Holidays and travel should be something to look forward to, but it is important to plan ahead - even more so if you have diabetes and you want your journey (and blood sugars) to run smoothly.

Vaccinations

Some countries insist on certain immunisations for visitors, so it is wise to check in advance what (if any) vaccinations are required. There are no vaccinations contra-indicated because you have diabetes, but be aware that some may affect your control of your blood sugar levels in the hours or days that follow.

Identification and custom

It is sensible to wear some form of identification bracelet/necklace indicating that you are diabetic - especially if you are insulin-dependent. It is wise to carry a letter from your doctor stating you have diabetes and the treatment you use, or a British Diabetic Association photo identification card. This could be crucial if you are taken ill or if you have any problems going through customs. You are not required to declare insulin/medicines/syringes, as these are personal medical requirements.

Insurance

The cost and availability of medical services differs from country to country. Some countries have a reciprocal health care agreement with the UK, so emergency medical treatment is free or available at a reduced cost. All EEC countries have such reciprocal agreements with the UK, for which you need to present an E111 form at the point of treatment (available from post offices). In many countries, all consultations, treatment and medical supplies must be paid for. This can be very costly, and adequate medical insurance is vital. Insurance policies that will reimburse you if you need to be flown home in an emergency are advisable. Ensure also that holiday insurance packages do not exclude pre-existing conditions such as diabetes.

Illness

Being ill is unpleasant and can spoil a holiday, especially if you are unwell in a country where foods are different and hygiene standards dubious. Knowing what to do regarding your medication and food intake is essential, so discuss this with your diabetes nurse or specialist before you leave. Find out about anti-diarrhoea medication and motion sickness tablets as well as food hygiene. Having the name and address of the local diabetes association may also be useful if you are taken ill.

Medical supplies

It is very important to take enough medical supplies (insulin, syringes, etc.) so that you don't have to waste valuable time and money. Your GP can only write a prescription for three months' supply of some items, so if you are going away for longer you will need to consult a local doctor. Many of the insulins and/or oral hypoglycaemics available in the UK are available in other countries. The manufacturers of most products can also give you an idea of worldwide availability. Have both the generic name and the brand name of your medication to hand, as brand names often differ in other countries.

The most important thing is to take everything you need with you if possible. This is especially true if you are visiting more remote and adventurous countries, where medication that is apparently 'standard' in Europe may not be available. Even U40 and U80 insulin may still be used.

On the journey

Whether you are travelling by train or plane, boat or car, take food with you in case of delays or extensions to journey times. Include quick-acting carbohydrates, such as sugar and glucose tablets, as well as the longer-acting variety, such as biscuits, fruit, chocolate, sandwiches, etc. If you are prone to travel sickness you may also need to take motion sickness tablets before your journey.

If you are driving, remember to test your blood sugars before leaving, and eat regularly on the journey. If you take sulphonylureas or insulin, test your blood sugars every two hours over long journeys in order to avoid hypoglycaemia.

Long periods of sitting relatively motionless may cause your blood sugars to rise, but on balance it is preferable to have them running a little high rather than low, as hypos can be very dangerous at the wheel and embarrassing and inconvenient on buses and trains. Remember, though, that you may be quite active at the beginning and end of a trip, as you rush to get to the station or airport (and then to the platform or departure gate), cart heavy bags about or pack the car.

Don't bother to request a 'diabetic diet' when flying - it almost invariably comes too early or too late, and then turns out to be either unappetising or inappropriate or both. Take what comes and adapt as usual (your own extra carbohydrate supplies may prove useful here).

Packing for the trip

Pack insulin in your hand luggage, as flying altitudes can cause baggage in the hold to freeze, and checked luggage may be lost or delayed. It is wise to keep all essential items, such as your insulin and blood glucose meter, close at hand, or at least split between yourself and a travelling companion.

Crossing time zones

Timing your insulin injections when flying across time zones can present problems. As you fly westwards (e.g. UK to USA), the day lengthens and you may need an additional injection of short-acting insulin. Conversely, as you fly eastwards (e.g. UK to Far East), so the day contracts, and you may need to reduce your insulin doses to compensate for the shorter gap between injections. It is impossible to give advice to cover all eventualities, so before you leave discuss your trip with your diabetes nurse or specialist, armed with local times of arrival and departure and the duration of the flight. Although the whole process sounds complicated, it rarely causes serious problems. As mentioned above, as a general rule of thumb it is prudent to let yourself 'run a little high' in order to avoid the risk of hypoglycaemia.

Insulin storage

Though extremely high temperatures can cause a drop in insulin activity, this is a problem that is often exaggerated. Unless you are planning a prolonged stay in a very hot country, it will be sufficient to keep your insulin in a reasonably cool and shady place. For lengthy travels and in very hot climates, use an insulin-carrier with a frozen water container to act as a coolant. Make sure freezing facilities are available and keep vials out of contact with the frozen blocks. Alternatively, keep your insulin in a plastic sandwich box and keep it cool. Wide-necked vacuum flasks and polystyrene containers are other useful cheaper options.

Climate

Take sensible precautions in extremes of temperatures. In hot climates, use a good sunscreen and drink plenty of fluids; in cold climates, conversely, wear warm socks and comfortable sturdy shoes to protect your feet. Remember that some blood glucose test strips over-read in very warm conditions and under-read in colder climates. Hypoglycaemia can be more of a risk in hot climates, perhaps because insulin is absorbed more rapidly when the skin temperature is higher. Reduced and more erratic carbohydrate intake also play a part. It is important to be aware of this possibility, and to watch food intake and blood glucose levels closely.

Activity

Generally people are more active on holiday than they are at home, taking long walks, trying out new sports, etc. Others may do less, missing out on their usual daily activities to lie on the beach and relax. Monitor and record your blood sugars regularly, as this will provide useful information for future travel.

Foot care

Some people with diabetes return from holidays in warm climates with foot ulcers. This usually affects older Type 2 (non-insulin dependent) diabetic people, often with peripheral neuropathy (numbness of the feet). Walking barefoot on hot flagstones or stony beaches can commonly cause the trauma that precipitates ulceration. This can ruin a holiday, so it is sensible to take care of your feet and avoid going barefoot.

Food

Remember that a holiday is a time to sample new and different foods. Many people are daunted by the prospect of selecting from strange menus and eating unaccustomed foods. Yet in most places food consists of the same basic ingredients: fruit, vegetables, meat or fish and usually plentiful amounts of starchy foods such as rice, potatoes, bread and pasta.

Most people drink more alcohol on holiday, but remember that if you are taking some tablets or insulin it can lower your blood sugars It is wise to drink only with food, and where possible to choose low-alcohol or alcohol-free alternatives. Drink plenty of water, bottled if you are doubtful about the purity of the local water supply.

For more information, contact the British Diabetic Association (10 Queen Anne Street, London W1M 0BD, tel 020 7323 1531). The BDA produces general travel information as well as information specific to certain countries.