It can be a daunting task for diabetics to make sure they are well prepared when going on vacation.
Most patients with diabetes have Type 2 diabetes, in which the body cannot use insulin effectively.
Besides medication, the diabetic will need to take along equipment such as a glucose meter to monitor blood sugar levels.
Those on insulin not only need to pack their insulin but also syringes .
Dr Goh Su-Yen, head of the endocrinology department at Singapore General Hospital, recommends that diabetics carry a letter from their doctor stating the type of diabetes they have and a brief medical history and therapy.
They should also carry a copy of the prescription and the medicines and equipment needed in their carry-on luggage.
She said: "It may be prudent to carry twice the quantity of medications and supplies that you would usually require, in the event of delays, lost luggage or theft."
Insulin users should also carry some sugary food, which can come in handy during flight delays or should there be a lack of suitable food on board, added Dr Goh.
Dr Seow Cherng Jye, a consultant endocrinologist at Tan Tock Seng Hospital (TTSH), said diabetics should bring their blood sugar levels under control before travelling.
"Be familiar with regular blood glucose monitoring using your glucometer and test strips," he said, adding that diabetics can check with the airline about special meal options.
For instance, people with Type 2 diabetes can opt for low-carbohydrate meals .
Dr Kon Yin Chian, a senior consultant endocrinologist at TTSH, Dr Seow and Dr Goh give their take on how to deal with several travel scenarios that diabetics may face.
1. TAKING A LONG-HAUL FLIGHT
Keep your glucometer and carbohydrate supply within easy reach. If there is turbulence on board, you may not be allowed to get out of your seat to retrieve these items from the overhead cabin.
If you are on insulin injections, keep track of the time at the departing location. Use it to determine when to take your insulin jabs.
Check your blood glucose every four to six hours. Drink plenty of sugar-free fluids, and avoid alcohol.
Before the trip, discuss your itinerary, including any layovers, with your doctor to get advice on how to adjust your insulin doses.
2. ENGAGING IN PHYSICALLY DEMANDING OUTDOOR ACTIVITIES
Pack a hypoglycemia kit on top of a standard First Aid kit. This kit should contain foods that release sugar quickly, such as glucose tablets or gel, as well as foods which release sugar slowly, like muesli bars.
It should also have a glucagon injection kit. Ideally, teach a travelling partner how to recognise symptoms of low blood sugar, check your blood glucose and administer glucagon injections if needed.
Of course, don't forget your insulin and other medical supplies, including spare syringes or pens, ketone test strips, glucose meter and spare batteries for the meter.
3. ADJUSTING MEDICATION TIMINGS FOR TIME DIFFERENCES
When you travel east, you lose several hours. So, taking a normal day's worth of insulin on this shortened day could cause low blood glucose levels, or hypoglycaemia.
So, take less than your usual dose of insulin or, if you are on diabetes pills, you may need to omit a dose.
You gain time when you head west, so your normal insulin dose may not be enough, especially if the time difference is four to five hours and more. Also, if you take an extra meal, an extra mealtime insulin dose may be required.
4. INSULIN STORAGE, PURCHASE AND USAGE
Pack all insulin in carry-on bags, even if you are not using all the supplies during the flight.
If you put them in check-in luggage, the low temperatures in the plane's cargo hold may degrade the insulin.
Some airlines require additional paperwork if you are on insulin injections or using an insulin pump. Submit these documents early as it may take time to process them.
Temperatures of below 2 deg C and above 30 deg C can degrade insulin, making it ineffective. So, if you are going somewhere with a different climate, keep your supplies in an insulated bag or container.
Once opened, a bottle of insulin can be used for up to one month if kept at room temperature. Store unused insulin bottles and pens in the fridge - but not in the freezer.
If you need to buy insulin abroad, check that the concentration strength is right for you - some countries use different measurement units.
Before using insulin, inspect it for abnormal changes in appearance, like clumping or frosting. This may signal a loss of potency or contamination, so do not use the insulin.