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 is 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.
People with diabetes can travel just the same as people without diabetes. You will need to do more planning to make sure travel plans include management of diabetes.
When travelling, it is important to think about:
Liquids in carry on bag - no more than 100mls
When flying internationally, the quantity of liquids, aerosols and gels are restricted to containers that can carry no more than 100ml in volume. Passengers can carry other supplies in their checked bags as usual.
Exemption for essential medicines like insulin - these can be more than 100mls
There is an exemption for essential medicines, medical devices, baby products and dietary supplements in liquid, aerosol or gel form greater than 100ml. 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 on-board 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 on-board in hand luggage in a re-sealable transparent plastic bag. The bag needs to be no larger than 1 litre in volume (no larger than 20cm by 20cm in size). Present it separately at the security screening point.
Tips for passing through security
Get to security points early.
Keep all diabetes supplies in one bag for easy access when going through security.
Make sure you have enough supplies when travelling with diabetes.
Carry your diabetes supplies in your 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, such as:
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’).
Before travelling, try to find out where you can get further supplies of insulin at your destination in case of an emergency. You can contact the diabetes association of the country you are travelling to, or contact the manufacturer of your insulin.
If you are travelling to parts of the world where risk of infection is high and medical care is limited, talk to your GP about whether to take anti-diarrhoea medicine and/or broad spectrum antibiotics.
Check some extra tips for people on insulin pumps and continuous glucose monitoring (including intermittently scanned CGM) when travelling.
Lithium batteries are not allowed in your checked luggage, but it is OK to have one in your child’s pump and a spare in hand luggage (in its packaging).
Have a written record of basal rates and ratios in case your child needs to come off the pump.
Carry supplies for coming off the pump, in case your child needs to do that. Take a spare insulin pen/syringe and some long acting insulin. Have a plan on how to calculate doses via injection.
12 hours before the flight change the pump cartridge, line, site and battery.
Insulin pumps and CGM should NOT be put through machines that use X-rays, including airline luggage X-ray machines and full-body scanners.
Its 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.
Security scanners will not damage blood glucose meters and insulin.
Change the pump time when you arrive at your destination
Check with the manufacturer of your child's pump or CGM for more specific advice.
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 blood glucose levels and advise adjustments. Your GP or diabetes team can supply appropriate letters and give advice about managing time zone changes. You can also discuss other issues such as insulin adjustments for activity changes, flights and overseas medical facilities.
If you don't already have it, ask for a copy of your most recent clinic letter. This summarises medical information about your child in case you need to seek medical advice away from home.
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.
Ask your doctor about suitable diabetes services at your destination. Your diabetes team may be able to 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.
Make sure your child is up to date with immunisations and has any special immunisations they need for travel to particular countries. Allow at least 2 months for this in case your child needs special immunisations - your family doctor will be able to give you advice about this.
Diabetes health professionals advise that children and young people with diabetes are fully vaccinated, including for flu and COVID-19.
Get travel insurance well in advance. As the insurer will usually need information from your doctor, you need to allow enough time for this process.
Check with the airline about meal times on the plane when travelling with diabetes.
Ask the airline or travel agent about approximate meal times on the flight and whether extra snacks are available. It is best not to ask for a 'diabetic diet' as this is often low in carbohydrate and not the type of food children like. Ask for a children's meal or normal meal and if there is not enough carbohydrate, have your own food available.
Take supplies of easy-to-eat carbohydrate for treating hypoglycaemia as well as enough extra carbohydrate in case of delayed meals during the flight, or delays between flights. Make sure your child keeps hydrated during the flight.
Prepare a kit for sick day management.
Revise information on sick day management and hypoglycaemia management.
Check the KidsHealth page on managing children with diabetes when they get sick [1]
For trips to countries where English speaking is uncommon, it may be a good idea to have medical letters translated into the local language and also some translations for important requests. For example, "I need to find a doctor", "I need sugar quickly". Making contact with the New Zealand consulate may also be a good idea for longer stays or in case there are any difficulties.
Like all travellers in overseas countries, you need to be extremely careful with food hygiene. In countries where water supplies and general hygiene is suspect:
You need specific insulin adjustments for your child for flights crossing time zones. These adjustments need to take into account:
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 unexpected hypos.
Carry plenty of extra carbohydrate.
Low glucose levels may happen if:
You don't need to make significant adjustments for travel with less than a 2 hour time shift (for example, Pacific Islands or Australia).
A checklist for young adults
See the travel checklist at the Diabetes New Zealand website [2]
Other helpful links
KidsHealth page - Managing children with diabetes when they get sick [1]
The content on this page has been approved by the Clinical Network for Children and Young People with Diabetes, Paediatric Society of New Zealand.
This page last reviewed 10 February 2023.
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Links
[1] https://kidshealth.org.nz/managing-children-diabetes-when-they-get-sick?language=rar
[2] https://www.diabetes.org.nz/young-adults-travel
[3] https://kidshealth.org.nz/sites/kidshealth/files/pdfs/long%20haul%20travel%20Pump%20guidelines%20%283%29.pdf?language=rar
[4] https://kidshealth.org.nz/sites/kidshealth/files/pdfs/Long%20Haul_Travel_STANDARD%20insulin%20Guidelines%20%282%29.pdf?language=rar
[5] https://kidshealth.org.nz/tags/diabetes?language=rar
[6] https://kidshealth.org.nz/contact?from=http%3A%2F%2Fkidshealth.org.nz%2Fprint%2F1927%3Flanguage%3Dko