Managing Chronic Conditions While Travelling

Whatever the condition, preparation follows the same pattern. Control is reviewed and optimised before travel, and enough medication is taken for the trip plus a reasonable contingency supply, carried in accessible hand luggage and split across bags so that lost baggage does not leave the traveller without treatment. Insulin, emergency medicines, devices and essential supplies stay in hand luggage, in their original labelled packaging, and the destination and any transit-country rules are checked. A repeat prescription and a clinic or prescriber letter are carried, along with some form of medical identification, and the traveller finds out where local care and the nearest hospital are. Devices such as pumps, sensors and auto-injectors, and any needles, are carried with a supporting letter, since airlines and security often ask for one. Every medicine is checked against anti-doping rules before travel, and travel and medical insurance is confirmed to cover the condition and, importantly, medical repatriation.

Diabetes needs the most planning. Insulin is kept in hand luggage rather than the hold, where it can freeze, stored to the product instructions and protected from heat, kept cool without direct contact with ice packs and never frozen, including in a hotel fridge. Clear insulin that turns cloudy or brownish has been damaged and is not used, though some insulins are normally cloudy, so it is an unexpected change in appearance that matters. Whether a pump, continuous glucose monitor (CGM) or sensor can pass through x-ray machines or body scanners is device-specific, so the manufacturer guidance is checked and alternative screening requested only where needed.

Glucose control on tour can move in either direction, since exercise, heat, illness, dehydration, stress and altitude all affect it, so insulin is adjusted individually with more frequent glucose and ketone monitoring. Altitude adds a catch: glucose meters and strips, and continuous monitors, can read inaccurately above roughly 2500 to 3000 metres, and reduced cabin or altitude pressure can force bubbles in a pump reservoir and deliver insulin unintentionally. Sick-day rules are carried in hard copy with ketone-testing supplies and glucagon, basal insulin is continued during illness, and pump users carry injectable rapid-acting and backup long-acting insulin with a written pump-failure plan, since a pump interruption can quickly cause diabetic ketoacidosis (DKA), which with a sodium-glucose cotransporter-2 (SGLT2) inhibitor can occur at only modestly raised glucose.

Asthma is usually straightforward with preparation. The traveller carries enough preventer and reliever inhalers with a spare and a spacer, keeps a written asthma action plan, and stays alert to triggers that change abroad, such as cold air, altitude, air pollution, local allergens and respiratory infections. Exercise-induced bronchoconstriction is planned for with a good warm-up and a reliever beforehand where needed, and frequent reliever use or exercise symptoms should prompt a review of asthma control rather than simply more pre-exercise reliever. Anti-doping rules matter here. Inhaled corticosteroid preventers are permitted. Inhaled salbutamol is permitted up to 1600 micrograms over 24 hours, not exceeding 600 micrograms in any 8 hours, and inhaled formoterol up to 54 micrograms over 24 hours, with salmeterol and vilanterol having their own separate limits. Inhaled terbutaline is prohibited at all doses, and non-inhaled beta-2 agonists such as tablets are prohibited, so these and any use above the inhaled limits need a therapeutic use exemption (TUE). Oral or nebulised treatment in an exacerbation may need exemption assessment, but emergency care is never withheld, with a retroactive exemption afterwards.

Allergy that can cause anaphylaxis is managed around adrenaline. Anyone prescribed it carries two adrenaline auto-injectors, or two of whichever adrenaline device they are prescribed, at all times and in hand luggage, and knows how and when to use them. Adrenaline is the first treatment for a serious reaction, a second dose is given after five minutes if symptoms do not improve or are worsening, emergency services are called at once, and the person is laid down with the legs raised, or sat up if breathing is difficult, and not stood up suddenly. An allergy action plan and medical identification are kept, expiry dates are checked before travel, and because food labelling and allergen awareness vary between countries, a translation card describing the allergy in the local language is valuable.

Crossing time zones is where timing gets difficult. For insulin, the broad principle is that travelling east shortens the day and usually means a temporary reduction, while travelling west lengthens the day and may increase the requirement, though these are guides only and depend on the insulin type, pump settings, meals and flight timings, and a small time difference often needs no change. The detail is worked out with the diabetes team before travel, using the flight and arrival times, with frequent glucose checks through the journey and a readiness to treat a hypo. Other regular medicines are handled medicine by medicine rather than by a single rule, with particular care for those with a narrow therapeutic margin, and alarms or reminders help make sure nothing is missed. The same care applies to keeping every medicine within anti-doping rules while the schedule shifts.

• •Diabetes UK gives practical guidance on travelling with diabetes, including supplies, insulin storage, devices and adjusting insulin across time zones.
• •UK Anti-Doping and the World Anti-Doping Agency set out the status of asthma inhalers and other medicines and when a therapeutic use exemption is needed.
• •Asthma and lung and allergy charities provide condition-specific travel advice, and TravelHealthPro informs general medicines and travel planning.
• •Specific advice is individualised with the person's own diabetes, respiratory or allergy team, especially for insulin timing across time zones.

• •Carry enough medication for the trip plus a contingency, split across accessible hand luggage, with a prescription, a clinic letter and medical identification.
• •Keep insulin cool and never frozen, do not use it if the appearance changes unexpectedly, and check device guidance before airport screening.
• •Glucose control can move either way with exercise, heat, illness and altitude, so adjust individually and monitor glucose and ketones more often, and do not stop basal insulin when ill.
• •Travelling east usually means less insulin and west more, as a broad guide only, and a small time difference often needs no change.
• •Inhaled corticosteroids are permitted, and inhaled salbutamol up to 1600 micrograms in 24 hours and 600 in any 8 hours and formoterol up to 54 in 24 hours; terbutaline and non-inhaled beta-2 agonists need an exemption.
• •Anyone at risk of anaphylaxis carries two adrenaline devices in hand luggage, gives a second dose after five minutes if not improving, and calls emergency services.