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					                                                       diabetes in young persons in elgin


Just a day to the beach or a long stay across the ocean should not be a problem for
someone with diabetes. With trips and travels you have to allow for unexpected
events. ‘The bus/train/plane may be late, the restaurant closed, no proper food
available, breakdown of the car, flat tire, etc.’ All this helps to make your holiday to
an experience. With a few things in mind and common sense diabetes will not spoil
the fun.

    Keep your insulin with you in your handbag (not in luggage compartment or on
      Take twice as much supplies as you need
      Split it in two and keep each in a separate bag
      Keep insulin cool (not too hot, not frozen)
    Have food available
   Carry hypo remedies
      Glucogel
      Dextro tablets, biscuits
      Drinks (e.g. concentrated lemonade mix)
   Have your meter with you
   Check more often
   Carry a letter for customs
   Take less insulin when it is expected to be:
      a warmer climate
      an event of more activities
   Check your travel insurance

It is best to keep the normal routine as much as possible Outings are usually
exciting and require more food. Having food with you is easier than having to shop
around for it.
If the day starts early than take a snack at getting up and inject the insulin at the
usual breakfast time. If the child gets up early and falls asleep again in the car or so,
then don’t give extra snack.
Take lunch at the usual time when on a twice daily injection regime.
Often supper/tea is a bit later on such a day. If it will be substantially later an option
than is to have a small snack or the evening snack at teatime. The meal can than be
taken later with the usual insulin.

The days of travel to and from the holiday destination are the important ones to
consider because this involves travelling, and thus doing nothing. The same applies
for these days as for a day out. For the other days of the holiday the same advice is
to follow as much as possible the normal routine.
Think about the change in temperature (warmer=less insulin) and the activities to
undertake (more active=less insulin). A reduction of 20-25% may be necessary.

Don’t worry too much about a higher blood glucose if you know that the insulin has
been given and there is plenty to drink.

www.drwillem.com/diabetes                                                                1
                                                     diabetes in young persons in elgin

Keep in mind that some want to sunbathe and others want to swim when it is warm.
This of course needs a different amount of carbohydrates and insulin.

Travelling through time zones makes a day longer (to the west) or shorter (to the
east). The usual total daily dose is meant for 24 hours and therefore needs
adjustment. There is no need top change the total daily dose if the time difference is
3 hours or less.

A handy solution is to for instance the TRAVEL DOSE or the HOUR DOSE:

Travel Dose:
Take the total daily dose and divide by 4. This is the Travel Dose in clear insulin
(Actrapid, Humulin, NovoRapid, Velosulin). Take this dose every 6 hours before a
The next day back to normal doses again of the regular types of insulin.


* twice daily regime

       Breakfast 20 units Mix                   TRAVEL DOSE =
       Teatime 12 units Mix                     (20 + 12) / 4 = 8 units

* three times daily regime

       Breakfast 20 units Mix                   TRAVEL DOSE =
       Teatime 4 units Fast                     (20 + 4 + 8) / 4 = 8 units
       Teatime 8 units Slow

Basal Bolus Regime
For people on basal bolus regime (4 times a day), the time travel is not too
 Continue with long-acting insulin (glargine or detemir) every 24 hours. This
   means that if you travel westward over 6 hours, than to take the insulin 6 hours
   earlier at destination time. Also is possible to keep a British watch going and to
   take the insulin at the usual home time.
 Take the usual amount of fast acting insulin before meals.

www.drwillem.com/diabetes                                                               2
                                                    diabetes in young persons in elgin


      Someone who takes the glargine or detemir at 21.00 hours in Aberdeen
      travels to Los Angeles, where it is 8 hours earlier. This person should
      take the same dosis in Los Angeles at (20 – 8 =) 13.00 hours.

      Similarly if that person travels from Aberdeen to Sydney (9 hours later),
      then the glargine/detemir should be taken at 21.00 hours in the
      aeroplane (where British time is kept) and after arrival in Australia to
      continu taking the glargine/detemir at (21 + 8 =) 05.00 hours.
      Keep British time in the aeroplane on the return flight.

      Take note that the day may shift as well.

General advice:
 Take carbohydrate food in smaller portions, more frequent
 Don’t have too much of fizzy diet drinks
 Take travel sickness medication if you expect to be sick
 Have a plastic bag at hand
 Don’t forget your insulin

Camping out with other young people is great fun. These events are usually full of
activities and excitement. That is a great experience and there is no reason why
someone with diabetes should not also take part. Think about your safety by:
Telling your friends about diabetes
Informing the responsible adults

www.drwillem.com/diabetes                                                            3
                                                            diabetes in young persons in elgin

Example of letter for customs and others who may ask for it

   NHS GRAMPIAN                                Clinic for Young Persons
                                               with Diabetes in Moray
                                               DrGray’s Hospital
                                               Elgin (Moray)
                                               IV30 1SN
                                               01343 543131

   To whom it may concern

   re: Calum MacFarlane, d.o.b. 21/09/1999,
        Alt-na-Green, Lossie Road, Elgin IV30 1AB

   This to confirm that the above person is known to this clinic with a diagnosis of
   diabetes mellitus type 1.
   For this he needs to carry on his person:
    Insulin in vials and/or cartridges,
    Injection pens, needles and syringes,
    Blood glucose monitoring equipment (meter, finger prickers, test strips),
    Glucose tablets, food and drink.

   Please contact this clinic in case of emergencies.


   Dr Willem J van IJperen, MSc MD, MA, DCH, FRCPCH
   Consultant Paediatrician

   Elgin, date

www.drwillem.com/diabetes                                                                   4

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