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  • Driving and travelling with diabetes

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    Driving

    This material reproduced with the permission of the Land Transport Safety Authority (LTSA) 

    If you’ve got diabetes, you need to be aware of the risks involved when you’re driving. If you know the risks, you can take steps to manage them.

    Newly diagnosed?

    If your diabetes has just been diagnosed and treatment is still being adjusted, you may not be fit to drive just yet. Check with your doctor.

    Hypoglycaemia (low blood glucose)

    Low blood glucose levels are dangerous for drivers with diabetes. If you’re taking insulin or tablets for diabetes (except Metformin), it’s very important that you avoid low blood glucose levels, which can greatly impair your driving and cause crashes.

    Hyperglycaemia (high blood glucose)

    High blood glucose levels could leave you feeling unwell or tired, and may affect your ability to drive safely. You should avoid driving while you’re hyperglycaemic.

    Passenger services and heavy vehicles

    People with insulin-dependent diabetes are not normally allowed to drive taxis, heavy trade and passenger service vehicles. If a diabetes specialist wrote on your behalf to the Chief Medical Advisor of the Land Transport Safety Authority (LTSA), we might make an exception. Strict conditions would apply.

    Precautions while driving

    If your diabetes is well controlled you can drive a private car safely. However, there are times when you need to take precautions.

    • Always have meals and snacks before and during long journeys. It’s safest not to delay meal times. Take regular short breaks from driving
    • Check your blood glucose levels regularly. If you feel that your blood glucose is low, stop driving and treat with a quick acting sugar, eg three glucose tablets. Follow this up with a plain muesli bar (not recommended on a regular basis) or biscuits. Wait until the sugar has started to work before you start driving again
    • Keep a supply of plain muesli bars, biscuits, glucose tablets, dried fruit and long lasting fruit juice in your pocket or in the glove box
    • Don’t delay treating low blood glucose levels. The brain becomes confused when the blood glucose reach low levels. Be aware of your own warning signs. Although a mild hypo may not seem to impair your driving it’s vital to act before your judgment is affected
    • If you experience hypoglycaemia unawareness (hypos without warning signs), it may be unwise for you to drive. You should discuss this with your doctor or diabetes nurse specialist
    • Remember that changing a car tyre or pushing a car could result in low blood glucose levels. Be prepared!
    • If you have diabetes, alcohol can be particularly dangerous because it can cause hypoglycaemia or worsen its effects. We recommend that people with diabetes avoid consuming any alcohol if they’re going to drive

    When you shouldn't drive

    In some situations you may need to refrain from driving. If you have a mild hypoglycaemic episode we recommend that you don’t drive for at least an hour, to give your brain time to recover.

    If you have a severe hypoglycaemic episode (eg when you need someone else’s help to deal with it), you shouldn’t drive for 24 hours. If you have several hypoglycaemic episodes you should talk to your doctor before you return to driving.

    If you have a severe hypoglycaemic episode while you’re driving, whether you’re involved in a crash or not, you shouldn’t drive for at least a month. It’s likely you’ll need to be reviewed by a specialist before you can safely return to driving, and you need to talk to your doctor.

    Long-term complications

    Your driving ability could be affected by long-term complications of diabetes, such as eyesight deterioration and the loss of normal sensation in your feet. Check with your doctor.

    Licence conditions

    Some drivers with diabetes may be issued with a licence that has certain conditions attached. The conditions will depend on the type of licence (classes and endorsements), how the diabetes is controlled, any history of hypoglycaemic attacks, compliance with medications and an assessment of any medical complications that are commonly associated with the diabetes. The LTSA’s Director decides the type of conditions to impose, having regard to the Medical Aspects of Fitness to Drive booklet and in consultation with the LTSA’s Chief Medical Adviser.

    Legal note

    Insulin and tablets for the control of diabetes are classified as drugs under the Land Transport Act 1998. You may be prosecuted under this Act if you’ve been misusing or abusing diabetes medications and your driving results in crashes or injuries. For a case to proceed, however, there would need to be proof that the way you’d used the drugs was contrary to medical advice.

    Where can I find out more?

    Don’t hesitate to see your doctor or your diabetes educators if you have any questions. A handbook that includes a chapter on diabetes, Medical Aspects of Fitness to Drive, has been issued to all doctors.

    For more information contact the Land Transport Safety Authority:

    PO Box 2840
    Wellington

    Alternatively, visit the LTSA website or freephone 0800 699 000.

    Read more about driving and travelling with diabetes:

    Hittin the Road with diabetes
    Above 5 to Drive

    Traveling

    Key points

    • If you are entering remote areas carry supplies and a guide sheet for treating illness
    • If you take insulin carry it on you when flying and check the strengths of any insulin you are prescribed overseas
    • Always take out medical insurance when travelling
    • Check your blood glucose more often than usual while travelling
    • You can find helpful tips at the bottom of this page, and you can read more here

    You can usually do all you want to do when travelling with Type 2 diabetes. But it helps if you plan ahead.

    How you prepare depends on where you’re going and for how long. Two weeks backpacking through Europe takes different planning than a week at the beach. Will you be crossing time zones? What kind of food will you eat and when? Will you be more active or less active than usual?

    General travel tips

    • Test your blood glucose frequently. Your whole routine of activity and food is likely to be very different. The type of food you eat may also change
    • Keep a daily record of insulin doses and test results (to help you identify any trends, and to help any medical advisors that you may need to see)
    • If you are having problems with your blood glucose levels, follow the guidelines you worked out with your team before you went away and/or contact a hospital or diabetes doctor in the area for advice
    • If you do visit a hospital take along as much supporting documentation as you can (your medications, test results, travel/medical insurance forms etc.)
    • Some insulins have different names and are supplied in different strengths in other countries. If you have to use insulin from another country make sure it is either the same strength as you are used to or a diabetes specialist has helped you make the necessary dose adjustments to take a different strength insulin
    • Avoid using local needles if not sterile
    • It’s smart to watch what you eat and drink when travelling. Avoid tap water overseas (including ice cubes made from tap water). Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and this may make your blood glucose management more difficult.
    • Wear comfortable shoes and never go barefoot. Check your feet every day. Look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation on your feet.
    • Go wherever your heart leads you. But remember that you take your diabetes with you. Your self care is your travelling friend

    Getting ready

    Consider telling your travel agent that you have diabetes and explain some of the particular needs that travelling with diabetes entails. That way, a suitable itinerary can be planned to meet your needs.

    It’s a good idea to visit your doctor for a check-up several weeks before you leave. Show your itinerary to your health care team and work out plans for your food and medication, especially if you are travelling through different time zones.

    Immunisations

    Get immunisation shots (if you need them) at least one month before you leave. If the shots make you unwell, you’ll have time to recover before your trip.

    Health insurance

    Health insurance for your trip is an absolute must. All travellers are prone to infectious illnesses as they travel through new countries. Having Type 2 diabetes puts you at higher risk. An infection or injury can also be harder to manage when you have Type 2 diabetes. It is important for you to be able to access good quality healthcare if you need it.

    Diabetes-related documents

    Before any trip, get three papers from your doctor:

    • A letter for customs if you are carrying blood testing equipment and/or insulin delivery devices (e.g., pens, pen needles, or syringes)
    • A letter for a doctor (should you need to see one when you are away)
    • A prescription for your medication and test strips (in case you need to get more supplies)

    The letter for customs:

    • Should state that you have diabetes and should state that if you are carrying testing or insulin delivery equipment on you it is for treatment of your diabetes
    • Store the original of this letter safely with your travel documents. Have enough photocopies of the letter to give to the customs agents at each border you are crossing. Don’t give away your original!

    The letter for a doctor should:

    • Explain you have Type 2 diabetes and what medication type and dose you are on
    • Note any other medical conditions you have
    • List any allergies you have or any foods or medications to which you are sensitive

    Supplies of diabetes medications

    Make sure you have a full supply of all your diabetes medications before you leave. Your prescription should enable you to get ample supplies of your medication and test strips. Enough to get you through to the next time that you will be settled in a country where you are certain you can get supplies (try not to run low on medication or test strips while you are travelling).

    Other medicine supplies

    If you are going into remote or isolated areas is often sensible to get a prescription from your doctor for anti nausea and vomiting medication, anti diarrhoea medication, and some basic anti fungal and antibiotic medication. Doing this will mean you’ll have the medications you need should you become sick overseas and are unable to get medical help quickly. Discuss your needs with your doctor and remember to get he/she to give you instructions on when and how to use the medication. Get the prescription filled before you leave and carry these medications with you.

    Diabetes identification

    It is best to wear a medical ID bracelet or necklace that shows you have diabetes. It is also wise to carry a card in your wallet or amongst your travelling papers that states you have Type 2 diabetes and what medication you take.

    Visit the MedicAlert Foundation of New Zealand website for more information about obtaining a medical ID bracelet.

    Managing low blood glucose levels

    (Low Blood Glucose) If you take sulphonylurea tablets or insulin for your diabetes carry a source of simple carbohydrate on you, e.g., orange juice, glucose tablets, jelly beans. It also pays to carry a small complex carbohydrate snack on you (e.g., muesli bar).

    People on holiday often drink more alcohol than usual. Try to drink only moderately, and be aware of the safety guidelines for drinking alcohol if you are on sulphonylurea tablets or insulin.

    Managing sickness and high blood glucose levels.

    If you get sick overseas you may not have access to the same level of health care that you have in most parts of New Zealand. You may be on a camel trip across the Sahara!

    It is important for you to be clear about how to go about managing sickness and high blood glucose levels for people with Type 2 diabetes. If possible go over the guidelines for managing illness with Type 2 diabetes with a diabetes nurse educator before going away.

    Remember, stop taking metformin (metomin, glucophage) if you develop vomiting or diarrhoea. You can start back on it when you are well again.

    If you are in remote areas take:

    • A good supply of unsweetened fluids. The best is a supply of bottled water
    • Anti nausea and vomiting medicine
    • Anti diarrhoea medicine
    • If you are out of reach of medical help, keep a supply of a basic broad-spectrum antibiotic tablets handy
    • Anti fungal cream
    • Your own knowledge about how to manage your diabetes during illness
    • Basic guidelines written down (for yourself and others) on managing Type 2 diabetes in illness.

    Packing

    Pack more medication and blood-testing supplies than you think you will need. Pack all of these in your personal carry bag so that your medication and testing supplies are always with you. This way you are less likely to get separated from your essential supplies if your luggage goes astray. Also the temperature in the baggage compartments of some planes can be very low. This can damage your testing strips or meter or insulin (if you take insulin).

    Your carry bag should contain:

    • Your diabetes medication and any other medications you take
    • Blood testing supplies (include extra batteries for your glucose meter)
    • A diabetes identity card stating your name and the fact you have diabetes
    • A supply of suitable food or glucose to treat low blood glucose levels if you take insulin or sulphonylurea tablets

    Travelling with insulin

    Keep these things in mind when you travel with insulin:

    • Insulin doesn’t need to be refrigerated, but if insulin is stored in very hot or very cold temperatures it may lose its strength
    • The glove compartment or boot of your car are not good places to store your insulin as they can get very hot. Nor are backpacks or cycle bags exposed to direct sunlight
    • If you plan to travel by car or bike or be out in the elements, take steps to protect your insulin
    • There are travel packs available to keep your insulin cool. They are insulated bags. Another option some people use to keep their insulin cool is a small wide-mouthed thermos. This can be bulky however and if you are hiking or travelling light you may prefer an insulated bag
    • At room temperature the insulin you have opened (and are using) retains its potency for 30 days

    Insulin doses when travelling

    Managing your insulin doses while travelling is complex, especially if you are crossing time zones rapidly (by air). Crossing time zones, effectively, makes your day either longer or shorter, so you’ll need to adjust your insulin doses (and food) to compensate for this.

    The safest way to plan your insulin management when travelling is to work it through with your specialist diabetes team before you leave. Give yourself plenty of time to plan by making this appointment well in advance of your departure date.

    Take your full travel itinerary when you see the team. Make sure you come away with a plan you are happy with and that you understand. This plan should be written down. See more on managing your insulin across time zones in the “Tips for Travel by Air” section.

    Tips for travelling by air

    Food

    Some people have found that if they request special diabetes meals on airlines that they get served meals that are very low in carbohydrate. It is often best to order standard meals and to make healthy choices within that.

    Safety

    If you are on medications that can cause your blood glucose levels to go low let the cabin staff know. This way they will be alert if you need any help. Also carry glucose and a carbohydrate snack on you.

    If you are on insulin

    The security scanners used at check-in will not damage insulin or blood glucose meters.

    Wait until you see your food coming down the aisle before you take your injection. Otherwise, a delay in the meal could lead to a low blood glucose level.

    If you are on insulin you may need to make changes to the dose or timing of your injection when moving across time zones. Having two watches often helps you keep track of  these changes. Keep one watch on the time of the country you have just left. This will enable you to remain very clear on when your next insulin would have been due. You can also accurately judge how much time has passed since you had your last insulin if you record your insulin doses against this time.

    Have a plan worked out in conjunction with your specialist diabetes team in advance as to how you will manage your insulin doses if you are crossing time zones.

    Avoid risks of blood clots in your legs

    Keep up a good level of activity during your journey. Walk around in the terminal before boarding.

    When you are booking your seat try to get an aisle seat. Because you have diabetes you are more likely to develop blood clots in your legs. To prevent this happening it is essential that you get up and walk around in flight for a few minutes every hour while you are awake. Doing simple stretching exercises when seated also helps. Move your ankles in circles and point and release your toes often. This encourages good blood flow in your legs.

    Blood glucose testing

    You may find it helpful to test your blood glucose levels more frequently while travelling. The timing and content of your food will change. It is also easy to mix up the effects of jet lag with either high or low blood glucose levels, so it pays to know what your glucose levels are doing. Remember when you are tired it is easy to neglect your diabetes. But it is at these times that you need to know more about what is happening.

    Tips for travelling by sea

    With the wide array of mouth-watering foods available on cruise holidays, it’s easy for your diabetes management to get out of kilter. Talk to your diabetes educator or dietitian before you leave about how you plan to deal with the food aspect of the trip. It’s often helpful to get a sample menu from the cruise line so you can get an idea of the types of foods that will be served.

    Cruise ships offer some great activities to help you stay active. These range from aerobics classes, swimming, gym workouts, dancing, or strolling the deck at sunset.

    It’s a good idea to make the cruise staff aware of your diabetes in case any problems arise. Keep a card or I.D. on you that states you have Type 2 diabetes.

    Tips for travelling by car

    Our “Diabetes & Driving” section contains practical information about what you need to look out for when you are driving, as well as some of the legal aspects of driving in NZ with diabetes. Your travel agent can often find out in advance the rules covering driving in the countries you will be visiting. If you are on diabetes medication that can cause low blood sugar levels test your blood sugar before and during driving and treat any low blood sugar levels promptly.

    Tips for travelling by foot (or other physically active means, e.g., cycling or kayaking)

    A holiday in the great outdoors can be a wonderful retreat from the pressures of everyday life. But there are a few things to consider before you go. Here are some tips:

    • Avoid going camping or hiking alone
    • Tell someone where you will be and when you expect to return, so you can be found if there is an emergency

    The key to enjoying a trip of this kind is to try to avoid things that may significantly alter your blood glucose levels. Be aware of safety and try to avoid sunburn, injuries and contaminated food or water. Make sure your foot wear is sturdy and also fits you well. Don’t use brand new shoes to hike in, try them out before the trip.

    Eat and drink enough to meet your needs. Take extra food, water and medication. If you are on medication that can cause your blood glucose to go low take supplies of simple carbohydrate (e.g., glucose, sugar).

    Hiking, cycling or kayaking nearly always means you are a lot more physically active than usual. If you are on sulphonylurea tablets or insulin you may find your blood sugar levels begin to go low. If this happens it is often best to reduce the dose of these medications while you are having the extra activity. Talk to your specialist diabetes team before you go if you are planning a very active holiday. Ask them to help you plan for dose reduction if need be.

     
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