By Joseph Wolfsdorf, MD, associate chief, Division of Endocrinology
Now that school is out, kids are ready to jump in the pool, play outside and of course, go on vacation. With routine day trips or week-long vacations, families must plan wisely when picking a destination, booking a flight, reserving a hotel and most importantly, packing a suitcase. When traveling with a child who has diabetes, those decisions can be even more challenging.
What is diabetes?
Diabetes is a disease that affects an estimated 18.2 million people in the U.S., about 210,000 of whom are children under age 20. In a healthy person, insulin, a hormone produced by the pancreas, moves glucose into the cells where it's used for energy. However, in people with diabetes, either the pancreas produces too little or no insulin (Type 1 diabetes), or certain cells in the body are resistant and don't respond normally to the insulin that is produced (Type 2 diabetes). This inability of insulin to work properly causes glucose to build up in the blood and spill into the urine.
This life-long condition requires constant care that shouldn't be ignored, especially during the fun and easygoing days of summer when families tend to retreat. When traveling with a child who has diabetes, consider the following recommendations:
Packing the family suitcase
When traveling with your child, plan ahead to make certain all the essential items are packed. Bring a bag containing:
All routine medical items, including insulin, syringes, blood glucose testing supplies, lancets, glucose meter, ketone strips and a glucagon emergency kit.
Extra medical supplies, such as back-up insulin and any other medications.
Extra snacks and drinks that the child prefers.
Planning airline travel
Working with your child's diabetes team (pediatric endocrinologist, diabetes nurse educator, dietitian/nutritionist and social worker) and with your airline can result in a safe and easy flight. Before hitting the skyways:
- Notify the airline that your child has diabetes.
- Schedule a consultation with your doctor if traveling through time zones so insulin dosage alterations can be planned.
- Bring a physician's note that specifies your child's condition.
- Place all medical items in your carry-on bag, since insulin will freeze if packed in suitcases placed in the cool storage section of the plane and because your luggage may get lost.
- Try to pack all medical supplies in the original labeled container from the pharmacy. Since it has the name of your child, pharmacy and doctor, it also serves as extra verification of your child's condition.
- Pack extra medical items in case of unexpected travel delays.
- Pack snacks and drinks in case of unexpected meal delays.
- Make sure your child wears a Medic Alert tag around her neck or wrist identifying that she has diabetes.
Spending hours outdoors
When on vacation, children are likely to be more active. In order to prevent hypoglycemia (low glucose levels that hinder energy levels during physical activity), be sure to:
- Check blood levels more frequently throughout the day, as prolonged, strenuous exercise increases the risk of hypoglycemia.
- Eat bigger snacks since more glucose is used up during intense exercise.
- Wear plenty of sunscreen.
Restaurant stops are customary when traveling, so balance daily activities, insulin and food accordingly. When dining out, remember:
- Don't hesitate to ask what the serving size of your child's meal is and how much carbohydrate, protein and fat content is included. It's wise to travel with a copy of The Doctor's Pocket Calorie Fat and Carbohydrate Counter (www.calorieking.com).
- Substitute side orders. For example, order vegetables or a salad instead of french fries.
- Pay attention to portion size. If the serving is too large, encourage your child to eat part of the meal and take the rest with her.
- Avoid fried or breaded foods as they add fat.
- If the family chooses fast food, try to eat healthier at the next meal.
- Timing of meals and snacks is especially important for children who use intermediate-acting insulins such as NPH or Lente, because the child must eat when the insulin is having its peak effect. So make reservations and steer clear of restaurants during the most hectic times.
The summer is a time for vacationing with family and friends, and by planning ahead, children with diabetes can avoid unhealthy situations and have plenty of fun.