Tips for diabetic travel in hot climates

In honor of the heat wave currently crushing Europe to death and making my un-air-conditioned life nearly unbearable, I’m interrupting my very slow recap of Asia to bring you a special bulletin about traveling with Type 1 diabetes when it’s hot out. Traveling with T1D can be tough anyways, but heat does especially weird things to my blood sugar on the road. Sometimes my insulin works quicker, other times my body’s stress response from dealing with the heat raises my blood sugars. Add to that the general travel stress, changed routines, and weird diet, and I’m usually dealing with a lot more than just jet lag for the first couple days of my trip.

In March, I took a month-long trip through eastern Asia, including Thailand and Cambodia, where it was the hot season and the temperatures were usually above 100*F (38*C). I was walking 20 kilometers a day, which is a huge activity jump compared to my sedentary desk job, until I spent a few motionless days lounging on a hot beach and snorkeling. The whole time I was inhaling khao phad, mango sticky rice, and pineapple smoothies with unknown amounts of added sugar syrup. A true recipe for disaster. So, how did I handle traveling in hot climates, especially for a longer trip? Here were my methods, as a Fiasp & Lantus pen user and Libre 3 wearer.

The tips

I’ll post a disclaimer here stating that I am not a medical professional, and this is not medical advice. These are just tips I’ve acquired over 20 years of international and often solo travel with Type I diabetes. If you have questions regarding your personalized care, please speak with your doctor rather than taking advice from a well-meaning Internet stranger.

The biggest concern is what to do with my insulin and other temperature-sensitive diabetic paraphernalia in hot climates, since insulin and blood sugar measuring devices can be destroyed by overheating. In Asia I stayed in hotel or private hostel rooms that had air conditioning and sometimes a mini-fridge, but I also switched cities every few days and some journeys lasted more than 12 hours, so I couldn’t rely solely on hotel rooms for cooling my drugs. Also, the power in most Southeast Asian hotel rooms is rigged to turn off when you leave the room to conserve energy. Sometimes there are ways to get around this (I’ve seen tricks using a magnet, or if you’re not traveling alone then you can just leave the second key in the slot), but my little tree-hugging heart doesn’t like to run the A/C if I’m not around. Unfortunately, my rooms lacked good insulation and the “hallways” were open to the outdoors, so within an hour, the room was right back at ambient temperature. Here’s what I did:

1. Frio cooling packs. These pouches are made of gel and work via evaporation, so they require no batteries or electricity of any kind to keep your insulin cool. When the gel starts to dry out, you can “recharge” it by soaking it in water for a few minutes. In SEA I did this every couple of days. I’ve brought my Frio in my carry-on through airports all over the world and it’s never been confiscated, and only once did airport security even look at it. Note that the Frio won’t keep things fridge-cool, it will just keep them from overheating for up to a month as long as you use it correctly (this also means you should discard the insulin after 1 month, even if the insulin hasn’t actually been “opened” yet). A few notes for correct use: The pouch should always be left somewhere with good airflow to encourage evaporation (so don’t pack it deep in your bag or wrap it in plastic). Keep it away from direct heat sources, like sunlight or the top of a hot fridge, since the gel itself can get hot. The only place it doesn’t work very well is in extremely humid areas, since the evaporation slows down, but it worked well for me in hot-season SEA.
   
2. If there is a fridge in my room and I’m staying for more than 1 night, I’ll use it, but! I always do a test run first by sticking a few ounces of water in the fridge for a few hours first to make sure the fridge is not too cold, because I once had a hotel fridge that froze everything.  After the test is passed, I will remove most of my insulin from the Frio and put it into the fridge. I still always leave one pen/cartridge of each insulin type in the Frio (outside the fridge), to avoid putting all the proverbial eggs in one basket. This is a particularly good idea if you’re somewhere with regular power outages. I also put my spare Libre 3s and backup test strips in the fridge, since they can be stored as cold as 2 *C. Fridges are usually on their own power outlet that won’t shut off when you leave the room. Since I am a bit forgetful and have left insulin in hotel fridges before, I will do something weird like put one of my shoes on top of the fridge to remind myself I have stuff in there. If you’re staying in a hostel, I would recommend against storing insulin in a shared fridge where anyone can grab it or accidentally throw it out.

For my in-use insulin, it’s a bit trickier, because the inside of my day bag can sometimes reach temperatures hotter than the air when the bag sits in the sun. Wrapping my insulin in fabric and burying it at the bottom near a cool drink container is my usual method. Of course you can also get a smaller Frio for your daily insulin.

How I get my glucose sensor to stick the whole time

I wear a Freestyle Libre 3. To make sure it sticks the full 2 weeks while sweating and hiking and swimming, I clean the crap out of my arm with alcohol swabs before placing the sensor, and then I slap an 8-centimeter-long (3-inch) piece of physio/kinesio/sport tape over top of it. I like this tape because it’s designed to be stretchy, breathable, and sweat-resistant, and it’s also cheap, easy to find, and available in skin-color or obnoxious colors depending on your preference (I wear turquoise because I’m fabulous). Of course you can also buy special sensor-specific tapes online, but after I tried physio tape, I found the first option to be expensive and unnecessary. For the Libre, make sure you cut out a tiny hole in the tape to let the sensor’s hole breathe, otherwise the sensor might fail (for other sensors, some light Googling should tell you which parts should stay uncovered). I use a mirror while placing the tape and just make sure I can always see the sensor hole through the tape hole for accurate one-handed placement. I’ll usually carefully change the physio tape every 3-4 days, or as necessary when the corners start to peel up, especially after a day spent mostly in water. (Side note: I did try liquid skin glue for awhile, but it regularly caused sensor insertion failure for me and doesn’t work any better than just thorough cleaning with alcohol. In my experience skin glue also doesn’t make the physio tape last longer. )

Other general tips

Baby your blood sugar, especially until you find your travel rhythm. Check it often and expect the unexpected. The first few days of my Asia trip in Japan, I literally could not take 1 single unit of rapid-acting insulin without immediately having a low, even if I’d just eaten a carb-heavy meal that I’d usually need 6 units for. A common culprit for me is that my long-acting (Lantus) doses are too high because they’re calibrated for my normal life. I won’t give specific percentages or amounts here (again, speak to your doctor), but one of the first things I do when my blood sugar loses its mind is to step down my long-acting doses.

If your trip involves a time zone change, your circadian rhythm will probably take a few days to adjust, which includes your blood-sugar-affecting hormones as well as your sleep patterns. If you’re on a time-dictated insulin regime, including a pump with different basal rates, ask your doctor how best to shift it to the new time zone. With my Lantus, I often start the shift before I even set foot in the airport and just expect the next 24-48 hours to be a little weird.

Food and diet can be tricky, especially if you eat out a lot, but don’t panic. Most foods will probably bear some resemblance to what you eat back home, so I just break it down into approximate servings of known ingredients (rice noodles, meat, fruit, etc). A fallback plan is to grocery shop, since that food generally has nutrition labels attached. If you’re from the U.S., note that international nutrition labels will probably present information in standardized 100-gram increments rather than arbitrary serving sizes like “16 crackers”. For reading foreign language food labels, I highly recommend downloading Google Lens on your phone, which can translate in real-time using your camera as long as you have WiFi/mobile connection.

Above all, be kind with yourself and rest when you need to. The tropics will still be there to enjoy after you’ve recovered from your low/high. Your travel partners will understand, and if they don’t, find new travel partners. Strangers will usually help if you ask, be it a flight attendant who’s just a call button away or a nearby traveler carrying fruit snacks. In an emergency, diabetes is a disease without borders, and local medical professionals will know how to help you (Medical alert bracelets are your friend).

My Diabetic Packing List

These are the things I packed before leaving home. Note this is my standard packing list, not specific to hot climates.

• Sugar: Enough of my preferred (non-liquid) sugar source to handle at least 10 low blood sugars, for the journey and in case I have trouble finding a suitable replacement within the first few days.
• Insulin: 1.5 times the amount of insulin that I would normally use at home within the same time frame. I’ve had cartridges break, so I always carry at least 2 backups of each insulin type. You’re allowed to carry up to 3 months’ supply through airport security, and I’ve stretched it to 4 months with no issue. I only use cartridges because they’re smaller, but I always bring a few syringes too in case the refillable pens themselves break.
• Sensors: Depending on the trip length, I bring at least 1-2 spare sensors in case they fall off or otherwise fail.
• Glucose meter: I use my sensor almost exclusively, but also bring a standard meter and enough test strips to last the whole trip, in case I lose my phone/reader (as happened to me while living in Argentina with a Libre 2). It’s also good as a stop-gap while waiting for a new sensor to boot up, as a backup if your sensor fails when you can’t immediately replace it, or for double-checking your sensor results if they seem weird (high and low temperature, including sauna or hot tubs, can cause readings to fluctuate).
• Other: Physio tape, alcohol swabs, pen needles, “charged” Frio case, medical alert bracelet, letter from my doctor explaining my diabetes and care requirements in English (no one has ever looked at it though).

Happy travels!