support effective diabetes management. It is intended for use as an accessory to Dexcom CGM devices with data interface capabilities. Caution: The software does not provide any medical advice and should not be used for that purpose. Home users must consult a healthcare professional before making any medical interpretation and therapy adjustments from the information in the software. Caution: Healthcare professionals should use information in the software in conjunction with other clinical information available to them.

References

Last Updated: 10th May 2023