Spring Break has arrived! While sitting in one of the Washington, DC, airports to go to a conference, I ran into several of my excited families flying to fun locales including Disney World and the Caribbean! I have discussed travel strategies in the past; however, I have not addressed the more typical everyday travel situation by car or train. Many families choose ground transportation to avoid all the trappings of air travel: including TSA screening, packing diabetes related supplies, and the general inconveniences of flight delays, etc. How does one manage a long trip encompassing more than 3 hours by car or train? Once again, preparation is key!

1. Pack everything that you might need during your journey.
1. Insulin (If there are temperature concerns, consider packing in a cooler to avoid the loss of potency. If there is air-conditioning this is of less concern). I would strongly recommend having all types of insulin you currently use (including the insulin you may use just at night).
2. Associated supplies:  

                     i.     Syringes, needles, pens, pen needles

                     ii.     Glucose meter (And an extra meter in case the one in present use decides to become nonfunctional! I remember running around Orlando to find a pharmacy that had the appropriate replacement meter for a friend whose meter stopped working.)

                     iii.     Glucose meter strips (more than usual, in case of unforeseen situations)

                     iv.     Pump supplies (tubing, infusion sets, catheters, etc.) Extra insulin, such as Lantus or Levemir, in case the pump breaks, gets left in the bathroom at the restaurant, or gas station, etc.)

                      v.     Urine/blood ketone strips

3. Rapid acting carbohydrates
4. Other medications:    

                       i.     Oral medications (glucophage, synthroid, allergy meds)

                       ii.     Glucagon (yes, do bring it)

5. Other: anything else you can think of including emergency

contact information (family members, diabetes team, and pharmacy information)

                  f. Fluids (water, diet soda, etc.)

2. Evaluate the activity (or lack thereof) during the journey that will require changes in insulin dosing. Lack of activity while sitting in the car or train will generally result in higher blood sugars. Most people are surprised with these readings after a long car or train ride. Be prepared and proactive. You will need to make adjustments depending on the insulin regimen you are currently using.
1. If on split mixed insulin dosing with NPH and regular/rapid acting insulin, you might consider increasing the morning/evening basal (NPH) by a certain percentage depending on your diabetes team recommendations discussed prior to your journey. You also may need to give a bit more regular/rapid acting insulin despite making these changes if blood sugars are still high.
2. If on basal/bolus insulin via multiple daily injections or insulin pump, there are several options:   

                             i.     Check blood sugars more frequently and do the appropriate correction boluses (can do every 3 hours).