Living with diabetes

Traveling with diabetes

Talk to your doctor about your destination, especially if you are planning a long-distance trip. It is also recommended Addresses of German-speaking doctors to have at hand in the country of destination. For diabetics who want continuous medical care during their holidays, many tour operators now have corresponding offers.

Inform yourself about this before starting your journey climate and the current temperatures in your holiday country. Pack accordingly matching clothes a: It should be loose, comfortable and made of natural fibers.

Take care of a careful selection of yours Shoes and stockingsto avoid scouring and blisters. Prefer comfortable shoes without seams. For your stockings, choose cotton material that absorbs sweat better. Inspect your feet every night for injuries and bruises.

Important documents and documents

Grab the “Health Pass Diabetes“(published by the German Diabetes Society, DDG), if you do not already have it, and take it with you on the journey.When traveling to foreign-language foreign countries, an international diabetic passport in several languages ​​or one in the national language of the destination is recommended. It is also very useful international diabetic emergency card, It is available, for example, as a download from the homepage of the Diabetes Information Service Munich (www.diabetesinformationsdienst-muenchen.de).

Diabetics also need one medical certificate, which medically causes the entrainment of drugs, insulin syringes, pens, lancets, glucagon set, etc. This attestation should be filled out by the attending physician – depending on the destination of the trip, it is best to also use it in other languages ​​(such as English).

Do not forget yours too Impfausweis!

Medicines and accessories for diabetes therapy

Calculate before the trip, which Amount of diabetes medications (hypoglycemic tablets, insulin) you need for the whole holiday (or ask your doctor). Then take the best part of it – if you lose something or the stay extended unexpectedly.

Also, be aware that you have the Dose of the diabetes medication if necessary to adapt to your holiday activities. Maybe you are more active and move more than at home (muscle work reduces the insulin requirement). Or you relax most of the time only on the beach (less muscle work – insulin requirements increase). Therefore, test your blood sugar more often while traveling. Discuss any necessary dose adjustments with your doctor before you travel. This also applies to necessary dose adjustments larger time shifts (see below: air travel).

Put your diabetic medicines in one drugs plan together with drug names and dosages (or ask your doctor for that). With the help of the name of the active ingredient, you will also be able to obtain the right medicines abroad in the event of an emergency. But it is better to take enough medicine from home (see below).

Also consider packing important accessory for diabetes therapy such as:

• Blood sugar meter (including spare batteries), possibly reserve device
• Blood glucose test strips
• Blood sugar diary
• Acetone test strips
• Lancing device and lancets
• Insulin syringes, insulin pump with cannulas or pump accessories (plus replacement batteries)
• Glucagon emergency kit (if you are prone to severe hypoglycaemia)
• Blood pressure monitor (for diabetics with high blood pressure)

Besides, you should always glucose with you (even if you are not traveling). He is a quick help with low sugar. Also, glucose-containing juices within easy reach are handy.

Pay attention to the entire journey proper storage of the medication, This is especially true for insulin. It should be stored whenever possible between +2 degrees and +8 degrees Celsius (vegetable compartment in the refrigerator). To protect against increased heat, you can store the insulin, for example, in polystyrene, in a cooler or in a thermos flask, which you have previously rinsed with cold water. In-use insulin vials / cartridges can be safely stored for up to four weeks at room temperature. Do not expose it to strong heat or direct sunlight. To protect against cold (such as in winter sports) you should wear the insulin close to the body, such as in a belt pocket under the sweater.

Also some other contents of the first-aid kit are temperature-sensitive. Protect your blood glucose meter and the test strips from large temperature fluctuations and high humidity. The reaction of the test strips is bound to a certain temperature.

By the way: In yours travel pharmacy Of course, also the usual preparations and utensils, which are recommended for travel. These include, for example, preparations for gastrointestinal problems (such as motion sickness, diarrhea, constipation), plasters and compresses, disinfectants, etc. Your doctor can advise you on the compilation of the first aid kit.

air travel

The diabetes medications belong in the carry-on baggageOn the one hand you need them during the trip, on the other hand the checked baggage could be lost. In addition, the temperature in the hold of the aircraft can fall so much that, for example, the insulin freezes – then it is no longer usable! Also needed daily accessories such as blood glucose meter, insulin pump, lancets, etc. belong in the hand luggage. These as well as the medicines may be taken on board with a medical certificate.

Inquire in advance with your airline about any requirements and restrictions. Often, the insulin pen on board the flight attendants must be given for storage. As soon as you need it, you will of course receive it.

Take in the plane enough own food and drinke (especially with carbohydrates) with. Then avoid hypoglycaemia if, due to turbulence for example, food can not be dispensed or the flight takes longer than planned and then nothing is served.

For flights over multiple time zones, you should discuss with your doctor in advance how your Adjust medication have to. This is especially true for insulin therapy. Here are some general recommendations:

• During the flight and after that every two to three hours of blood sugar should be measured.
• Sometimes it can be safer to set the blood sugar level a little higher than normal to avoid low sugar.
• Time shifts of up to four hours (in both directions) generally do not require significant adjustments to insulin therapy.
• Flights to the West: A normal insulin dose before the flight. During the flight possibly fast-acting insulin (such as high blood sugar, increased carbohydrate intake, etc.). After arrival insulin injections at the usual time (new time zone!).
• Flights to the East: A reduced insulin dose before the flight. During the flight insulin dosage depending on the measured blood glucose level. After adding insulin injections at the usual time (new time zone!).

These recommendations are only of a general nature. Your doctor may give you different tips, adapted to your personal health.

nutrition

Fortunately, many diabetics no longer have to orientate their food choices when choosing their holiday destination – intensified insulin therapy (ICT) is now widely used. Type 2 diabetics on tablets have also gained more leeway – with medicines that work quickly with meals.

Rigid food rules on holiday are only available for diabetics who still carry out a conventional insulin therapy with fixed insulin dosages.

Diabetics should be aware of the typical foods and their carbohydrate content – if that’s possible. For safety’s sake, take a BE table and measure your blood sugar more often, especially if the food is not clear.

Drink enough! Generally, about 1.5 to two liters of non-alcoholic liquid are recommended during the day. In warmer countries you should even drink three to four liters of non-alcoholic liquid (Exception: cardiac and kidney disease diabetics!).

For alcohol Traveling is the same as at home (see below): Consume it only in moderation, and preferably never on an empty stomach, but with a carbohydrate-containing food. How to avoid low blood sugar.

Vaccination protection and malaria prophylaxis

Check your vaccine protection, especially against tetanus, diphtheria and polio. Depending on the country of destination, further vaccinations may be useful or even prescribed (such as yellow fever vaccination, typhoid vaccine, etc.). Please consult your doctor or a tropical medicine doctor. Take care in time before you travel, because some inoculations need a certain amount of time.

The doctor or tropical medicine doctor can also inform you about any necessary medical malaria prophylaxis.

Diabetes and alcohol

Alcohol is a cytotoxin that attacks various organs of the body that may have been pre-damaged by diabetes mellitus. In addition, diabetics whose liver is currently busy with alcohol detoxification are acutely exposed to the risk of hypoglycaemia. For diabetics it is therefore particularly important to know the effect of alcohol in the body.

hypoglycemia

Normally, the liver constantly releases small amounts of sugar into the blood to provide energy to the brain and muscles. Alcohol inhibits this sugar release. This lowers the blood sugar level. In combination with diabetes medications, it can easily lead to low blood sugar (hypoglycaemia). As a countermeasure, the body would actually release the hormone glucagon. It releases the sugar stored in the liver. But that too is prevented by the alcohol.

Alcohol consumption can cause a significant hypoglycaemia in diabetics – even several hours later, because the alcohol effect lasts for a long time. If a heavy drop in blood sugar happens during sleep, it can even become life-threatening for the diabetic.

overweight

One gram of alcohol has almost as many kilocalories as one gram of fat. Especially diabetics should therefore only with caution enjoy the “calorie bomb” alcohol. Because being overweight lowers the insulin sensitivity of the cells and increases the insulin requirement of the body. Especially diabetics, who are already overweight, should abstain from alcohol altogether.

nervous system

Alcohol and diabetes are the two main causes of damage to the nerves (peripheral polyneuropathy). When both factors come together, the nerves are damaged twice. The injury usually affects the nerve tracts of the feet and often causes diabetic foot syndrome.

impotence

Alcohol influences the potency. Diabetes mellitus can also lead to impotence via vascular and nerve damage. Diabetics who suffer from sexual disorders should therefore abstain from alcohol better.

heart

Alcohol in excess damages the heart in several ways. For example, regular consumption of alcohol can lead to hypertension. This damages the vessels and thus increases the risk of cardiovascular diseases (such as heart attacks and strokes). The same applies to lipid metabolism disorders, which are also favored by alcohol. In addition, alcohol can cause cardiac arrhythmias and damage the heart muscle cells, resulting in heart muscle disease (cardiomyopathy).

Diabetes mellitus also endangers the heart’s health. Vascular damage due to high blood sugar can affect the blood flow to the heart muscle. The possible consequences are coronary heart disease (CHD) and heart attack.

The heart is even more at risk if alcohol and diabetes occur in combination.

pancreas

The pancreas is particularly sensitive to alcohol. It is the main cause of inflammation of the organ (pancreatitis). Acute pancreatitis is life-threatening. If it is chronic, it goes into inflammatory thrusts and can lead to loss of function of the pancreas. This is fatal because only this organ can produce insulin.

Diabetics with diseases of the pancreas should therefore consume no alcohol. This is even more true for diabetics who only became insulin dependent on acute or chronic pancreatitis.

Since the pancreas also produces important digestive juices, damage to the organ causes serious digestive disorders and vitamin deficiencies.

liver

Alcohol and obesity of the liver, which is very common in overweight diabetics, together lead to scarring and eventually loss of function of the liver. This is called a “fatty liver cirrhosis”. Alcohol and diabetes also interact unfavorably here.

drugs

Many drugs are metabolised by the liver. If the liver is not fully functional, some drugs accumulate in the body and cause unwanted side effects. Conversely, some drugs are excreted faster by the loss of alcohol and no longer achieve the desired effect. This should be given special attention in the case of drug-dependent or insulin-dependent diabetes mellitus.

Alcohol consumption in moderation

Diabetics may drink alcohol, but should follow some rules. Especially type 2 diabetics should not drink alcohol regularly.

• Always consume alcohol with carbohydrate-containing foods. The hypoglycemic effect of the alcohol can be compensated by the carbohydrates or at least mitigated. This reduces the risk of hypoglycaemia.
• The risk of hypoglycaemia can be exacerbated if there are other blood sugar-lowering factors in addition to alcohol consumption. These are, for example, sports, dancing or prolonged abstinence from food.
• For the consumption of hard alcoholic beverages (such as liquor, vodka), wine and possibly even beer, do not inject additional insulin. If you want to drink sweet cocktails, mulled wine & Co., an extra dose of insulin may be useful. Discuss this in advance with your doctor!
• Do not drink large quantities of non-alcoholic beers. Although they contain hardly any alcohol (less than 0.5 percent), but a lot of malt sugar and thus unfavorable carbohydrates.
• Check your blood sugar more often while drinking alcohol, and in the hours thereafter. Hypoglycaemia can still occur 10 to 20 hours after drinking alcohol! For safety, inform relatives and friends about the possible risk of hypoglycaemia.
• Those who sleep soundly do not notice an alcohol-related drop in blood sugar. Therefore, it may be useful to eat carbohydrates before lying down, which slowly increase blood sugar (like whole grains, potatoes). In any case, you should check your blood sugar at bedtime!

Avoid alcoholif you are pregnant, have diabetic neuropathy or have liver or pancreas problems Even with disorders of fat metabolism (such as high cholesterol levels) and a tendency to low blood sugar, a complete abstinence from alcohol is recommended.

Diabetes and pregnancy

A diabetic, like any other woman, can give birth to healthy children – provided she is receiving regular medical attention before and during pregnancy. If the diabetes is not optimally adjusted during pregnancy, it can be dangerous for the maturing child and the expectant mother.

What can you do yourself?

At least three months before a (planned) pregnancy should be a HbA1c to be sought, ideally below 6.5 percent (at least but less than 7, 0 percent).

Before every meal and one to two hours afterwards pregnant diabetics should take the measure blood sugar, These measurements should be for a healthy development of the child in a particular area – as well as the measurements before bed and at night. The following target values ​​are recommended:

Time of measurement	Blood sugar in mg / dl	Blood sugar in mmol / l
sober / before eating	65 to 95	3.6 to 5.3
1 hour after the meal	< 140	< 7,7
2 hours after eating	< 120	< 6,6
before bedtime	90 to 120	5.0 to 6.6
at night (2 to 4 o’clock)	> 65	> 3,6
mean blood glucose (MBG)	90 to 110	5.0 to 6.1

Especially with unstable type 1 diabetes, frequent blood glucose monitoring is very important.

All women (including non-diabetics) should be on adequate care folic acid respect, think highly of. This prevents childish malformations (such as “open back”). At least four weeks before the (planned) pregnancy and until the end of the 12th week of pregnancy, the daily intake of 0.4 to 0.8 milligrams of folate is recommended. In addition, pregnant women should feed on folate (with green leafy vegetables, legumes, whole grains, etc.).

Also an adequate supply of iodine is very important for the health of mother and child. Pregnant diabetics should therefore take a preventive medication with at least 200 micrograms of iodide per day. In addition, a iodine-rich diet and the use of iodized salt are recommended.

Pregnant diabetics become additional ultrasound examinations advised to early identify possible growth disorders in the child.

Consequences of diabetes You should have a check-up before pregnancy and, if necessary, get medical treatment (for example, a diabetic nephropathy). A very common complication in pregnant diabetics is a retinal disease (diabetic retinopathy). If the eyes are still in order, diabetic women should go to the ophthalmologist before (planned) pregnancy, immediately after pregnancy and every three months thereafter until birth. If there are already changes on the retina, the doctor can arrange more frequent check-ups with the diabetic.

General tips recommended to every pregnant woman (including non-diabetic women) are:

• Do not smoke. Also avoid passive smoking.
• Do not use alcohol altogether.
• Take any medications (including herbal supplements) only if absolutely necessary and on medical advice. Also, talk to your doctor in advance of taking any supplements.

ICT or insulin pump?

In principle, both therapies are equivalent. Patients can be treated as well as with insulin pump therapy under intensified conventional insulin therapy (ICT).

Insulin requirements change during pregnancy. From the second trimester of pregnancy, it increases continuously (by 50 to 100 percent until birth). This is especially true in type 2 diabetics with severe overweight (obesity). On the other hand, the onset of birth often decreases dramatically. This makes a re-adaptation of insulin therapy necessary. Therefore, blood glucose must be measured more frequently than usual during pregnancy and after delivery. Diabetics learn from their doctor if and how they need to adjust their insulin dosages.

What risks are there?

Pregnancy in type 1 and type 2 diabetes is generally considered a high risk pregnancy. Careful medical attention and good metabolic control can reduce the risk of complications.

Important Complications and risks for mother and child are for example:

• In the first trimester of pregnancy, diabetics have an increased risk of hypoglycaemia.
• The risk of early miscarriage (early abortion) is increased in type 1 and type 2 diabetics. It depends on the metabolic setting before conception (higher risk for poorly adjusted blood sugar).
• The risk of childhood malformations is increased in diabetic women, also depending on the metabolic setting before conception. On average, it is around four times as high as in the general population and is therefore just under nine percent. Malformations of the heart and of the vessels close to the heart, neural tube defects (such as “open back”) and multiple (multiple) malformations occur most frequently.
• The child in the womb may become unusually large (macrosomia), which can cause problems with vaginal delivery. Often then a caesarean section is necessary.
• Even with unusual size (macrosomia) newborns of diabetic women are often “immature”, which affects the development of individual organs. This is especially true for the lungs.
• There is a risk of child hypoglycemia immediately after birth. However, regular blood sugar checks in the child within the first few days and possibly glucose supplements usually reduce serious health consequences for the baby.
• Pregnant diabetics are more susceptible to infections of the genital and urinary tract. Such urogenital infections can increase the risk of premature birth.
• Maternal hypertension may develop during pregnancy or may persist before. If the expectant mother additionally excretes protein with urine (proteinuria) and has accumulations of water (edema), there is preeclampsia (“pregnancy poisoning”). It can be dangerous for both mother and child (possible complications eclampsia, HELLP syndrome).
• An existing diabetic retinal disease (diabetic retinopathy) may worsen during pregnancy (usually in the third trimester).
• A mild diabetic kidney disease (diabetic nephropathy) may increase the risk of pre-eclampsia and miscarriage. Advanced nephropathy poses a high risk to the unborn / newborn (premature birth, stillbirth, delayed growth, developmental delays in childhood).

In both type 1 and type 2 diabetic women, the delivery in one Perinatal center with at least level 2 be planned. There, the maternity ward is directly connected to a neonatal intensive care unit (at least four cots). As an expectant mother you should be present at the latest by the 36th week of pregnancy in the perinatal center.