Travelling with Insulin and Other Diabetes Equipment

Insulin 

Insulin supplies

• Carry plenty of insulin. To be on the safe side you should ideally take double the amount you think you will need. If you are travelling for a long time, however, you may need to get supplies while you are away.
• Remember you may need to change your usual daily dosage. The type of food you eat, the amount of exercise you take and the change in temperature can all affect your blood glucose levels.
• Before you travel, find out about the availability of insulin where you are going. Different countries often have different names and strengths and may not use insulin pens. Take with you the contact details of suppliers in the main cities of the countries you plan to visit.
• If your type of insulin is not available, a supplier can often arrange for insulin to be sent to a particular pharmacy or collection point.
• If you are not based anywhere with access to a fridge, you may need to get a new supply of insulin when you are away.

Insulin strength

Most countries now use U-100 strength insulin, but you may come across U-40 and U-80 strengths. If you are unable to get U-100 insulin and need to use a different strength, you will also need the correct syringe for the insulin strength, otherwise you will take the wrong dose. For example, if you use a U-100 syringe with U-40/80 insulin you will take a much smaller dose, or if you use U-100 insulin with a U-40/80 syringe you will take a higher dose.

Temperature and light

Extremes of temperature and light may cause your insulin and blood glucose testing equipment to be less effective.

• Some research suggests that insulin can be kept at 25° C for up to 10 months, losing 5% effectiveness, and at 40° C for several weeks.
• However, many manufacturers will only guarantee the stability of insulin kept out of the fridge at 25° C for one month, and recommend it should not be used after this. If possible, you should always store insulin in a fridge in hot climates to prevent it losing its effectiveness. Never keep it beside a direct source of heat, e.g. a radiator or a fire.
• Insulin loses its effectiveness more quickly in bright light than in the dark. Do not expose it to direct sunlight.

Transport and storage

• If you are travelling by plane, remember that insulin should not be kept in luggage going into the hold, as temperatures often drop below freezing there and there may also be changes in air pressure. Always take it in your hand luggage.
• Carry insulin in a coolbag or coolbox, or in a polystyrene container. Pre-cooled wide-necked vacuum flasks are also useful.
• If you use a container with frozen plastic blocks, make sure the insulin is not directly beside them as it may freeze.
• If you are keeping insulin in a backpack, do not put it in the top pocket or near the outside of the backpack where it may get too warm.
• Haotian  is a company that specialises in cooling products, including travel wallets for carrying insulin. These are light and compact and do not need to be kept in a fridge as they are activated by cold water. 
• If a fridge is not available for storage, keep your insulin in the coolest, darkest part of the room. If it gets too warm, cover it with a cold, wet cloth.

Damaged insulin

Check the appearance of your insulin before you use it. The following may suggest that it has gone ‘off’.

• Soluble (clear and quick-acting insulin) may look cloudy or thick.
• Suspension or cloudy insulin may have lumps or clumps that do not disperse when gently mixed.
• The bottle or vial may have a frosted appearance with particles sticking to the sides. It may also look brownish in colour.

Blood glucose monitoring equipment

• Take a spare battery with you.
• Find out in advance about the availability and local name of test strips in the main cities of the countries you plan to visit.
• If you are travelling for a while, it may be worth taking a spare meter with you.

Heat and humidity

• Glucose meters and test strips can be affected by extreme temperatures and humidity. Check the manual before you go. Meters generally perform best within a temperature range of 15–35° C.
• Some test strips will give a false high result in hot weather, and a false low in cold weather.
• When using a glucose meter in extreme temperatures it is recommended that you carry out a quality control check using glucose solution, in order to ensure that the meter is reading accurately. You can buy small vials of either high, medium or low solution. However, once opened, they expire within 3 months.
• Blood glucose can be measured in millimoles per litre (mmol/L) or milligrams per 100 millilitres (mg%). See the conversion table in Preparing to Travel.
• Check that the test strips will not expire while you are away.
• It may be useful to pack urine testing strips. You can dipstick your urine for glucose and (if you have type 1 diabetes) ketones. Some blood glucose meters also monitor ketones. You can discuss the best combination of equipment to take with your diabetes care team. For more information, see Sick Day Guidance for Type 1 Diabetes and Sick Day Guidance for Type 2 Diabetes.

Insulin cartridges, pens and pen needles

• As equipment varies from country to country, unless you are going to be away for a significant length of time you should take more than you will need to avoid running out and having to use unfamiliar products. 
• In some countries, pens are not used. If you have never used syringes it may be worth learning how to do so before you go if you will be spending time in an area where pens will be unavailable and you run out.
• Before you travel, find out about the availability of pen needles in the correct length for you. In some areas only 12.7 mm needles are available. Needle length can make a difference to how quickly your insulin acts.