Being ill abroad
The sick day plan works the same abroad; everything around it is harder. What to pack for being ill, and knowing the route to help before you need it.
Being ill with type 1 is harder away from home for reasons that have nothing to do with the illness: you have finite supplies, you do not know where care is, and the things you would normally reach for may not exist where you are. Most of the difficulty is solved before you leave rather than while it is happening.
- Your sick day plan works abroad exactly as it does at home. Take it with you, in writing.
- Illness raises insulin needs, so a supply that was generous can suddenly be tight. Pack for being ill, not just for the trip.
- Ketone strips are the item people leave behind and the one that matters most when this happens.
- Know before you go how to reach care where you are, and have your insurance number somewhere you can find it while feeling awful.
- Vomiting and diarrhoea, common enough when travelling, push glucose down instead: a hypo can come on at the time or shortly after, and again hours later including overnight, and being unable to keep anything down is the version that needs help soonest.
Most of this is packing and paperwork
The sick day plan is the main thing. Whatever your team has agreed about insulin, checking and fluids when you are unwell applies identically in another country, and having it written down means you are not reconstructing it from memory in a hotel room. A photo of it on your phone counts.
Then pack as though you might be ill, because that is a different quantity from packing for the trip. Illness pushes insulin needs up, sometimes substantially, and a supply calculated for normal days can run short in a way that is inconvenient at home and a genuine problem abroad. The usual advice of taking roughly twice what you expect exists for exactly this.
Ketone strips are the specific item to name, because they are the one people leave at home. They are only needed when things are going wrong, they are easy to forget, and they are the test that tells you whether an unpleasant day is actually an urgent one. Check they are in date while you are packing, since they expire and nobody notices.
The same rules, in an unfamiliar place
The principles do not change. Keep taking insulin even if you are not eating, because background insulin covers your liver rather than your food and stopping it leads toward ketones. Keep fluids going. Check more often than usual, and check ketones rather than judging from glucose alone.
What changes is everything around it. You may not know where the nearest care is, you may not speak the language, and the pharmacy may not carry what you use. This is where the insurance policy earns its cost: most policies have a 24 hour assistance line, and that number is the one to have saved rather than searched for while feeling terrible.
Vomiting is the case that escalates fastest and the one travellers most commonly meet, given unfamiliar food and water. Being unable to keep fluids or sugar down removes your ability to treat a low and to prevent ketones at the same time, and it is a recognised reason to seek help rather than wait it out at home, let alone in a hotel.
Knowing the route before you need it
Look up before you travel how urgent care works where you are going, and what the emergency number is, since it is not 999 in most places and 112 works across much of Europe. Ten minutes of looking beforehand is worth a great deal at two in the morning.
Take the paperwork. Insurance policy number and assistance line, a GHIC if you are somewhere it applies, and a letter from your team about your condition and equipment, which is useful at borders and considerably more useful in a hospital that has never met you. A note of your insulin by its generic name matters too, because brand names differ between countries and the generic is what a foreign pharmacist will recognise.
And tell someone you are travelling with. Being ill somewhere unfamiliar while also being the only person who understands your condition is the situation to avoid, and one companion knowing the basics changes it entirely.
What makes it harder
Heat compounds illness by affecting hydration and by damaging insulin at the same time. Time zones complicate a sick day plan that assumed a normal day. And remoteness changes the calculation entirely: the same illness is a different proposition an hour from a hospital than four hours from one, which is worth factoring in when choosing where to go rather than after arriving.
How it plays out
Examples, not instructions or doses.
A stomach bug on day three, and no way to check ketones. The one item that distinguishes an unpleasant day from an urgent one, and it weighs almost nothing.
Two days of fever needing noticeably more insulin than planned, and a supply calculated for ordinary days. This is why the advice is to take roughly twice what you expect.
Feeling awful and searching a policy document for an assistance line. Saved in your phone before leaving, it is a thirty second call instead.
When it's urgent
Do not stop your insulin because you are not eating: that leads to ketones and DKA, which is a medical emergency wherever you are. Follow your sick day plan, keep drinking fluids, and check ketones. If you are being sick and cannot keep fluids down, have stomach pain, are breathing fast or deeply, or feel very unwell, get medical help where you are: use your insurance assistance line, and call the local emergency number (112 works across much of Europe, 999 in the UK). Do not wait to see whether it passes.