Chapter 117. Health Advice for International Travel (Part 8)

Diabetes Mellitus Alterations in glucose control and changes in insulin requirements are common problems among patients with diabetes who travel. Changes in time zone, in the amount and timing of food intake, and in physical activity demand vigilant assessment of metabolic control. The traveler with diabetes should pack medication (including a bottle of regular insulin for emergencies), insulin syringes and needles, equipment and supplies for glucose monitoring, and snacks in carryon luggage. Insulin is stable for ~3 months at room temperature but should be kept as cool as possible. The name and telephone number of the home physician and...
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Chapter 117. Health Advice for International Travel (Part 8) Chapter 117. Health Advice for International Travel (Part 8) Diabetes Mellitus Alterations in glucose control and changes in insulin requirements arecommon problems among patients with diabetes who travel. Changes in timezone, in the amount and timing of food intake, and in physical activity demandvigilant assessment of metabolic control. The traveler with diabetes should packmedication (including a bottle of regular insulin for emergencies), insulin syringesand needles, equipment and supplies for glucose monitoring, and snacks in carry-on luggage. Insulin is stable for ~3 months at room temperature but should be keptas cool as possible. The name and telephone number of the home physician and acard and bracelet listing the patients medical problems and the type and dose ofinsulin used should accompany the traveler. In traveling eastward (e.g., from theUnited States to Europe), the morning insulin dose on arrival may need to bedecreased. The blood glucose can then be checked during the day to determinewhether additional insulin is required. For flights westward, with lengthening ofthe day, an additional dose of regular insulin may be required. Other Special Groups Other groups for whom special travel measures are encouraged includepatients undergoing dialysis, those with transplants, and those with otherdisabilities. Up to 13% of travelers have some disability, but few advocacy groupsand tour companies dedicate themselves to this growing population. Medicationinteractions are a source of serious concern for these travelers, and appropriatemedical information should be carried, along with the home physicians name andtelephone number. Some travelers taking glucocorticoids carry stress doses in casethey become ill. Immunization of these immunocompromised travelers may resultin less than adequate protection. Thus the traveler and the physician must carefullyconsider which destinations are appropriate. Problems after Return The most common medical problems encountered by travelers after theirreturn home are diarrhea, fever, respiratory illnesses, and skin diseases (Fig. 117-2). Frequently ignored problems are fatigue and emotional stress, especially inlong-stay travelers. The approach to diagnosis requires some knowledge ofgeographic medicine, in particular the epidemiology and clinical presentation ofinfectious disorders. A geographic history should focus on the travelers exactitinerary, including dates of arrival and departure; exposure history (foodindiscretions, drinking-water sources, freshwater contact, sexual activity, animalcontact, insect bites); location and style of travel (urban vs. rural, first-class hotelaccommodation vs. camping); immunization history; and use of antimalarialchemosuppression. Figure 117-2 Proportionate morbidity among ill travelers returning from the developing world, accothe top 22 specific diagnoses among all ill returned travelers within each region. STDs, sexually tracould not be assigned. (Reprinted with permission from Freedman et al. © 2006 Massachusetts Medi Diarrhea See Prevention of Gastrointestinal Illness, above.