Tips for a Successful Car Trip While Living with Diabetes
Many families with members who have diabetes 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. But how does one manage a long trip encompassing more than three hours by car or train? Once again, preparation is key!
- Pack everything that you might need during your journey.
- 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).
- 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
- Rapid acting carbohydrates
- Other medications:
i. Oral medications (glucophage, synthroid, allergy meds)
ii. Glucagon (yes, do bring it)
- Other: anything else you can think of including emergency
contact information (family members, diabetes team, and pharmacy information)
f. Fluids (water, diet soda, etc.)
- 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.
- 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.
- 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).
ii. Use a temporary basal rate increase during the duration of the journey.
iii. Increase the basal insulin Lantus or Levemir. (Keep in mind that Lantus is a 24-hour basal insulin and the increase may last all day, whereas Levemir, often administered twice a day, could be increased either in the morning or evening, depending on the time of departure.
- Food intake: Traveling also is a fun time to try new foods. Keep in mind that most off the road eateries are "fast food" joints offering high carbohydrate/high fat meals that may result in surprisingly high blood sugars! Even if you know the carb amount in those burgers, the high fat content will keep the serum blood sugars elevated.
- Pack foods with known carbohydrate counts to be available for meals and snacks.
- Be prepared to look at the carb counts of fast food places and bolus accordingly. (Many of the carb counts are available in the menus. It is a rule in New York City!) And, 3 hours later be prepared to administer a correction bolus...especially if you are sitting in the car or train for those 3 hours.
- Try new foods and enjoy them. Be smart and check blood sugar if the carb amount/fat content was different than estimated. Correct, correct, correct!
- Activity: If you are traveling by car, you can make stops on the way. Get out and walk around a bit. Most places have park areas by the highway. NOTE: if you need to stop the car frequently due to increased urination, please check blood sugar! You also can walk up and down the train.
- HAVE FUN!