World Diabetes Day: Understand Diabetes, Get Involved
Eating out
My wife and I entertain a great deal and we often go out for meals with friends or in a restaurant. I have recently been started on insulin for diabetes. How am I going to cope with eating out?
Nowadays people with diabetes usually eat similar food to anyone who is following a healthy lifestyle. Although you shouldnormally try to avoid foods that are obviously high in sugar and fat, this may be difficult when you are visiting friends. Restaurants or takeaways should pose less of a problem as you can select suitable dishes from the menu. Many people using a basal + bolus regimen choose to take extra short-acting insulin to cover the extra food they are eating.
People on two or more doses of insulin a day sometimes worry about how they are going to give their injections when they are away from home. Nowadays with insulin pens there should be no difficulty. If there is nowhere else to inject, you can always retire to the lavatory just before sitting down to eat! People who are less shy discreetly give themselves insulin into their abdomen whilst at the table waiting for the first course to arrive. The use of an insulin pen can make the injection simpler, as bottles of insulin do not need to be carried around. Do not take your evening dose of insulin before leaving home in case the meal is delayed.
Fasting and diabetes
As a Muslim I wish to fast during Ramadan. Is this possible?
People with diabetes who fast during Ramadan may experience large swings in blood glucose levels, as a result of the long gaps between meals and the consumption of large quantities of carbohydrate-rich foods during the non-fasting hours. Therefore, if you have diabetes, you may be exempt from fasting. However, many people express a great desire to fast, and do not want their diabetes to prevent them from doing something they feel strongly about. If you have Type 2 diabetes and are treated by diet alone there should be no problem with fasting during Ramadan. However, there may be major changes in the type of food and drink that you consume during the non-fasting hours and this may affect your diabetes. If you are treated with insulin injections, sulphonylurea tablets, or a combination of the two, you shoulddiscuss how fasting may affect your blood glucose control with your diabetes team, before Ramadan begins.
My local youth group is holding a sponsored fast over a weekend. I have Type 1 diabetes – can I take part?
It would be very difficult and perhaps dangerous for you to go without food and, even more important, drink, for 48 hours. The problem is that, even in the fasting state, you need small amounts of insulin to prevent the blood glucose rising. Having taken insulin, you would then need food to prevent an overshoot leading to a hypo. Anyone who goes without food for long periods produces ketones, which could be another hazard. While your friends are fasting, why not think up something else you could do safely to raise money, using some of your creative powers?
Holidays and travel
Do you have any simple rules for people with diabetes going abroad for holidays?
Here is a checklist of things to take with you:
• Insulin (or tablets)
• Syringes or insulin pen and needles
• Test strips (and finger pricker) and/or meter
• Identification bracelet/necklace/card
• Glucose tablets
• Starchy carbohydrate in case meals are delayed
• Glucagon
• Medical insurance
• Form E111 (from the DSS) if travelling inside the EU
• Hypostop Gel.
Each year on our summer holidays, our daughter becomes violently sick on the ferry. She recovers quite soon after we get back on dry land but she can keep nothing down during the crossing and it is very worrying.
We presume your daughter is on insulin and, as a general rule; people on insulin need hospital help once they start vomiting.
Profuse vomiting leads to dehydration and if this is severe, the only treatment is a ‘drip’. The other worry is the risk of a hypo if your daughter has already had her insulin. Don’t be tempted to stop her insulin on the grounds that she is not eating.
There is no simple solution (apart from going by the Channel Tunnel) but the following ground rules may help.
• Take a standard antisickness tablet (e.g. Sea-Legs) at the recommended time before you sail.
• Try the ‘acupuncture’ wrist bands for seasickness now on sale at most chemists – they may just work for your daughter!
• Do frequent blood tests during the journey and immediately afterwards.
• If her blood glucose rises alarmingly, try giving her extra small doses of short-acting insulin.
• If her blood glucose values fall too low, give her Lucozade, Coca-Cola or some other non-diet soft drink.
Is it safe for someone with diabetes to take travel sickness tablets?
Travel sickness pills do not upset diabetes, although they may make you sleepy so be careful if you are driving. On the other hand, vomiting can upset diabetes so it is worthwhile trying to avoid travel sickness. If you do become sick, the usual rules apply. Continue to take your normal dose of insulin and take carbohydrate in some palatable liquid form, such as a sugary drink. Test your blood glucose regularly.
We are going on holiday and wish to take a supply of insulin and glucagon with us. How should I store them both for the journey and in the hotel?
Insulin is very stable and will keep for 1 month at room temperature in our temperate climate. However, it does not like extremes of temperature and can be damaged if kept too long at high temperatures or if frozen. It is best to carry your supplies in more than one piece of luggage in case one suitcase goes astray!
If you are travelling by air you should keep your insulin in your hand luggage – temperatures in the luggage hold of an aircraft usually fall below freezing and insulin left in luggage there could be damaged. Insulin manufacturers say it is stable for 1 month at 25° C (77° F), so it is perfectly safe to keep insulin with your luggage on the average holiday. Avoid the glove compartment or the boot of your car where very high temperatures can be reached. In tropical conditions your stock of insulin should be kept in the fridge.
Storage of glucagon is no problem as this comes as a powder with a vial of water for dilution. It is very stable and can survive extremes of heat and cold.
Airports now X-ray baggage for security reasons. Does this affect insulin?
Fortunately not.
I would like to go on a skiing holiday. Is it safe for me to ski, skate, and toboggan? Should I take special precautions?
It is as safe for someone with diabetes to ski and enjoy other winter sports as it is for anyone else. Accidents do occur and it is essential to take out adequate insurance to cover all medical expenses. Read the small print in the insurance form carefully to ensure that it does not exclude pre-existing conditions like diabetes, or require them to be declared. In this case you should contact the insurance company and if necessary take out extramedical cover for your diabetes. Diabetes UK can provide travel insurance that will cover your diabetes. Physical activity increases the likelihood of hypos so always carry glucose and a snack as you may be delayed, especially if you are injured. Never go without a sensible companion who knows you have diabetes and understands what to do if you have a hypo.
Is sunbathing all right for people with diabetes?
Of course people with diabetes can sunbathe. Lying around doing nothing may put your blood glucose up a little, especially if you overeat as most people do on holiday. So keep up your usual tests as you may need extra insulin. On the other hand, increasing the temperature of the skin may speed up the absorption of the insulin and can lead to hypos, so be prepared for changes.
Remember that sunbathing can increase the risk of skin cancer whether or not you have diabetes, so always take sensible precautions to avoid sunburn by covering up in the middle of the day particularly and using suncream with a high protection factor.
As I have diabetes should I be vaccinated when going abroad?
People with diabetes should have exactly the same vaccinations as anyone else. You are no more or less likely to contract illnesses abroad but, if you do become ill, the consequences could be more serious. In addition to the necessary vaccinations, it is very important to take protective tablets against malaria if you are going to a tropical area where this disease is found. More cases of this potentially serious disease are being seen in this country, usually in travellers recently returned from Africa or the East.
I am going to work in the Middle East for 6 months. What can I do if my insulin is not available in the country where I am working?
If you are working abroad for 6 months only, it should be quite easy to take enough insulin with you to last you this length oftime. Stored in an ordinary fridge it should keep – but make sure that you are not supplied with insulin near the end of its shelf life.
The expiry date is printed on each box of insulin. Most types of insulin are available in the Middle East, but you may have to make do with a different brand name or even insulin from a different source (pig, cow, or human). Strict Muslim countries regard pork and products from the pig as ‘unclean’ and porcine insulin may be hard to obtain in these countries. We have heard of customs officials in Saudi Arabia confiscating supplies of porcine insulin. To avoid this awkward situation it would be worth changing to human insulin before you try to enter such a country. The change may affect your control, and you should therefore make it in good time to allow yourself to stabilize before travelling. U100 insulin may be difficult to obtain outside the UK, USA, Australia, New Zealand, South Africa and parts of the Far East. Many European countries stock insulin in 40 units/ml only and special syringes for use with U40 insulin will have to be obtained. Diabetes UK can tell you which strength insulin is used in each country.
My husband has just been offered an excellent post in Uruguay, which he would love to accept. He is worried about my diabetes there and especially about the availability of my insulin. Can you let me know if my insulin can be sent by post?
It should be possible to obtain an equivalent type of insulin to your own in most parts of the world. If you are keen to keep up your normal supplies, Hypoguard Ltd are prepared to dispatch syringes and equipment for testing blood and urine to all parts of the world. Unfortunately Hypoguard are not able to handle insulin. You might be able to make arrangements with a high street chemist who would be prepared to send insulin by post, or John Bell & Croyden in London will send insulin abroad.
My friends and I are going to Spain to work next year. Can you tell me what I should take with me and whether I would have to pay if I needed to see a doctor?
Before you go abroad prepare yourself well – take spares of everything such as syringes, insulin, and testing equipment and keep spare supplies separate from the main supply in case your luggage is lost.
Medical attention is free in all European Union countries, although you should obtain certificate number E111 (from your local Department of Social Security office) before you go. For longer stays abroad, you should contact the DSS. For countries outside the EU, you should insure your health before you go. Diabetes UK Careline can help you with this.
I take insulin and need to fly to the USA. How do I cope with the changing time zones?
Flying from east to west (or vice versa) can be a bit confusing at the best of times and makes it difficult to know which meal you are eating. The box below gives some typical schedules for travelling from London to the east and west coasts of the USA plus the return trips. (If you use an insulin pen, the pattern for a basal + bolus regimen is exactly the same as the instructions here, apart from taking short-acting insulin before lunch on the plane. Many people using insulin pens are very used to injecting before each meal whatever time that is.)
When travelling keep to the following rules.
• Do not aim at perfect control. You have to be flexible especially on international flights. A hypo whilst travelling can be very inconvenient.
• Be prepared to check your blood glucose if you are at all worried and unsure how much insulin you need.
• In general, airlines are prepared to make special allowances for people with diabetes and cabin crew will do their best to help. Airlines say that they like to be warned in advancebut in practice this should not be necessary. One of the problems of ordering a ‘diabetic’ meal is that it is often carbohydrate-free, so the standard airline meal might be more suitable.
1. London–New York
Get up as normal and have your usual dose of insulin and breakfast. The departure for New York is usually around 12.00 noon, so have a good snack before boarding the plane. During the flight you will be served lunch and an afternoon snack. You will arrive at about 2.00pm local time but your body thinks it is 7.00pm. Eat soon after arrival with your normal evening dose of insulin. If you then go to bed at 10.00pm local time (3.00am to you) you will need a small dose of long-acting insulin before a well-earned sleep.
2. New York–London
The problem here is that the flights are usually in the evening and the night seems to be very short. Assuming that you are going to try and sleep on the plane, you should reduce your evening dose of insulin by one-third and have this at about 6.00pm New York time followed by a reasonable meal. After take-off at 8.00pm you should be served with a meal and should then sleep. You will arrive at London at about 7.30am local time, although it will feel to you like 2.00am. Most people have another journey home, followed by a good meal and then a sleep. You should have a dose of long-acting insulin before this sleep and try and get back into phase by the evening (local time).
3. London–Los Angeles
This is an 11-hour flight usually leaving around midday and arriving on the west coast at 3.30pm local time which feels to you like 11.30pm. During this long flight you will have to have an injection of insulin on the plane and this is best if taken before dinner served at 6.00pm London time. It would be safest to give half your normal evening dose as short-acting insulin and then try and sleep. On arrival at the other side you will need to travel to your destination and will probably have an evening meal at what will feel to you like the early hours of the morning. A small dose of long-acting insulin before this meal would cover your subsequent sleep.
4. Los Angeles–London
Leave at 6.30pm and after a 10-hour flight you will arrive in London just after midday local time which will feel to you like 2.00am. Meals on this flight are usually served about an hour after take off and an hour before landing, in the hope that you have a good sleep between these two meals. One way round this arrangement would be to have a dose of insulin immediately before the first meal, giving a normal dose of short-acting insulin and half the normal dose of long-acting insulin. Immediately before the second meal you could have a small dose of short-acting insulin alone. This should last you through until the normal evening meal at your destination, which would be preceded by a routine evening insulin dose.
