Travelling With Children Who Have Diabetes

Key points about travelling with children who have diabetes

• make sure travel plans include management of diabetes
• get a letter from your diabetes team or family doctor (GP) so you can carry diabetes supplies
• talk with your diabetes team about how best to manage diabetes during travel with
• make sure you take enough diabetes supplies

How travel can affect children with diabetes

Changes in your daily routine, food, climate, physical activity and time zones can affect diabetes. They can cause glucose levels to rise or fall unexpectedly. It is important to remember this when travelling and to check glucose levels regularly. This will allow you to quickly identify any changes in your child’s condition and help you manage problems if they happen.

How do I prepare for travelling with my child who has diabetes?

People with diabetes can travel just the same as people without diabetes. You will need to do more planning to make sure travel plans include management of diabetes.

When travelling, it is important to think about:

• length of journey
• the chance of delays
• timing of insulin
• difference in time zones
• availability of carbohydrate food
• access to medical services and diabetes supplies
• care of insulin and diabetes equipment
• customs regulations in different countries
• changes in type of foods
• changes in activity levels
• changes in medicine and sleep routines
• prevention and management of sickness away from home
• carrying a letter to authorise carrying diabetes supplies through customs and security check
• medical identification
• arranging travel insurance

General security requirements for international travel

Liquids in carry on bag - no more than 100mls

When flying internationally, the quantity of liquids, aerosols and gels are restricted to containers that can carry no more than 100ml in volume. Passengers can carry other supplies in their checked bags as usual.

Exemption for essential medicines like insulin - these can be more than 100mls
There is an exemption for essential medicines, medical devices, baby products and dietary supplements in liquid, aerosol or gel form greater than 100ml. This exemption includes insulin and related supplies, liquid medicines, dietary supplements and foods in liquid form and gel (‘frio’) packs for keeping insulin cool.

Have the letter authorising you to carry the exempt items on-board with you. Make sure it's easy to find.  

What to do with containers you carry on-board in hand luggage

You need to put any containers you carry on-board in hand luggage in a re-sealable transparent plastic bag. The bag needs to be no larger than 1 litre in volume (no larger than 20cm by 20cm in size). Present it separately at the security screening point.

Tips for passing through security

Get to security points early.

Keep all diabetes supplies in one bag for easy access when going through security.

See the information below on security screening for insulin pumps and continuous glucose monitoring (CGM).

What supplies do I need for my child with diabetes when we're travelling?

Make sure you have enough supplies when travelling with diabetes.

Carry your diabetes supplies in your hand luggage.

Divide essential diabetes equipment between 2 separate hand luggage bags in case one is lost. Don't pack supplies in your luggage in the cargo hold - they may be exposed to extreme temperatures or get lost at the airport. Make sure you have enough supplies, such as:

• insulin (pack more than you think you need)
• GlucaGen^TM
• syringes
• insulin pens
• blood glucose meter (plus a spare meter) and spare batteries
• blood glucose test strips
• ketone test strips
• medical identification stating that your child has diabetes
• insulin pump supplies
• hypokit including non-juice box options
• extra food for the flight and transit

Travelling to hot climates and keeping insulin cool

If you are travelling to hot climates, plan to keep the insulin and other supplies cool. You can buy travel bags with a gel pack (for example ‘frio’). 

Find out where to get further supplies at your destination

Before travelling, try to find out where you can get further supplies of insulin at your destination in case of an emergency. You can contact the diabetes association of the country you are travelling to, or contact the manufacturer of your insulin.  

Other medicine options to consider taking with you

• anti-nausea and anti-vomiting medicine
• anti-fungal cream

If you are travelling to parts of the world where risk of infection is high and medical care is limited, talk to your GP about whether to take anti-diarrhoea medicine and/or broad spectrum antibiotics.

Extra tips for children on insulin pumps and CGM

Check some extra tips for people on insulin pumps and continuous glucose monitoring (including intermittently scanned CGM) when travelling.

Carry a meter, extra pump and CGM supplies with you

• even if your child uses CGM, carry a meter to check blood glucose and ketones
• carry extra pump and CGM supplies and check expiry dates

Lithium batteries only in hand luggage

Lithium batteries are not allowed in your checked luggage, but it is OK to have one in your child’s pump and a spare in hand luggage (in its packaging).

If your child needs to come off the pump

Have a written record of basal rates and ratios in case your child needs to come off the pump.

Carry supplies for coming off the pump, in case your child needs to do that. Take a spare insulin pen/syringe and some long acting insulin. Have a plan on how to calculate doses via injection.

Things to do to the pump before the flight

12 hours before the flight change the pump cartridge, line, site and battery.

Scanning machines at security

Insulin pumps and CGM should NOT be put through machines that use X-rays, including airline luggage X-ray machines and full-body scanners.

Its best to ask the security agent for an alternative screening method and ask to go through a standard metal detector - with your child wearing their pump.

Keep the insulin pump or CGM on you at all times.

Security scanners will not damage blood glucose meters and insulin.

What to do at your destination

Change the pump time when you arrive at your destination

Check more specific advice with the manufacturer

Check with the manufacturer of your child's pump or CGM for more specific advice.

Does my child need a review by the diabetes team before they travel?

It's a good idea to make contact with your diabetes team before travel. This is especially important for overseas trips. They can help you review blood glucose levels and advise adjustments. Your GP or diabetes team can supply appropriate letters and give advice about managing time zone changes. You can also discuss other issues such as insulin adjustments for activity changes, flights and overseas medical facilities.

What letters and contacts does my child with diabetes need when travelling?

Most recent clinic letter

If you don't already have it, ask for a copy of your most recent clinic letter. This summarises medical information about your child in case you need to seek medical advice away from home.

A letter about your diabetes supplies

For overseas trips and domestic flights, ask for a letter stating that you will be carrying diabetes supplies. These will include insulin and syringes, as well as fluid and food for hypoglycaemia treatment. Having this letter will avoid any problems at customs or security inspections.

Contacts for diabetes services at your destination

Ask your doctor about suitable diabetes services at your destination. Your diabetes team may be able to give you contact names, addresses and phone numbers for most parts of the world. Make sure you have the contact phone and email address of your usual diabetes team in case you or others need to contact them about your child.

What immunisations does my child with diabetes need before travelling?

Make sure your child is up to date with immunisations and has any special immunisations they need for travel to particular countries. Allow at least 2 months for this in case your child needs special immunisations - your family doctor will be able to give you advice about this.

Diabetes health professionals advise that children and young people with diabetes are fully vaccinated, including for flu and COVID-19.

What about travel insurance when travelling with my child who has diabetes?

Get travel insurance well in advance. As the insurer will usually need information from your doctor, you need to allow enough time for this process.

What about meals on the plane when travelling with my child who has diabetes?

Check with the airline about meal times on the plane when travelling with diabetes.

Ask the airline or travel agent about approximate meal times on the flight and whether extra snacks are available. It is best not to ask for a 'diabetic diet' as this is often low in carbohydrate and not the type of food children like. Ask for a children's meal or normal meal and if there is not enough carbohydrate, have your own food available.

Take supplies of easy-to-eat carbohydrate for treating hypoglycaemia as well as enough extra carbohydrate in case of delayed meals during the flight, or delays between flights. Make sure your child keeps hydrated during the flight.

How can I prepare for sick days when travelling with my child who has diabetes?

Prepare a kit for sick day management.

Revise information on sick day management and hypoglycaemia management.

Check the KidsHealth page on managing children with diabetes when they get sick

For trips to countries where English speaking is uncommon, it may be a good idea to have medical letters translated into the local language and also some translations for important requests. For example, "I need to find a doctor", "I need sugar quickly". Making contact with the New Zealand consulate may also be a good idea for longer stays or in case there are any difficulties.

What care do I need to take with food and hygiene when travelling with my child who has diabetes?

Like all travellers in overseas countries, you need to be extremely careful with food hygiene. In countries where water supplies and general hygiene is suspect:

• drink only bottled water
• avoid ice cubes
• avoid salads
• avoid street food sellers and market stalls

What adjustments should I make for overseas flights and time zone changes when travelling with my child who has diabetes?

Insulin adjustments

You need specific insulin adjustments for your child for flights crossing time zones. These adjustments need to take into account:

• the length of the flight
• the time zone changes - how many hours difference between home and your destination
• timing of meals, snacks and stopovers
• usual pattern of insulin doses
• time of arrival at destination and plans for that day (for example, sleeping or being active)

Important things to remember

• never stop insulin on flights
• do extra glucose checking
• keep one watch on local departure time and one on destination time
• set an alarm or arrange for someone to wake you to avoid oversleeping on the plane or after arrival

Be prepared to give extra doses of rapid insulin

Be prepared to give extra doses of rapid insulin whenever glucose levels are above the target range. Higher glucose levels are more likely during flights because of inactivity. You can usually give corrections 3 hourly - check with your diabetes team.

Be prepared for hypos

Be prepared for unexpected hypos.

Carry plenty of extra carbohydrate.

Low glucose levels may happen if:

• there is an overlap of long-acting insulin doses due to time zone changes or
• if your child eats less food because of sleeping more than usual

No significant adjustments needed for travel with smaller time shift

You don't need to make significant adjustments for travel with less than a 2 hour time shift (for example, Pacific Islands or Australia).

Helpful links for chiuldren and young people travelling with diabetes

A checklist for young adults

See the travel checklist at the Diabetes New Zealand website

Other helpful links

Information on long haul travel with an insulin pump (Diabetes Service, Starship Child Health) (PDF, 114KB)

Information on long haul travel with standard insulin (Diabetes Service, Starship Child Health) (PDF, 111KB)

KidsHealth page - Managing children with diabetes when they get sick

See more KidsHealth content on diabetes

Check out KidsHealth's section on diabetes