Diabetes (and/or Health) Traveling

I am not sure if this is helpful or info you already know, but here’s details from the UK:

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/travel

You are allowed to travel with essential medical equipment but Heathrow security is incredibly strict. 2 friends of mine who have diabetic children have had issues travelling through there as well as other U.K. airports. Return journeys are always much easier.

Security can insist on inspecting each item and asking a lot of questions. It’s very stressful, takes ages and you have to be able to say no to some unreasonable demands, eg opening packets that need to stay sterile. Basically, you just have to be prepared for it be difficult and try to remain calm so that you don’t end up losing track of all your other belongings. It shouldn’t be like this but unfortunately this is the reality.

I know you can get some sort of travel refrigeration device, like a mini battery operated fridge, to keep insulin in.

I sympathize with you.

CPAP machines are usually not considered a piece of free carry on luggage in Europe.

I cannot think of much to add on top of my head, but in some EU countries, insulin can be purchased w/o a doctor's Rx. I had luck in Spain, but it depends on the pharmacist. In Germany, a companion ran out of insulin, but was able to get it as emergency supply, at the discretion of the pharmacist.

For going through security at airports, you will need a doctor's letter for your CPAP and your pump. I know this is a pain in the neck, but it's better to be safe than sorry. You can also ask for a manual check.

For hotel booking, make sure there is a fridge in your room and that there are sufficient outlets by the bed side. This requires more research in advance.

For water for the CPAC machine, it's not always easy to find distilled water at supermarkets. I suggest you go to a pharmacy. Tap water is usually pretty hard in Europe.

As to adding a forum, the website is rather fixed and past requests for additions may vet noted but rarely actioned.
You can ask for the specific country, General Europe, Packing, or Disability Travel forums. I am not saying Diabetes is a disability, but the folks their may have unique solutions to some of your challenges.

The travel forum search function looks across all categories - here are search results on "diabetes" for last 2 years:

https://search.ricksteves.com/?button=&date_range=2y&filter=Travel+Forum&query=Diabetes&utf8=%E2%9C%93

You might get better answers from an online support group dedicated to diabetes.

On my last RS tour there were 2 members who were insulin-dependent. They had a little cooler bag but it needed to be plugged in to the bus's power ports so there was always a commotion when we were starting out for the driver to turn on the power. It would have been better for them to have checked to see if their device could run on a power bank and just had that hooked up until the bus was at full power. Not all the power ports on the bus worked (normal for most of the tour buses I've been on in the last few years) so that was an issue as well.

It would be great for you to do a Trip Report when you get back especially with your experience thru Heathrow.

CPAP machines are usually not considered a piece of free carry on luggage in Europe. ..For going through security at airports, you will need a doctor's letter for your CPAP.

I carry a CPAP and have never had either of these issues. I've always been able to bring on the CPAP with my carry-on and personal item, and have never brought (or needed) a doctor's letter. You might for the insulin, of course.

And I am assuming you know that you do not need distilled water for your CPAP. Distilled water just eliminates having to clean out the chemicals that can settle in from tap water. But you can do that with a soft towel or washcloth. There's no health hazard to using tap water at all.

But I'm am going to question your determination to use carry-on luggage only. Carry-on is great if you've got a small amount of stuff to carry on. But if you start having a lot of extra things like medical supplies or anything else that you need for your travels, it's going to make your life a lot easier if you check a bag. You can maneuver things around all you want, but let's face it, medical supplies take up space and also cause problems going through security, as others have noted.

It's true that there is some inertia/friction/threshold to be overcome that works against adding a new category - not specifically working against adding the one you suggested, but just adding more categories generally. Too many categories and you eventually end up with....TripAdvisor (or something that resembles it structurally), where there are literally hundreds of forum and sub-forum categories, which must be daunting to administer and maintain (never mind simply navigating it as a user).

It's not unheard of to add a new category here (it does happen occasionally) but I'm sure isn't done without a lot of consideration. That's appropriate.

Something to consider: From a technical and administrative standpoint, it's probably a whole lot easier to rename an existing forum (and to "evolve" its focus as needs change) than it is to add a brand new one. (That's just a guess, but it's how things often work.)

There's an existing category now dedicated to "COVID-19 & Travel". Of course, we're not entirely done with COVID 19 yet (actually, that doesn't matter - what matters is that COVID 19 isn't done with us yet...) but things generally continue to trend in good directions as far as COVID and travel goes, and the activity in that forum appears to be declining (everyone says hooray to that, the webmaster probably most of all). Perhaps the name and focus of that forum category could evolve to something more encompassing, such as "COVID-19 & Other Travel Health Concerns."

There definitely needs to be a place where COVID-specific discussions (appropriate discussions, I would stress) still need to go. But as COVID continues its transition from the hair-on-fire, worldwide emergency for all things travel related, to something less disruptive that we all need to live with, maybe there's room in that (potentially-renamed) forum for other travel-related health issues?

Would a renamed "COVID-19 and Other Travel Concerns" category meet the OP's needs (as well as the needs of other travelers managing health issues) and still work for COVID-related discussions? I dunno, just something to consider.

My husband uses a CPAP and we've flown into England, Ireland, Spain, Germany, Belgium, Netherlands, and France with it. He's always carried it on along with another carry on item and it's never been an issue. It's been treated just like in the US which is as a piece of medical equipment that doesn't count as your carry on item. He's never been asked for a doctor's note.

I'll be very upset if I have to resort to that. We've worked very hard to travel with carry-ons only and it makes travel so much easier.

As the Baby Boomers' travel surge gets into full swing, more and more
people with these life-saving and very specific needs will hinder free
travel for Rick's main constituency.

I want to agree with Mardee about digging in your heels on the carry on only issue. Yes, carry on only is nice IF it works for your needs. But it no longer works for your needs. Life happens. Circumstances change. So the wise ones adapt and change to meet those new challenges. And Rick's main "constituency" has never been restricted to only those who refuse to check bags under any circumstances. Although they can be a very vocal group. What Rick advocates is the elimination of unnecessary packing. There are PLENTY of Rick Steves devotees who dont think twice about both taking a slightly larger suitcase, and checking them for flights. Im one of them.

So what if you have to check one bag in order to manage your equipment and supplies? The only thing that matters is that you can handle that luggage from the time it arrives at the luggage caroussel until you drop it at the check in counter on your return trip.

I don't think a new category would make any difference. Most of us regulars barely notice them as we use the All Topics list.

I've been on 10 RS tours, and have always checked a bag. What works for me is to check a 22" bag (my trekking poles go in this bag), and I use a smaller, wheeled backpack as my carry on. My CPAP goes in this bag. I am able to handle my luggage myself, and that's really all that matters.
I've never been asked for a doctor's note for the CPAP.

By Rick’s main constituency for tours, I meant those of us who are retired or close to retirement. That’s who has been on the 12 RS tours we’ve taken. Yes, there are occasionally younger folks (my daughter and her husband came on a trip with us last year). I’m talking trends here. I’m not hard and fast about never checking a bag, but it’s going to be a last resort for me. I’m tired of delayed and lost baggage. Makes the trip more stressful and if there’s a loss, untenable. And that means most of my clothes would go in the checked bag because for certain I won’t put medical equipment in the plane’s hold. First, because I can’t afford to lose it, and second, because much of it can’t go through the stronger x-Ray that checked bags go through (strong caution from the maker of those supplies). Thanks to everyone for thoughtful comments and suggestions. I still believe a category for people with special medical needs would appreciate a forum specifically targeted in this area. I’m not starting a petition or anything, but maybe someone will see the usefulness of it. I feel that I have a closing window of opportunity to travel with ease and semi-athletic effort. I’m planning on doing cruises when I can no longer climb Ireland’s rocky coasts, etc.

You can write to the airline and they'll give you an extra carry on allowance for your supplies. Normally we travel as a family, so one of the carryons is for diabetes supplies, a backpack where you put everything, don't ever check it, take it always with you.
Regarding the insulin, check FRIO , they're specially designed for carrying insulin, you just have to submerge the bag in cold water for a few minutes every 3 days and it will keep the insulin cool.

Regarding carry-on allowances, the low cost airlines are usually not flexible. Also, depending on the size of the aircraft, you may have to gate check your CPAP if it's in a large bag or roller bag.

My husband and I are both Type 1 Diabetics and we will be doing our 11th RS tour in May. We do carry letters from our doctors explaining that we have to carry all these supplies with us, but we’ve never had to use them. We use Frio insulated pouches to keep our insulin cool. They need to be soaked in cold or cool water every few days, but they’ve kept our insulin good for month long trips. We also do back-to-back tours when we can. We are super diligent about packing light so that we have room for all of our diabetic supplies in my day pack or and my husband’s back-pack. Our personal items are usually completely full of our diabetic supplies and everything else goes in our carry-on bags. I use a pump and don’t risk going through the X-ray machine, so that always takes longer.

We have everything in marked ziplock bags and usually once we explain why we are carrying a mini-drug store, everything goes through okay. We have a sharps clipper (sort of like a toenail clipper with storage) that takes care of needles. We typically bring about 25% more supplies than we need, just in case. But because there are two of us, we can bring a little less. My husband’s pen needles are my backup because they take up less space than my pump supplies.

We tried bringing fewer glucose tablets and we unable to find them in Sicily and Turkey. Juice boxes will work in a pinch, but they are pretty inconvenient. We will get juice boxes when we are at a location for 2-3 days. Our preferred low treatment snacks are granola bars and we have had trouble finding the healthier ones we prefer sometimes. Despite not ever having had any serious issues, I still get extremely anxious going through security at each and every airport. But we love traveling so much that it’s worth it. PM me if you have questions.

I'm flying today to Amsterdam from the United States. I purchased ( paid for out of pocket) a travel sized CPAP machine a couple of years ago and am so glad that I did. It has been an excellent purchase for traveling. It not only is much smaller and lighter than my home CPAP, but it also doesn't need a humidifier or water at all. I was able to pack the CPAP, a fairly heavy down coat, a pair of boots, and my most of my clothes for this trip in my 21" Samsonite roller bag, and my other essentials in my personal item. As a retired airline employee, I usually fly standby and sometimes am required to check my carry on bag at the gate. If that happens, I will just remove my CPAP and coat from the roller bag and check the bag.

I always make sure I have a change of clothes packed in my personal item, as well as medication and electronics.

I have never had to bring a prescription from my doctor for the CPAP when entering or departing in Europe.

I'm another fan of FRIO insulated pouches. We've traveled several times with these for my insulin dependent son and have found they work beautifully. They come in different sizes, depending how many pens, etc. you have to carry. I also used TSA Cares which helps if you need extra help getting through security. I found it easier to keep all medical supplies in a separate bag (equipment, liquid meds, letters, pills, etc.) and just handed it over to the agent. I also packed an extra small empty sharps container (ordered from Amazon) in my bigger bag that I stuffed with sox until I arrived. One year, I carried a small Tupperware container with a lid and used that for sharps until I got home.

BTW, if anybody flies Air Canada from the US to Europe, you may be able to get a stopover in Toronto or Montreal for free or a small fee. Go to a pharmacy or to Costco and buy insulin there. It does not require a doctor's Rx and it's MUCH, MUCH, MUCH cheaper. Think CA$30 vs US$150-200.

Barkinpark, I would suggest you double check your sources. Most Insulin formulations are not an OTC drug in Ontario or Quebec. Or in any other province AFAIK. A pharmacist might permit an emergency dose, or doses. Otherwise a Rx from a Canadian doctor is required.

I use FRIO to keep pens and insulin cool, plus a neoprene cover for the insulin bottles. FYI I don't need to buy insulin in Canada. I am able to buy insulin at $35 a bottle in the USA (Medicare). I will only take one bottle as I have all this other stuff to carry on for the insulin pump. I have borrowed a carry-on from my daughter and it's slightly bigger than our ultra-lightweight Antler carry-on. I will have two personal items, one with all the medical supplies and it will have extra room if they insist we only have one each and my husband will put his smaller personal item in the bag with the medical stuff until we get on the plane. I've downloaded all the info and sheets provided by TSA and the UK so hopefully that will be good enough for France (we also fly Nice to Copenhagen). We then fly Bergen to Amsterdam, then Amsterdam to Seattle -- so hoping it all works then too. However at the end of our trip, I will have a LOT LESS medical equipment left so I might be able to consolidate. I've watched security trash items at Heathrow, but no other location we've been to has been so randomly harsh and irrational. I have the travel CPAP as well, no water needed and very compact. So I'm now fairly confident and I thank everyone who provided helpful suggestions and confirmation that I was on the right track. Thank you RS fans!

I will add a few things.

Doctor's letters are not required for medical equipment and may in fact be completely ignored. They are completely useless because they are so easy to reproduce. I do recommend taking any pharmacy labels for prescription drugs/supplies.
Unless you are traveling for more than 30 days, keeping insulin at low temperatures isn't really necessary. It is necessary to keep the insulin from getting over 86 degrees F, so a cold pack is good insurance and would be needed in hot climates.

I am less sure about international travel, but regarding domestic travel, insulin pumps are well understood by TSA agents. I know hundreds of people on insulin pumps and not one of them has had a problem flying either domestically or internationally without a doctor's note.

Speak to your doctor or other reliable resource to get the best information, because completely relying on what people write on the internet might lead you astray : )

I know this is old. I am T2D/prediabetes. Its not the same as T1D. I control/manage with diet and excercise.
I had dificulty with RS provided meals in Italy. One meal at first, the Tour Guide insisted that they could not make
any substitutions. The meal was 1st course, pasta, 2nd course stewed meat with a huge load of mashed potatoes.

I had to be very forcefull on multiple occasions about the content of dinners. RS philosophy is that the customer takes what is presented.

I am going with my brother on another RS tour to France. If I get the same grief, it will be the last RS tour. Cost or no cost concerns, there is no rhyme or reason to make things like meals difficult on your customers. Let me choose an alternative(salads, etc). I do not want the Tour Guide making the choice.

The meal with the pasta/mashed potatoes, the tour guide got some quite good grilled vegetables for the first course. She did nothing about the potaoes on the second course. Salad was not available. She should let me have a second course with the mixed vegatables and the stewed beef and not stuck the potatoes in front of me.

@Thomas,
Please be sure you have described your dietary restrictions in detail on the Tour Account page when you sign up for a tour. Since it is too late for that regarding your upcoming tour, please call the RS office and discuss this with them.

Please have some understanding that your guide will not have medical/nutrition training so may have difficulty with knowing how to substitute your food. It also won't hurt you to occasionally have a serving of low fiber carbs like potato. Just eat a smaller portion.

In reply to @Thomas, we have had great experience with getting tour guides to accommodate our dietary needs. I am T2 diabetic and I know what foods I have to either avoid or sample in small quantities. When you're not on insulin, you have to carefully count carbs and balance carbs with plenty of protein. I hope you have taken some classes in carb counting (it's boring and tedious I know) so you know what you're in for. I use an app on my iPhone called My Fitness Pal. It does a great job. You can track all your meals or just look up carbs for the food you're going to have. Some of the food in our recent tour to Scandinavia was not great, but I managed to keep in balance. If you don't have a sensor installed, you will have to check blood glucose 2 hours after meals to see how you've done. Over time you will learn. I agree with others who have suggested letting RS know in advance what your food requirements are. There were several of us on our two recent tours who spoke to the tour guide at the end of the intro meeting. They were both very accommodating. We always had a salad option and a vegetarian option. And you can always opt out of a group meal and go get what you want either at the same restaurant, or go to a different one if it's that vital to your mental and physical health. No need for the grumps. RS is eager to offer you choices so you have the best vacation that suits you. After 12 RS tours, we've got the experience to back up that statement.

@vandrabrud, just to add another experience with doctor's letters and such. I was asked to show my doctor's letter in Nice at the security check. He scolded me that the letter was not in the same bag as the supplies! We were asked to step aside in several places where the agent used his smartphone to scan the labels and look up the manufacturer on my insulin pump supplies.

Not all security checkpoint agents are familiar with insulin pumps. One agent in Seattle even asked me to remove it before he allowed me through security. I refused of course (especially because removing it would have exposed part of my body I didn't want to expose!). They had me show them some features of my pump by me pushing buttons!!! Amazing! I asked for a personal screening but they were so slammed they didn't want to take the time I suspect. They eventually let me go through the Millimeter wave scanner which is perfectly safe for all medical items that I am carrying. You just can't put them through a regular X-ray machine. But they then sequestered them in a separate room and held up our departure by 15 minutes until an agent was available to talk to me and ask for personal information that was in the letter!!!

I actually know one of the scientists who invented the Millimeter wave scanner technology and I contacted him before I flew with my insulin pump the first time. (He worked at Pacific Northwest National Laboratory when the system was developed and then sold to companies who used the technology to create the scanners). He gave me great confidence with scientific info to back it up. Very low risk.

It's true in my experience that USA TSA agents are more knowledgable and easy-going than foreign check points. But you have to be prepared for the worst case scenario. In my experience, Heathrow and Nice have been the toughest to get through. I will avoid Heathrow going forward. Even Paris is easier though much more chaotic. I learned a lot with my first trip abroad taking all my pump supplies (enough for a month--two sets for each week). Now I am prepared for our next two tours this fall.

On keeping medication cold I would just add to be very careful about fridges in hotel rooms. We discovered in Sweden last year that the room fridge turned off every time we were out of our room. The keycard needed to be in the slot for the fridge to work. I ended up with my medication not being kept cool by the fridge. Mine was arthritis medication (Cosentyx injectables). After panicked contact with my rheumatologist she suggested I just use it anyway as there was no way for me to get a replacement supply overseas.

@AussieNomad. We recently discovered that any card in the slot will keep the electricity on, not just the room key card. Keep that in mind, but please be eco-friendly and turn off all unnecessary lighting and devices that you aren't using while out.

@Thomas - I’m vegan which is a choice not a necessity. My experience over 12 RS tours (and 13 Road Scholar tours) is that the ability to get a vegan meal is totally dependent on the skill of the guide. After a couple of group meals Ive learned to assess whether to go with group meals or strike out on my own. I’m not a foodie and can easily supplement or make sure I stop at a grocery store during the day for snack items.

I hope your next tour works better for you! At the very least I hope the guide can tell you what’s on offer ahead of time so you can make some choices.

We discovered in Sweden last year that the room fridge turned off every time we were out of our room. The keycard needed to be in the slot for the fridge to work.

Why didn't you just ask for another key card? I do it all the time so I can keep one keycard in the slot and one with me. I have a bad habit of forgetting to take the key card out of the slot when I have just one card.

But as stated previously, most key cards are the same size. Any one will work.

@OP,
Yours is the first story like that I have heard in the US. The good news is that now those agents will be better informed for the next traveler. As I suspected, having a letter didn't seem to help.

I can't comment regarding the requirements in other countries. Anything that makes travel more difficult is a bummer as it is already exhausting. I hope you have many smooth trips in your future!

Wow I'm sorry you had trouble and were scanned and checked so much. I have traveled extensively with my son and fortunately we haven't found trouble anywhere. They haven't checked his bag, or ask him to show anything, they just do a manual quick check and that's it, but bo trouble whatsoever with his supplies.

Why didn't you just ask for another key card?

We did once we realised that it did this. By that point my extremely expensive medication had been above 5 degrees all day while we were out enjoying ourselves. It never occurred to us that a mini bar that included drinks would not stay turned on when we left the room.