Article from September, 2016



Michael J. Manyak, MD, MED 92

Medical preparation for a trip into the field is more than having your shots and your diarrhea medicine packed. One increasing problem that gains little attention on remote travel is the traveler with diabetes. Diabetes mellitus (DM) is serious chronic condition that affects over 350 million people globally with an expected 50 percent increase over the next decade. Once considered rather rare at younger ages, there is an increasing incidence of DM in the general population with the mean age at diagnosis now decreased to age 45 and previous racial differences in occurrence have disappeared. This has become a serious widespread medical problem and chances are one of your expedition members may have this disorder.

DM is characterized by high levels of glucose caused by defective insulin production or action. Type 2, the most common, usually appears in adulthood and has a direct relationship to obesity and inactivity. DM is directly associated to development of high blood pressure, cardiac disease, and stroke. The risk for death among people with DM is roughly twice that of people without DM of similar age. Because DM affects small blood vessels, complications from this disease commonly affect many organs including the eyes, kidneys, legs and feet, and skin. Increasing travel by diabetics makes it imperative for travelers with this condition to prepare and be alert for problems related to DM. With proper attention and control of their condition, diabetics can travel as freely as others in most instances.

Expedition and trip leaders should be aware that diabetics may hide their condition to avoid being scratched from the mission or trip. Failure to disclose DM may have very serious consequences for the patient as well as jeopardize the objective for the other members of the trip if someone has to be evacuated. Furthermore, travelers may not realize that the exertion of an expedition may alter their metabolism and change the requirements for medical management of their DM. Expedition leaders should keep an eye on any diabetic in their group for signs of distress. It would be wise to discuss with any diabetic traveler whether they have problems with management of their condition, if they have brought sufficient medication including for an extension of their trip, and if they have testing capabilities for glucose levels.

BEFORE TRAVEL Diabetics need to have the condition well controlled and are strongly recommended to consult with their physician before travel. Because DM can affect blood pressure, heart function, and the kidneys, it is imperative that they have medical clearance before an expedition.
• Travel often comes with increased stress, changes in meal schedules and types of food available, changes from daily exercise routines, and lack of quick access to medications. All of these can have an effect on DM management, sometimes quite profound.
• Diabetics may have suppression of the immune system and are more susceptible to infection. Routine vaccinations must be up to date.
• Travelers with DM should consider receiving pneumococcal vaccine, additional Hepatitis B vaccine, and inactivated flu vaccine because their immune system may be inadequate.
• If going to an area with a high likelihood of poor sanitation and water supply, consideration should be given to antibiotic prophylaxis to prevent traveler’s diarrhea.
• Yellow fever vaccine must be discussed with a physician and if a waiver is sought for the country of entry, it will not guarantee prevention of quarantine, refusal of entry, or mandatory vaccine upon arrival.
• Make sure you have good evacuation insurance.

• Pack twice as much insulin or medicine needed for the trip to ensure that you have adequate supplies in case of trip delays or extensions. This includes finger stick equipment and strips to test glucose levels.
• Hand carry all medical supplies because luggage can be lost. Bring a letter from your doctor stating that you have DM and need to hand carry medication.
• Diabetics who use insulin pumps or monitors need to check with the manufacturer to determine if their equipment is affected by scanners and suitable for use on planes.
• Carry snacks on the plane. It is prudent to alert flight attendants to your condition if it is not stable.
• Wear a medical bracelet or necklace and carry a medical card stating that you have DM.
• If insulin is transported in the baggage in cargo, check the insulin for crystals and discard if present, it is likely inactive.
• Pay attention to storage temperatures for insulin at your destination.
• Check feet frequently for impending infections. Quickly seek medical attention for signs of infection in the feet or anywhere. Wear comfortable, non-restrictive shoes.
• Seek medical evaluation for excessive thirst, more frequent urination, sudden visual changes, tingling in feet or hands, or excessive fatigue.



This article was published in The Explorers Journal


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