Wish you were here!” - University of York · “ Wish you were here!” Travel tips for patients with diabetes

“ Wish you were here!”

Travel tips for patients with diabetes

EXPECTATIONS!

What can you expect from me?

What I “hope” from you!

TRAVEL RISK ASSESSMENT

In 2011 U.K. citizens made 55.7 million visits

abroad, despite the recession

Ref: (ONS 2012 & Health Protection Agency 2012)

Travel Risk Assessment – 6 D’s

Destination

Date of Departure

Duration of stay

‘Deeds & doings?’

Diagnosed conditions

Diagnosed allergies

DESTINATION

Country / countries being visited in the order

being visited?

Type of transport being used to arrive and

travel between?

Time zones/ periods in transit?

DATE OF DEPARTURE

Time for vaccination programme?

Time for patient education for

destination(s)

Time for specific guidance re long term

condition

Time to address concerns/ liaise with

specialist team(s)

DURATION

How long away from home?

How long in each country if multi-centre

trip?

How far away from medical care?

“Deeds & doings!”

Are you planning any

special activities?

Are you planning to

drive overseas?

How do you intend to

spend you time whilst

away?

DIAGNOSED CONDITIONS

Current medication

Co-existent conditions

Drug interactions e.g. malaria

chemoprophylaxis / antibiotics.

Compliance/concordance with existing

treatment

Self management experience

Diagnosed allergies

Including intolerances and sensitivities – e.g. nut allergy

– epi pen use & carrying through customs

food intolerances - changes in blood glucose control

egg allergy – vaccine safety options

VACCINATIONS -1

Starting point = completion of current UK

vaccination programme

Mandatory vaccines

Recommended vaccines for country+

being visited

VACCINATIONS - 2

Vaccines needed in light of trip

requirements – special itinerary

Discuss timings of any programme of

vaccines needed

Discuss cost implications as necessary

Ensure general health stable prior to

course of vaccinations

CHECK LIST FOR PATIENTS WITH

DIABETES

Diabetes identification

“Emergency care package” – sick day

rules, when to change management of

condition

Details of local medical care centres for

expertise and advice – check out

www.diabetes.co.uk / 0800 585 088

before leaving UK

Checklist continues

GP letter – i.e. headed paper detailing

confirming condition / detailing current

prescription / known allergies and

relevant PMH.

Insurance: check small print!

EHIC – European Health Insurance Card

LOCATE

UK driving license & DVLA feedback if

insulin user

Ideally………….

Complete a baseline assessment with 4+weeks prior to travelling.

Check-out that patient competent to self manage

Liaise with specialist services as necessary

ALWAYS recap the basics – even experienced travellers benefit from a refresher

Special Risks

WARM CLIMATE risks

e.g. sun/ heat can impact on dehydration &

energy loss

Food hygiene –insects / cross contamination

with food preparation & storage

All inclusive !

Care of feet – burns from pool tiles/ objects in

sand/ hot swollen feet from climate change =

blisters

Special risks

COLD CLIMATE risks

Impact of cold – slows down insulin absorption but shivering increases energy loss

Hypothermia

Foot care – frost bite, enclosed sweating feet, blisters

Accidental slips and falls – minor trauma =risks from infection

Special Risks

TIME ZONE CHANGES

If travelling for less than 4 hours – monitor

as normal -minimal impact on insulin/

blood sugar likely

WEST VS EAST dilemma ?

Special Risks

ALTITUDE SICKNESS

Trekking at altitude increasingly popular:

but results in huge energy expenditure,

even over short durations,

with potential effects on those travellers

with diabetes

ALTITUDE SICKNESS ……………….2

Walking for a distance of 4,000 metres

=

4-6 hours

= re-hydration needs of >4 litres

Suggest 2-3 hourly blood sugars/insulin monitoring

www.medex.org.uk

and

www.moutainmed.org

Special risks

TIME OUT !

GROUP ACTIVITY

“What would you carry in your hand

luggage?”

(Think health & diabetes – not swimsuit &

suncream !”)

“Take Home Messages !”

1. Diabetes is not a contra-indication for travelling !

2. Careful planning is the key- short term & long term travelling

3. Diabetes medications offer no additional risk – greatest risks are acquired.

REFERENCE LIST

o Department of Health (2006) Immunisation against Infectious

Diseases (The Green Book) the Stationery Office, London

http://immunisation.dh.gov.uk/category/the-green-book/

o Philips A (2012) Principles of Diabetes Care Quay Books, London

o www.fitfortravel.nhs.uk/advice

o www.diabetes.co.uk or tel: 0800 585 088

o www.ehlc.org.uk

o www.nathnac.co.uk

o www.medex.co.uk

o www.moutainmed.co