Some people are unlucky enough to develop diarrhea and vomiting while on holiday. For this reason, it is a good idea to ask your doctor to give you some anti-emetic and anti-diarrheal pills to take with you. At the first sign of trouble get yourself to a comfortable refuge with a bed and a toilet. Get a large supply of clean water – mineral water in sealed bottles is safe – and some liquid glucose such as Lucozade, Coca Cola or Pepsi Cola. Start checking your blood glucose level. Your glucose level will probably rise and you may need more insulin than usual. Be prepared to check your glucose very frequently, probably every one or two hours, if things start to go very awry, and take more frequent additional doses of fast-acting insulin. Get help early if needed.
If you are on oral hypoglycemic pills you may vomit them up or not absorb them because of the diarrhea. If you see recognizable pills in the vomit, try taking some more pills at the same dose. If they still do not stay down, or your glucose level starts to rise, you probably need some insulin to tide you over the attack. Seek medical help.
If you are vomiting and not managing to eat you may start making starvation ketones. If your glucose is low, try sipping your sugary drink, because even if you vomit you will have absorbed some glucose through your mouth. Alternatively, try sucking glucose tablets. When you feel like eating a little, try a few digestive biscuits, Graham crackers or something similar. During a diarrheal illness you may lose a lot of fluid and in some cases this may make you feel lightheaded. This may be more pronounced if you have autonomic neuropathy. Try to keep drinking small amounts of fluid all the time, to keep up with what you are losing. If you feel giddy, get up slowly, and call a doctor. When the worst is over, give yourself a day or two to recover gently.
Very long trips
If you are on a very long trip, of more than thirty-six hours, divide the journey into “night” (sleeping time) and ‘day”, and have three meals and your usual between meal snacks during the ‘day’. Have a slightly reduced dose of your insulin as usual before the first meal after waking and before the last meal before sleeping. Check your blood glucose level before each meal and before bed and if it is high, top up with 2 to 4 units of fast-acting insulin. It is better to err towards 10 mmol/1 (180 mg/dl) than 4 mmol/1 (72 mg/dl) when travelling, to make sure that you avoid hypoglycemic attacks.
Funny foreign food
There is no reason why people with diabetes should not be adventurous in their eating. Avoid obviously sugary or very greasy foods. Fresh food (providing it is well washed or cooked) is usually all right. Fish is a good food for a diabetic diet. Pasta (sometimes the whole-wheat variety) and rice are available in most places, and many different countries use beans and legumes in their cooking. If a strange dish looks tempting, try it -the occasional naughty food is not a disaster. If the meals are larger than you are used to, have a little more rapid-acting insulin before them.
If the meal times are very different from those at home, do not worry. If you are on once-daily very long-acting and several rapid-acting doses of insulin, have your rapid-acting insulin before the meal, whenever it is. If you are on twice-daily medium-acting or long-acting with short-acting insulin, you can either take both the medium-acting or long-acting and short-acting insulin before the evening meal whenever that is, or, if this is going to create problems overnight, take your medium-acting or long-acting insulin at the usual time and have the rapid-acting insulin before the evening meal. Consider the interval between injections and try to ensure that the medium-acting and long-acting injections are spaced out, as they would be at home. Your changed eating habits are only for a limited period.
However, you should not forget to adjust your insulin dose and food intake to suit your level of activity. Lying in the sun uses up less energy than tramping around ancient monuments.

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