Traveling with Diabetes Internationally

I’ve traveled to 90 countries over the years. Currently my husband and I are 100% nomadic, traveling the world while running our businesses remotely. Also, I have Type 1 Diabetes.  Traveling continuously while managing diabetes can be very challenging, but it’s worth it. It’s all about planning, preparation and being resourceful.

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Diagnosis

I was first diagnosed in 2004 – it was an autoimmune “gift” for my 40th birthday. I was in the best shape of my life so this came as quite a surprise. Originally diagnosed as Type 2, this was later amended to LADA (Latent Autoimmune Diabetes of Adulthood), or adult Type 1, as my pancreas gradually stopped producing insulin.

Devices

I had a Medtronic pump and sensor back in 2011.  I used it with varying degrees of success. However, it died in Russia and I never replaced it. To me it seemed that using multiple daily injections (MDI) was a better way to manage my blood sugar; they just seemed to work faster with less fuss. I got a Dexcom in 2015 and this was an immediate game-changer.  Today I have the G7 and I love it. It gives very accurate blood sugar readings every five minutes, but most importantly, it tells me if it’s going up or down and how fast. Actionable data! Once we get back to the U.S. for a longer period of time, I plan to get the Omnipod, a true closed-loop system.

Medical Insurance

Our previous medical insurance cost us so much ($1700 / mo).  When we started our nomad journey, we gave that up in favor of travel health insurance from Cigna that costs a lot less ($700 but there are some that are even less).  It excludes my diabetes, but covers us for anything serious that arises.  We pay for insulin and Dexcom supplies out of pocket (and we still get a discount with the Cigna policy).  In fact, I ordered my Dexcom supplies on Amazon before we left and paid less than when it was “covered,” and I got it within two days. I just have to keep my prescription up to date, then have Amazon ship when we are in the U.S.

Challenges of Traveling with Diabetes

When we first discussed going nomadic, I had huge concerns about my diabetes management. I had traveled overseas plenty with diabetes, but never for more than a month or so. I had no idea how I was going to be away from the U.S. for months at a time.

Blood Sugar Management on the Road

While the Dexcom gives me readings every five minutes, I still get distracted. Sometimes hours will pass between glances at my blood sugar. We eat at restaurants mostly, and I am not a great carb counter. I tend to swag it and usually end up high. Fearing the low has always driven my management, as being high just seems safer. However, I am now learning how to be “bold with insulin.” I always keep carbs on me – typically gummy bears or chocolate. In our accommodations I like to have orange juice (although harsh on the stomach in the middle of the night) or a banana (but too fragile for transport.) Whenever a hotel, restaurant, or airport lounge has a candy jar, I always grab one or two to keep in my bag. Something healthy, portable and long-lasting that I really love are dates, so sometimes I carry those with me.

We love doing food tours so I have to be extra careful to take enough insulin beforehand and to monitor the blood sugar during the tour. It’s a little hard to anticipate what we’ll be eating and drinking and when the eating will actually start. Generally the sampling starts right away. However, we had a tour once where the guy talked for an hour before we got to the food, so I have to just roll with it – but be prepared.

Exercise

Getting enough exercise is really important in keeping blood sugar under control. Sometimes we have access to a gym at a hotel or on a cruise ship, and we take full advantage, but most of the time we don’t. Therefore, walking is an activity we don’t compromise on. We each have an Apple watch that tracks our steps. We aim to hit a minimum of 10,000 steps per day and to close our Move, Exercise and Stand rings, and Mark makes sure we do this Every. Single. Day. Walking after a big meal is especially important. The other rule is to ALWAYS take the stairs. In airports and on cruise ships – it really makes a difference.

Keeping Insulin Cold

Since 2013, I have been using the FRIO Insulin Cooling Wallet to keep my insulin pens cold. I use them not just for travel, I use them 100% of the time. These gel pouches come in an array of sizes and colors. You just soak them in cold water and they keep insulin safe for a minimum of 45 hours (more than five times longer than an ice pack) — even in constant environmental temperatures of 100 degrees Fahrenheit (If they work in Texas, they’ll work anywhere.) In reality, they last for a week or more before I have to soak them again. You can buy these on Amazon. I have one that holds 2 pens (for fast- and long-acting), several that hold five pens (which fits 6 pens or a box of cartridges) and one that holds one pen for going to dinner with a small handbag.

While traveling, we *usually* have a fridge in our airbnb, hotel room, or cruise cabin. As soon as we arrive, I offload my insulin to keep it cold. Laying the FRIO pouches out before we pack ensures that I don’t forget to take my insulin with me when I leave. (If you don’t use FRIOs, another handy way to remember your insulin is to put one of your shoes in the fridge :-).

🧊 Fridge Fail

Funny story: In October 2023 we stayed at a hotel in Venice that had a fridge in the hallway for three rooms to share. I stuck my insulin in the back where it wasn’t visible to anyone who might be using the fridge. The next day the manager asked if it was mine; he said the fridge wasn’t plugged in, but he’s also a diabetic so he got it working immediately. So double-check that it’s on! A day later, we went to retrieve a bottle of water we left there, and it was frozen solid. Yes, someone turned the temperature all the way down and my insulin froze! So community fridges might not be optimal. Once, when we had an RV, I accidentally froze my insulin and it really freaked me out. However, it still worked fine – once it thawed. So hopefully this will be okay. Always an adventure!

Finding Supplies Overseas

Buying Insulin Overseas

Historically we’ve taken shorter trips (up to a month), and I’ve always brought along enough insulin, medications and supplies for the trip. With prescriptions even this can be a challenge if your insurance doesn’t like to dispense more than a months’ worth at a time. Sometimes I would have to get a “vacation override” to get enough to last the duration.

I use insulin pens to manage my blood sugar: a rapid-acting like Novolog or Fiasp, plus long-acting Levemir for my basal. Since we’re traveling for months at a time, I’ve had to buy insulin on the road this year – first in the Netherlands, then in Mexico, and most recently, in Canada. I show my prescription at a pharmacy but I don’t think I even need it; mostly they look at it to make sure they give me the same thing or the equivalent. The pharmacist in Canada said “Oh, I think that’s over-the-counter.” Imagine that!

Sometimes I’m able to get Fiasp; other times they only have a different or generic brand, but they are all insulin aspart – different brands of the same fast-acting insulin – and I never even notice a difference. Except in the price!

Dexcom Supplies

We are members of lots of great Facebook travel groups. These forums are awesome resources for diabetes care in a specific country. They aren’t specific to diabetes, but there’s always someone who has diabetes and shares the same challenges. If you ask a question, you usually get a helpful answer from someone. I moved from the Dexcom G6 to the G7 in September 2023 partly because the G7 is smaller than the G6. Carrying nine at a time is easier and takes up less space.

The G7 is available overseas now, but only in Germany, Austria, UK, Ireland, and Hong Kong. As far as I can tell, it’s only available by shipment, so you would need a local shipping address in that country. Incredibly, at least in the UK, you don’t even need a prescription to get a Dexcom.

I didn’t try ordering in Ireland recently because we were only there a few days. Also, I feared that having a U.S. credit card with a U.S. billing address might have presented a problem. We had friends from Florida visiting us in Portugal, so I shipped them my Dexcom order on Amazon and they brought it to me. That will last 90 days, then I’ll be back in Austin to restock. After that, I’ll have to figure something else out, but I’m hoping the G7 will be more widely available next year.

Glucose Meter

I always travel with a blood glucose monitor kit as a backup way to check my blood sugar in case of emergency. What kind of emergency? Keep reading.

Packing Diabetes Supplies

When I travel, I always put all my insulin in my carry-on luggage using the FRIO wallets. I keep several weeks of medications in pill sorters in my hand luggage; the rest goes into the suitcase. Currently I keep my Dexcom supplies in my hand luggage.

In June 2022, we flew to Portugal (via multiple stops in Canada and Netherlands). We arrived… but our checked luggage did not. And we didn’t see it again for SIX WEEKS! It had my Dexcom supplies, meds and glucose monitor in it, so I had to go off the Dexcom when the sensor I was wearing expired. After that, my only option was to go buy another glucose monitor. The good (?) news is that people everywhere have diabetes, and supplies are the most expensive in the U.S., so getting new stuff overseas is typically easier and cheaper anyway. (The monitor I bought from a pharmacy in Portugal came with an instruction manual that was only in Portuguese; no worries. A quick model search on Google brought up the manual in English.)

Also, now we use Apple AirTags to track our checked luggage. 😄

Airport Security and Customs

In all the years I’ve been traveling internationally with insulin, wearing a pump or a Dexcom, and carrying supplies, I’ve never had a single question about any of it while passing through security or Customs. Occasionally my carry-on bag gets flagged for additional scrutiny because of the insulin, but once they realize what it is, they send it through.

The Juicebox Podcast 🧃

I discovered The Juicebox Podcast in September 2023 and it has changed my life as far as diabetes management is concerned. Many people with Type 1 Diabetes struggle with bad information as well as a lack of device training and practical blood sugar management techniques, and the primary goal of this podcast is to change that. If you or someone you love is struggling to get their blood sugar under control, I highly recommend this podcast, which was started by a man whose daughter was diagnosed aged 2. She’s now in college and he has over 1,000 episodes on a vast range of topics related to T1D.

Conclusion: Traveling with Diabetes

Type 1 Diabetes doesn’t have to control your life and prevent you from doing the activities you love. Traveling internationally with diabetes can be challenging but it’s doable, even for an extended amount of time. I manage this with information, planning and preparation. It’s so worth it.