Dr Sarah Jarvis is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and the resident doctor for BBC Radio 2.
When I first became a GP in 1990, diabetes wasn't a common condition. Today, the situation is very different – since the early 1990s, the number of UK adults with diabetes has more than trebled, from 2% to 7%. In fact, 1 in 10 over 40s in the UK is now living with diabetes.
There are two main types of diabetes. This is an autoimmune condition – your body's immune system, which usually helps you fight off infection and other intruders, mistakes part of your body for an enemy and attacks it. Type 1 diabetes usually comes on in childhood or early adulthood, and needs treatment with insulin injections from day one. That's because your pancreas can't make insulin – essential to regulate your blood sugar – at all. It's nothing to do with lifestyle and your weight or body shape doesn't affect your risk of type 1 diabetes.
Today, about 9 in 10 people with diabetes in the UK have type 2 diabetes, which is all (or at least largely) related to lifestyle. It's most commonly diagnosed in over 40s, and apart from getting older the biggest risk factors are being overweight and having type 2 diabetes in your family. If you're of South Asian origin, or if you're an 'apple' rather than a 'pear' (i.e. excess weight accumulates around your midriff rather than your hips and thighs) you're also at higher risk.
Type 2 diabetes doesn't need insulin from day one – and with careful lifestyle management, you'll often be able to avoid needing injections entirely. The mainstays of treatment are a healthy diet and lifestyle changes (as they are for type 1 diabetes) along with tablets as needed.
Can I travel if I have diabetes?
Absolutely! There's no reason you shouldn't enjoy your holidays as much as anyone else if you have diabetes. However, depending on your medication and other factors, you'll need to do some extra preparation to avoid unpleasant surprises on your trip.
When should I contact a doctor if I'm ill?
If you have diabetes and become unwell when you're away, you should follow the advice given to you by your medical team. This might include checking your blood glucose more regularly, eating and drinking as normally as possible, and drinking plenty of sugar-free fluids. If you're taking insulin, you should never stop it, even if you're not eating very much.
Check your blood glucose regularly and be guided by your results and the advice your doctor has given you.
You should seek medical help if:
- You're unable to eat or drink.
- You're on holiday on your own and have no support.
- You have persistent diarrhoea or vomiting.
- Your blood glucose levels are very high or very low.
- You feel drowsy or confused.
- Your symptoms are becoming worse or you don't know what to do.
Glucose monitoring
More than a 'flash' in the pan
In March 2022, the National Institute for Health and Care Excellence (NICE) produced new guidance which has proved music to the ears of campaigners. If you use insulin (or take certain tablets for type 2 diabetes) you need to monitor your blood glucose carefully.
If your glucose is persistently high, you're at much higher risk of complications of diabetes such as kidney damage, eye problems and issues with your circulation which can lead to amputation. Episodes of low blood glucose (called 'hypos') can cause drowsiness and even, in severe cases, loss of consciousness or death.
Continuous Glucose Monitoring -sometimes called 'flash' glucose monitoring – involves wearing a sensor just under your skin that continually records your blood glucose. It allows you to check your glucose levels without the same need for finger pricks and helps you see whether your blood sugar is too high, or whether you're heading for a hypo. There's good evidence that using CGM improves both your overall glucose control and your risk of hypos.
NICE recommends that everyone with type 1 diabetes should have access to CGM – currently, less than half of people with type 1 diabetes in England have been prescribed it.
If you have type 2 diabetes and use insulin, NICE recommends you should be offered access to CGM if you:
- Don't recognise early symptoms of low blood glucose.
- Have severe or repeated hypos.
- Can't check your blood glucose using finger-prick testing.
- Need to measure your blood glucose 8 or more times a day.
Top tips for travelling with Diabetes
Dr Sarah Jarvis is the Clinical Director of the Patient Platform, an active medical writer, broadcaster, and the resident doctor for BBC Radio 2.
Having diabetes absolutely shouldn’t stop you from enjoying your holiday – but you definitely need to take a few precautions. Start planning well before you travel, to avoid medical mishaps ruining your trip.
- Take twice as much as you normally need of any medication or equipment you need for your diabetes. This will avoid problems if medication is damaged or your return is delayed – for instance, if you are in a country which requires self-quarantine for COVID-19 or if you become unwell while you’re away.
- Always carry your medication in its original packaging, along with a copy of your prescription in your hand luggage. If you're travelling with someone else, split your supplies with them in case one bag gets lost. You’ll need to go through airport security with them so you can explain that the medication is yours and provide proof you need it.
- If you use insulin, you will need to have a doctor’s letter with details of your condition confirming that you need to carry needles, insulin, and hypo treatment in your hand luggage (your GP may charge for this letter). Pen devices, lancets, test strips and needles will need to be carried in your hand luggage in a transparent plastic bag. You’ll need to take this out of your luggage to go through security, you should also take all your equipment with you on your person when travelling. You’ll need to store your insulin at the correct temperature, so you shouldn’t put it in the hold of the plane - it may freeze in the hold, preventing it from working effectively. Contact your airline provider in advance to discuss this.
- Check in advance with your pharmacist about how to store your insulin (if you use it) and contact your hotel to check there’s a fridge to store it. Take a cool bag and plastic ice blocks to store your insulin (if you’re using one that includes plastic ice blocks, never let the insulin come into direct contact with them).
- Remember that food abroad if often different from your diet at home. There’s no reason why you shouldn’t try new foods, but you do need to know the carbohydrate content. Install a Carbohydrate & Calories app on your phone or use the Carbs & Cals Pocket Counter from Diabetes UK.
- Always take out specialist travel insurance, even if you’re travelling to a country covered by the Global Health Insurance Card (GHIC). The GHIC doesn’t cover all eventualities, and it means you’re entitled to the same terms as a local, rather than automatically getting free healthcare. Make sure your travel insurance covers the loss of prescription medication so that you can claim to recoup the cost if you do have to buy replacement medication should yours be lost or stolen.
READ MORE: Diabetes Travel Insurance
Travelling with a pump or CGM
If you use continuous glucose monitoring, you'll need to let your airline know. The same applies to insulin pumps – the Civil Aviation Authority’s Advisory Health Unit recommends everyone with diabetes should contact their airline, if possible a few weeks in advance, to discuss medical devices they need to take on board.
This is because of the wireless connectivity of pumps and CGM. You may not be allowed to keep your devices going while you're flying. If this is the case, you may need to talk to your medical team about using standard insulin injections, or finger-prick testing for blood glucose, while you're in flight.
X-ray scanners can prevent some insulin pumps and CGMs from working properly. This means you shouldn't go through a whole-body scanner or X-ray machine while wearing your pump or CGM. As well as contacting your airline, it's worth printing out a Medical Device Awareness card that you can show to security staff.
COVID-19 and diabetes
During the pandemic, it became clear that people who had diabetes were at higher risk than others of becoming seriously unwell or dying from COVID-19.
So it's important not to be complacent about COVID-19 if you have diabetes, but there's lots of good news too. Having either very high or very low blood sugar increases your risk of serious complications from COVID-19. But if your blood glucose (sugar) is well controlled, your risks are greatly reduced.
If you have diabetes, you may need to take extra precautions if you become unwell for any reason. These precautions are commonly called 'sick day rules for diabetes'. What you'll need to do and when you should seek medical help will depend on what type of diabetes you have, which medication you use and any other medical conditions you have
You should discuss with your doctor what steps you should take if you become unwell. This is particularly important if you're going on holiday and may not be able to contact your regular medical team.
Other precautions
If you have diabetes, you'll have had regular advice about eating and drinking – the advice you'll have been given will depend on your individual circumstances and the type of medication you take. If anything, it's more important than ever to take this advice into account when you're abroad: you may be travelling across different time zones, eating at different times, and want to try new foods.
There are lots of tips for other steps to take in our 'top tips for diabetes' section. Take all that on board and there's no reason you shouldn't enjoy your holiday, safe in the knowledge that you're safe.
Get a quoteSingle Trip insurance is for one-off, individual trips and will cover your specified travel dates. This is usually up to 45 days; however, some insurance providers can cover up to 94 days. If you’re not a frequent traveller, single trip cover is a great option and will likely be cheaper than an annual multi-trip cover.
If you travel 2 or more times a year, annual trip cover may very well save you money. The maximum duration of any trip will always be specified and will vary by provider. But don't worry, when you get a quote, we'll ask you what your maximum trip length is and only show you quotes that match!
A pre-existing is any medical condition for which medical advice, diagnosis, care, or treatment was recommended or received before applying for a travel insurance policy. For some conditions, we'll need to know if they have ever been present, whilst for others if they occurred within a certain period.
A pre-existing condition is a diagnosed medical condition that existed before taking out a policy. We'll ask a series of questions about the medical history for you and any travellers on your quote. If you answer yes to any of these, you will need to tell us about the traveller's conditions. This could be a condition that a traveller has now or has had in the past. If you are not sure what conditions you need to declare, we have online support available to help you 24/7!