Handling Sick Days Abroad with Type 1 Diabetes

Getting sick while traveling is miserable for anyone. Getting sick abroad with Type 1 diabetes adds a whole extra layer of complexity. Your blood sugar goes haywire, you might not be able to eat, and figuring out healthcare in a foreign country while feeling terrible is not fun.

I’ve been through it multiple times. Here’s what I’ve learned about managing sick days abroad.

Why Illness Affects Blood Sugar

When you’re sick, your body releases stress hormones to fight infection. These hormones make you more insulin resistant.

Typical Blood Sugar Patterns During Illness

The general rule: illness raises blood sugar, even if you’re not eating.

The Sick Day Rules

These apply at home and abroad:

Rule 1: Never Stop Insulin

Even if you can’t eat, you still need basal insulin. Your body needs insulin to survive, not just to cover food.

Rule 2: Check Blood Sugar Frequently

Rule 3: Check Ketones

If blood sugar is over 250 mg/dL and you’re sick, check ketones.

Ketone levels:

If you don’t have ketone strips, err on the side of caution.

Rule 4: Stay Hydrated

Dehydration makes everything worse. Drink fluids constantly.

• Water
• Clear broth
• Electrolyte drinks
• Sugar-free if blood sugar is high
• Regular if blood sugar is low or you need carbs

Rule 5: Know When to Seek Help

Go to a hospital if:

• Blood sugar won’t come down below 300 despite corrections
• Moderate or large ketones that won’t clear
• Vomiting and can’t keep fluids down for 4+ hours
• Signs of severe dehydration
• Confusion or altered consciousness
• You feel like something is seriously wrong

Food Poisoning Protocol

This is the most common illness for travelers. Here’s my specific protocol:

If Vomiting

1. Stop eating until vomiting stops
2. Sip fluids as tolerated
3. Reduce bolus insulin dramatically (no food to cover)
4. Monitor basal needs - may need to reduce initially, then increase
5. Check BG hourly during active vomiting
6. Watch for lows - vomiting can cause lows

If Diarrhea Only

1. Keep eating bland foods if possible
2. Stay hydrated with electrolytes
3. Monitor blood sugar more frequently
4. Expect higher readings - illness effect plus dehydration
5. Increase insulin as needed for highs

Food Poisoning Supplies

Keep these in your travel kit:

Adjusting Insulin When Sick

Pump Users

Temp basal increases:

Start conservative and increase if needed.

Boluses:

• May need larger correction doses
• Correction factor may need adjustment
• Be careful with food boluses if uncertain about keeping food down

MDI Users

Long-acting insulin:

• Usually keep the same dose
• Some people increase by 10-20% during illness
• Consult your doctor’s sick day rules

Rapid-acting insulin:

• Use correction doses more frequently
• Your correction factor may need to be more aggressive
• Wait 3-4 hours between corrections

When to Go to the Hospital

Definite “Go Now” Signs

• Vomiting for 4+ hours, can’t keep fluids down
• Blood sugar over 400 that won’t respond to insulin
• Moderate or large ketones that aren’t clearing
• Confusion, extreme drowsiness
• Severe abdominal pain
• Unable to take oral insulin (MDI users)
• Any signs of DKA: fruity breath, rapid breathing, confusion

The “It’s Not Getting Better” Timeline

Finding Medical Help Abroad

Before You’re Sick (Prepare Now)

1. Know the nearest quality hospital
2. Have your travel insurance info accessible
3. Save emergency numbers in your phone
4. Know how to say “I have Type 1 diabetes” in local language
5. Keep medication list ready to show doctors

When You’re Sick

1. Contact your travel insurance first if possible
2. Go to international hospital if available
3. Bring all your medications
4. Bring your glucose data/meter
5. Explain you have Type 1 diabetes immediately

Language Barriers

Phrases to have ready (translate before you need them):

• “I have Type 1 diabetes”
• “I take insulin”
• “I might have ketones”
• “I need IV fluids”
• “I cannot stop taking insulin”

Recovery Phase

Once the acute illness passes:

Blood Sugar Patterns

Insulin Needs

• Gradually reduce back to normal settings
• Don’t drop too fast (can cause highs)
• May take several days to fully normalize
• Resume normal eating gradually

Prevention

While you can’t prevent all illness, you can reduce risk:

Food Safety

• Drink bottled water
• Avoid ice in drinks (unless reliable source)
• Eat fully cooked foods
• Avoid street food that’s been sitting out
• Choose busy restaurants (high turnover)
• Peel fruits yourself

General Health

• Wash hands frequently
• Get adequate sleep
• Stay hydrated even when healthy
• Consider probiotics
• Be careful with buffets

My Sick Day Travel Kit

The Worst 48 Hours of My Travels

I got food poisoning in a small town in Indonesia. Vomiting, diarrhea, couldn’t keep anything down. My blood sugar was all over the place. I ran out of the oral rehydration salts I should have stocked more of.

I spent most of those 48 hours on the bathroom floor, testing my blood sugar every hour, sipping tiny amounts of water, and wondering if I’d made a terrible mistake moving abroad.

Then it passed. As suddenly as it started, I started feeling human again. Within 72 hours I was back to normal, eating pad thai and watching the sunset like nothing had happened.

Sick days abroad are scary in the moment. The combination of feeling terrible, managing unpredictable blood sugar, and being far from home is genuinely hard. But your body knows how to fight illness. Your job is to support it with fluids, insulin, and monitoring. And to know when to get help if things aren’t improving.

You’ll get through it. I did, multiple times. The key is preparation and staying calm.

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