Your Guide to Post-COVID Travel with Type 1 Diabetes

It’s important to know that contrary to initial reports, air travel now is actually relatively safe. According to federal law, masks are currently required in all airports and on all airplanes.

Airplanes are also equipped with high quality, high-efficiency particulate air (HEPA) filters. Officially, certified HEPA air filters block and capture 99.97 percent of airborne particles over 0.3 microns in size by circulating cabin air once every 2 to 4 minutes.

So if you need to remove your mask to eat or treat low blood sugar while flying, it’s OK.

What is more dangerous are airports, where mask-wearing can be sparse, because of the “except while eating or drinking” loophole. And it can be difficult to physically distance yourself 6 or more feet from others.

Many countries require proof of vaccination to fly, and the United States requires a negative COVID-19 test upon entry, so most people, at least when flying internationally, are at lower risk to be carriers of the disease.

Jill Weinstein, a retiree and avid traveler in Denver, has lived with T1D for over 50 years. She tells DiabetesMine, “I didn’t travel until I made sure I was fully vaccinated. Since then, I’ve been on about 5 trips to visit family, one vacation with a friend, a hiking trip to Minnesota, and a sailboat trip in Belize. I haven’t really noticed any inconvenient differences, besides having to wear a mask in the airport and on flights, which I’m fine with.”

She continues, “I am also looking forward to a trip to Europe in October and hoping case counts stay low until then.”

The first thing to keep in mind when traveling with T1D is that you need time to prepare. Always plan to pack at least several days in advance, so you aren’t in a rush when packing and can thoughtfully map out everything you’ll need.

A quick rule of thumb is to pack nearly three times the amount of supplies you think you’ll need for a trip, plus backups in case some of your modern gadgets get lost or don’t work properly during your journey.

That means packing both insulin pump and continuous glucose monitoring (CGM) supplies, and extra syringes, vials of long-acting insulin, a glucometer, lancing device and lancets, and test strips in the case your insulin pump malfunctions while traveling.

The calculation may look something like this:

In addition to all your diabetes supplies, toiletries, and clothing, you’ll need to pack extra supplies for travel in light of COVID-19. First, however, is making sure you’re up to date on all your COVID-19 vaccines. Make sure you’ve had two full doses and at least one booster.

The Centers for Disease Control and Prevention (CDC), given the most recent Omicron surge, has recommended those with severe risk of poor COVID-19 outcomes, including those with diabetes, may receive a second booster at least 3 months after the third dose.

Talk with your doctor to see if they feel you should receive a second booster shot before travel.

Be sure to have your proof of vaccination with you at all times either on your smartphone or the physical card or printout. (You can get a digital QR code here.)

Additional items you’ll need to pack are:

• a high quality KN95 or N95 mask (and several spares)
• hand sanitizer
• disinfectant wipes
• rapid COVID-19 tests, if you wish to see people in close, indoor settings once you arrive at your destination

James Elliott, an #insulin4all advocate and T1D researcher who splits his time between North America and Northern Africa, tells DiabetesMine: “You should keep snacks that won’t perish on you at all times. I keep Cliff bars, but anything will work. Planes can get delayed or stay on the tarmac for hours. That’s happened to me before, and you don’t want to go low without having something nearby.”

“Traveling between countries has me well aware that jet lag will mess up your blood glucose levels for a few days, so don’t beat yourself up about it,” he said.

• Wear a KN95 or N95 mask at all times while at the airport and while on a flight. However, taking off your mask to treat hypoglycemia is always OK.
• It’s still wise to physically distance yourself from other travelers as much as possible. Staying 6 feet away from anyone not in your party is ideal.
• Wash your hands often, especially after going through airport security, using the bathroom, and before eating.
• Carry and use hand sanitizer liberally. As part of their Stay Healthy, Stay Secure campaign, The Transportation Security Administration (TSA) is temporarily suspending their 3-1-1 rules around liquids. The TSA is allowing one oversized liquid hand sanitizer container, up to 12 ounces per passenger, in carry-on bags. All other liquids, gels, and aerosols brought to a checkpoint will continue to be limited to 3.4 ounces, carried in a one quart-size bag, except for medical supplies, which are also exempt.
• If possible, avoid public transportation or ride shares to and from the airport. Opt to have family or a friend drop you off, or drive yourself and pay to park at the airport to further avoid close proximity to strangers.
• Book a morning flight if you can. Aircrafts are now being thoroughly cleaned every night, so aiming for a morning flight is a better guarantee that your flight will be free of viral particles and germs than a flight leaving in the evening.
• Once you’re seated on the airplane, wipe down your tray table, seat, head rest, and arm rests with disinfectant wipes. Planes are quickly cleaned between trips, but a more thorough job will ensure you’re properly killing any viral particles and germs.
• Sitting in a window seat may help protect you as well, as fewer people are walking by you (and thus inadvertently breathing their viral particles past you). Additionally, sitting in the front of the plane may provide better air circulation and fewer viral particles.
• Try to sleep on the flight, listen to music, or read, instead of making friends. Talking spreads viral particles in the air. The fewer people you talk with, the less likely you are to exchange viral particles with someone who is sick, and the less likely you are to become sick yourself.
• If you plan to travel by air, it’s best to check your state’s travel advisories as well as the CDC’s travel recommendations by country to assess your risk.

Traveling with diabetes, despite the challenges, can have some perks. If you are flying domestically (within the United States), you are eligible for certain protections and accommodations under the Americans with Disabilities Act of 1990, administered through the TSA Cares program.

You’ll need to tell a TSA security officer that you have diabetes, and if they question it, tell them it’s a protected class of disability under the Americans with Disabilities Act.

To make this easier, you may want to utilize the TSA Disability Notification Card. Simply print out the card at home and fill in your information. It can help you save time and any awkwardness in the TSA security line, while still ensuring you receive the disability accommodations you are guaranteed in the United States.

To further avoid any confrontation or questioning at the TSA security checkpoint, you can also carry a letter from your endocrinologist or primary care physician confirming your condition and outlining your diabetes needs. Here’s a sample letter that may help you and your doctor get started.

Once you’ve communicated that you have a disability, you are entitled to the following:

• Under the TSA Cares program, you are allowed to carry liquids through security, if they’re used to treat low blood sugar. If you regularly treat your lows with orange juice for example, you can bring it through TSA security. Just make sure to let them know it is “medical,” and they’ll manually scan it and allow it through.
• Additionally, you are allowed to carry an unlimited supply of your diabetes supplies, with no questions asked. No, you won’t get in trouble for flying with 100 insulin syringes in your carry on, despite any sideways glances you may receive.
• People with disabilities, including diabetes, are always allowed to preboard flights. This can give you extra time walking down the jet bridge, or to set up your things, so you can arrange for your diabetes supplies and low snacks to be out and near you during the flight. On smaller flights, this also ensures that your roller carry-on bag actually makes it onto the plane with you, instead of you being forced to gate check it. Being without your insulin and/or diabetes supplies, for any amount of time, against your will, is never OK.
• People with disabilities are allowed an extra carry-on bag (personal item-size only) for their medical supplies. This is in addition to any personal item or carry-on bag you’re already taking onboard, only if it contains just your diabetes supplies.

People feel differently about whether they’re comfortable going through the X-ray machine or advanced scanners with their insulin pumps or CGMs. Rest assured: The TSA states that passengers with portable insulin pumps or glucose monitors can be screened by advanced imaging technology, metal detectors, or they may ask for a simple pat-down. If you’re unsure if your device will be damaged by any imaging technology, check with your device manufacturer for guidance.

“There is no shame in asking for disability accommodations. Some airports have special programs for invisible disabilities, such as the sunflower lanyard program,” Elliot tells DiabetesMine.

The Hidden Disabilities Sunflower program is relatively new, and in essence, provides lanyards to people with invisible disabilities to wear while they travel, specifically at airports and on airplanes. It is a discreet way to signal to airport staff that you live with a disability and may need a little bit more support and time when traveling.

The program was established in the UK in 2016 and has since grown into a global movement with a presence in over 35 U.S. and three Canadian airports. Jet Blue airlines is the first U.S. airline to purchase and support the program with a rollout planned for 2022.

If you have a Diabetes Alert Dog (DAD) and they need to fly with you, you may also tell a TSA officer that you utilize a service dog for your diabetes management, print out a TSA Disability Notification Card with that information on it, or provide a letter from your doctor stating your need for a service animal, and you shouldn’t have any trouble. Airlines and airports are tightening down on service animals, however, so having a letter from your doctor is probably the easiest way to avoid any delays at security if your DAD is traveling with you.

If you have any questions, you can call TSA’s toll-free helpline for people with disabilities at 855-787-2227 with questions about screening policies, procedures, and what to expect during your security screening. The helpline is open from 8 a.m. to 11 p.m. ET and from 9 a.m. to 8 p.m. on weekends and holidays.

Also, remember that the Americans with Disabilities accommodations do not apply when you’re traveling internationally. Take extra precautions when traveling abroad and make a note that certain allowances (like preboarding flights and carrying juice through security) may not be allowed in foreign airports.

It’s best to check with your airline and destination country to understand their rules and regulations.

During a global pandemic or not, it’s helpful to keep the following tips in mind for the next time you travel:

• Eat before you leave for the airport, so you’re not: a) figuring out difficult carbohydrate counts in an airport with not many options and b) eating in a crowded food court, with little room to physically distance yourself from other people. You’ll also save money this way.
• Adjust your basal rates accordingly if you use an insulin pump. Some people’s blood sugar tends to go extremely high while traveling, and for some, it drops. Adjusting your settings the morning of your trip will help to prevent travel-day headaches and inconvenient highs and lows.
• Be sure you know what to do in case your insulin pump malfunctions.
• Wear a medical alert bracelet, such as MedicAlert, and carry emergency contact phone numbers on your person.
• Carry all snacks in your carry-on bag so they’re easy to access at all times.

“Beware of lows when hauling your luggage to and from the airport, and especially after you leave the airport, before you get to where you’re staying. If you’ve got the money, don’t feel guilty about taking a taxi or a rideshare (instead of public transit, that can take much longer). Don’t feel guilty about giving yourself a break,” Elliott told DiabetesMine.

His final advice is don’t panic. Remember that COVID-19 has been with us a long time, and it’s not going anywhere anytime soon. If you’re vaccinated and boosted and wear a high quality KN95 or N95 mask, you are at a lower risk of catching COVID-19. Take precautions but don’t let them freak you out or convince you that you should never travel again. And especially if you’re traveling for pleasure, remember to have fun!

After any traveling, make sure to self-monitor for any symptoms of COVID-19 or any variants (including fever, headache, sore throat, runny nose, congestion, or trouble breathing).

Take an at-home antigen or PCR test 3 to 5 days after your travels to check whether you’ve contracted the virus. Remember, many people are asymptomatic, so test even if you don’t have symptoms.

If you do have COVID-19, call your doctor right away for advice and quarantine for 10 days — or until you’re testing negative on a PCR test and before seeing others or returning to work or school.