Cruising With Diabetes
While diabetes doesn't have to keep you from cruising, you must accommodate it with smart preplanning. Here's what you need to know about traveling with diabetes on a cruise.
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The Prep
First, ask your doctor for a prescription for insulin and other medications you might need in the event of an emergency. Also, get a letter detailing any allergies and exactly what you need to do to keep your diabetes in check.
No matter where you travel, wear a medical ID bracelet that shows you have diabetes. If you leave the country, the American Diabetes Association (ADA) recommends learning how to say, "I have diabetes" and "Sugar or orange juice, please" in the languages of the countries you'll visit. If you have a flight with meals, you can request in advance one low in sugar, fat and cholesterol.
When you travel, the ADA and others recommend packing twice as much medication and blood-testing supplies as you think necessary. Pack these in a carry-on bag and keep it with you at all times. In addition, bring snack packs of crackers, cheese, peanut butter, fruit, nutrition bars and some form of sugar (hard candy, raisins or glucose tablets) to treat low blood glucose. It's a good idea to keep your insulin in a bag that will keep it cool. Whenever possible, the FAA recommends keeping medicine in original pharmacy-labeled packaging.
Finally, plan for time zone changes. As the National Diabetes Education Program notes, "Make sure you'll always know when to take your diabetes medicine, no matter where you are. Remember, eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed." To keep track of shots and meals through changing time zones, keep your watch on your home time zone until the morning after arriving at your destination.
Also, contact your cruise line's disability services department to inform them about your dietary restrictions, and ask about the availability of a refrigerator for your insulin. Also, request a brief meeting with the maitre d' to review your dietary restrictions.
In Flight
One of the chief worries of people with diabetes about air travel is airport security and screening. "People get very concerned that they may not be able to take their pumps, syringes and needles on planes," observes former ADA president Dr. Vivian Fonseca, chief of endocrinology at the Tulane University School of Medicine in New Orleans. He recommends carrying a physician's statement that says, "This is to certify that this patient has diabetes and requires insulin." It should address any questions that arise at a security checkpoint.
Moreover, the TSA clearly states in its own regulations that insulin and diabetes-related supplies and equipment are allowed through a checkpoint once they have been screened.
The regulations also state that if you are concerned or uncomfortable about going through a walk-through metal detector with your insulin pump, notify a security officer that you are wearing one, and you can request a full-body pat-down and a visual inspection of your pump instead. Advise the officer that the pump cannot be removed because it is inserted with a catheter under the skin. You should also let an officer know if your sugar is dropping during screening or if you need medical assistance.
While in flight, take care to eat wisely. If you use insulin, the ADA recommends waiting until you see the food cart nearby before taking a shot. Otherwise, a delay in the meal could lead to low blood glucose. If you inject insulin while in flight, be careful not to inject air into the insulin bottle due to the pressurized cabin.
Onboard Your Cruise
Jetlag can make it difficult to tell whether you have very low or very high blood glucose, so check as soon as possible after landing. If you don't have a sharps box, notify your stateroom steward upon boarding, and they will usually provide a proper disposal container.
Cruise line policies differ when it comes to refrigeration of medications. Many will supply a stateroom mini-fridge. Others will provide insulin refrigeration with 24-hour access through room service or the front desk.
If you are more active than usual during your cruise, your blood glucose level could drop too low. Just in case, bring snacks when hiking or sightseeing. Dr. Fonseca cautions never to go barefoot and, as you do at home, to check your feet regularly for blisters, redness and swelling. On any shore excursion, take along your meds and a pair of extra socks to keep your feet dry. As he says, "You're on vacation, but you've got to remember that you've brought your diabetes with you."
Use the gym and take a fitness class. Also, he says, watch your diet. Ships offer many savory food choices that are sugar-free or low in fat, sugar and cholesterol. "If it's a buffet, you can make choices. Focus on making the healthy choices," Dr. Fonseca says.
Finally, he recommends checking your blood glucose more frequently than you would at home because changes in diet, activity level and time zones can impact your blood glucose level in unexpected ways.
For information about cruising with a different medical condition, see our articles on: