An experienced international traveler, Eritrea Mussa flies between continents several times a year for work and family. A few years ago, after arriving in Berlin from her home in Dallas, she noticed her CGM was malfunctioning.
Mussa, 33, who has had T1D since age 8, had packed more than enough insulin and other supplies — but no backup transmitter. At the time, Mussa was using a G6, which required a separate transmitter.
“My Dexcom readings were all over the place,” she recalled telling a coworker: “My blood sugar has been in range only 4% of the time today. I don’t know what’s happening. I need help.”
Luckily, in Berlin for a diabetes conference, she was surrounded by others with CGMs. Her colleague lent her a new transmitter, and Dexcom sent a replacement overnight. It was a reminder that even experienced travelers can encounter unexpected challenges.
“You never know when you’ll need to switch out your equipment,” Mussa said. “For instance, when you’re on a train, and it’s crowded, you might need to go to the bathroom and switch your things out quickly from your backpack. So have extra supplies with you, know where you can get more, and know where you can get help.”
As Mussa learned, traveling can bring the unexpected. For people with T1D, that means having more than enough insulin, and, if needed, backup pump(s), pens, and CGM supplies, said Dr. Magdalena Bogun of Columbia University’s Naomi Berrie Diabetes Center. Adding that a doctor’s note explaining medical needs can also be a good idea.
“The first thing I do is make a list of all the diabetes supplies I’ll need to pack well ahead of time, when I can focus and am not rushed,” said Scott Johnson, from San Diego, California. “I usually bring at least three times what I think I’ll need. You never know when a pump site or CGM sensor will fail.”
Johnson said he always packs his perishable supplies — like insulin — and a few days’ worth of pods and sensors in his carry-on bag, knowing that checked luggage can go missing.
Joanne Milo, 72, who writes The Savvy Diabetic blog, said she always leaves prepared — even for day trips. “I can tell you about the anxiety I feel before leaving my home,” she said, “even for a 2-hour road trip.”
She carries a bag with insulin, pump supplies, syringes, Afrezza, glucagon, glucose meter, and fast-acting glucose.
She also has a larger ‘mini go-bag’ for day trips and overnight travel, said Milo. This includes her medical history, emergency contacts, and a medical ID bracelet.
Even the most thorough packing can’t cover every scenario. Running out of insulin while away from home can be stressful and costly. While there are options, being proactive is key, explains Diana Isaacs, an endocrine clinical pharmacist at the Cleveland Clinic, in this T1D Exchange article. In certain circumstances, for instance, a local pharmacist might be able to help.
Before traveling, “Make sure prescriptions are all up to date, and request refills if needed,” advised Deborah Brickman, CDCES at Columbia’s Naomi Berrie Diabetes Center.
Before you go:
Packing essentials:
During transit:
Leora Apfelbaum, CDCES at Columbia’s Naomi Berrie Diabetes Center, recommends that pump users update device settings to the current time zone upon arrival. “If you’re spending time in multiple time zones, update it each time you land,” she said. “For smartphone-dependent pumps, your phone will update the time automatically.”
For those on multiple daily injections (MDI), Apfelbaum suggests keeping long-acting insulin doses aligned with the home time zone. If this timing is inconvenient, she recommends speaking with your care team about adjusting your schedule.
Johnson said he updates his pump time to the local time when he lands, but longer flights between time zones can still be challenging. “I use an AID system that works behind the scenes to ease the transition,” he said. “But I still usually experience a day or two of higher blood sugars. I think the travel and the disruption to my routine stress my body, and I see that in my blood sugars.”
Travel days often mean less movement, which can affect glucose levels — especially on longer routes and international flights. With so much sitting, the body typically uses insulin less efficiently. For some people, even getting out of the airplane and walking through the airport can cause a quick drop in glucose.
With diabetes, you are allowed to carry liquids, “like juice, or gel packs to keep insulin cool,” even above the 3.4-ounce limit through airport security, according to the U.S. Centers for Disease Control and Prevention. Be sure to inform the TSA agent.
In addition, if you’re carrying CGMs or an insulin pump or patch pumps, you can request a “hand inspection” if the device manufacturer recommends avoiding scanning technology.
Laurie Harper, 73, from upstate New York, has been traveling internationally with T1D since 1971. Back then, she traveled with insulin vials and syringes.
Today we have more advanced tools, but preparation still matters, she said. “Travel is unpredictable, so I watch glucose trends and make small adjustments. I always have snacks with me so I can respond quickly to lows.”
Bogun acknowledged that disrupted routines with travel can be a challenge when it comes to meals: “I tell patients to plan meals as much as they can and to choose meals they’re familiar with.”
Carb counting for unfamiliar foods can be challenging, she said. When unsure, consider estimating conservatively and monitoring glucose closely afterward.
Johnson said that meals on the road have been easier with an AID system. “I do tend to err on the side of caution, estimating lower carb counts than I think,” he said, “because I’d rather be a little high for a bit than deal with interruptions from a low while traveling.”
The refrain of “Bring more supplies than you think you will need” is common among experienced travelers with T1D. “I usually recommend bringing enough insulin and supplies for three times the amount of time you will be traveling,” echoed Brickman.
It’s also important to store insulin properly. “If the weather is hot at your destination, carry insulin in an insulated pouch,” she added. Avoid leaving it in a hot car and use cooling packs until refrigeration is available.
That said, it’s important to be cautious with small hotel refrigerators, which can sometimes freeze insulin — especially when it’s stored near the freezer compartment. If insulin accidentally freezes, it should be discarded, as it will not work properly.
For Mussa, her most common mistake is forgetting to charge everything. “I try to charge all my diabetes devices before I travel because you never know where you’re going to be, and not all airports have outlets,” she said.
Travel with T1D adds layers of complexity, especially when routines, schedules, and environments change. Even with preparation, not everything will go as planned. Paying attention to trends and making small adjustments can help you stay on track.
With experience, many travelers develop strategies that make navigating these challenges more manageable — turning unfamiliar situations into something more predictable over time.