Diabetes, Syringe pens
Adjust Insulin Schedule Smart During Travel Today
Mar
Traveling with diabetes can be a daunting task, especially when it comes to managing insulin schedules across different time zones and routines. However, with proper planning and adjustments, individuals with diabetes can enjoy their travels while maintaining optimal blood glucose control. It’s crucial to understand how travel can affect insulin requirements and to develop a personalized strategy for adapting insulin doses and timing.
This article aims to provide practical guidance and expert tips for adjusting insulin schedules smartly during travel. We’ll explore the factors that influence insulin needs while traveling, such as changes in meal times, physical activity levels, and stress. By understanding these variables and implementing evidence-based strategies, individuals with diabetes can navigate the challenges of travel with confidence and minimize the risk of complications.
Understanding Insulin and Travel
Types of insulin and their action times
Insulin is a vital hormone for individuals with diabetes, as it helps regulate blood glucose levels. There are several types of insulin available, each with different action times and durations. Rapid-acting insulin, such as lispro and aspart, begins working within 15 minutes and peaks at 1-2 hours[1]. Short-acting insulin, like regular insulin, starts acting within 30 minutes and peaks at 2-4 hours. Intermediate-acting insulin, such as NPH, has an onset of 2-4 hours and peaks at 4-12 hours. Long-acting insulin, like glargine and detemir, provides a steady insulin release over 24 hours[2].
Importance of maintaining insulin schedule during travel
Maintaining a consistent insulin schedule is crucial for individuals with diabetes, especially during travel. Disruptions in insulin timing can lead to fluctuations in blood glucose levels, increasing the risk of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). These complications can not only impact the enjoyment of travel but also pose serious health risks if left unchecked.
Factors affecting insulin requirements while traveling
Several factors can influence insulin requirements while traveling, making it essential to adjust insulin doses accordingly. Changes in diet, such as trying new foods or eating at irregular times, can impact blood glucose levels. Physical activity levels may also vary during travel, with increased walking or sightseeing affecting insulin sensitivity. Stress, whether from travel logistics or unfamiliar environments, can cause hormonal changes that alter insulin needs[3].
Risks associated with improper insulin management during travel
Improper insulin management during travel can lead to various complications. Hypoglycemia, characterized by symptoms like shakiness, confusion, and sweating, can occur if insulin doses are not adjusted for changes in meal times or physical activity. On the other hand, hyperglycemia, which causes increased thirst, frequent urination, and fatigue, can result from insufficient insulin or missed doses. These complications can not only ruin travel experiences but also lead to more severe health issues if not addressed promptly.
Pre-Travel Preparation
Consulting with healthcare provider before travel
Before embarking on any trip, it’s essential for individuals with diabetes to consult their healthcare provider. This consultation allows for a comprehensive review of the travel itinerary, including destination, duration, and planned activities. The healthcare provider can offer personalized advice on adjusting insulin doses, managing supplies, and handling potential challenges specific to the trip[4].
Obtaining necessary travel documents and medical supplies
Proper documentation is crucial when traveling with insulin and diabetes supplies. Obtain a letter from your healthcare provider explaining your diabetes diagnosis, treatment plan, and the need to carry insulin and related supplies. This letter can help navigate airport security and customs procedures. Additionally, ensure you have sufficient medical supplies, such as insulin, syringes, glucose meters, and test strips, to last the entire trip, plus extra in case of unexpected delays or emergencies[5].
Packing insulin and related supplies properly
Proper packing is essential to maintain the integrity of insulin and diabetes supplies during travel. Insulin should be stored in a cool, insulated bag with gel packs to prevent exposure to extreme temperatures. Avoid placing insulin in checked luggage, as it may be subjected to temperature fluctuations and potential loss. Pack extra supplies, such as batteries for glucose meters and backup insulin delivery devices, in case of malfunction or accidental damage[6].
Planning for time zone changes and meal times
Time zone changes can disrupt regular insulin schedules and meal times, making it necessary to plan ahead. Research the local time at your destination and develop a strategy for adjusting insulin doses and timing accordingly. Gradually shifting insulin administration and meal times a few days before travel can help the body adapt to the new schedule. It’s also essential to plan for in-flight meals and snacks, ensuring they align with your insulin regimen and blood glucose management goals.
| Task | Details | |
|---|---|---|
| 1 | Consult healthcare provider | Review travel plans and get personalized advice |
| 2 | Obtain necessary documents | Secure medical letter and prescription copies |
| 3 | Pack insulin properly | Use insulated bag with gel packs |
| 4 | Plan for time zone changes | Adjust insulin schedule and meal times |
Adjusting Insulin Dosage During Travel
Monitoring blood glucose levels closely
Frequent blood glucose monitoring is crucial when adjusting insulin doses during travel. Changes in routine, diet, and physical activity can significantly impact blood sugar levels, making it necessary to check glucose readings more often than usual. Keep a travel-friendly glucose meter and sufficient test strips readily accessible to enable regular monitoring[7]. Logging blood glucose values, insulin doses, and relevant factors like meal times and exercise can help identify patterns and guide insulin dose adjustments.
Adjusting basal and bolus insulin for time zone changes
When traveling across time zones, it’s essential to adjust basal and bolus insulin doses to maintain blood glucose stability. For long-acting basal insulin, gradually shift the injection time by 1-2 hours per day leading up to the trip to align with the destination’s time zone. For rapid-acting bolus insulin, adjust the timing of injections to coincide with meals in the new time zone[8]. It’s important to work closely with a healthcare provider to develop an individualized plan based on the specific insulin regimen and travel circumstances.
Managing insulin during layovers and flight delays
Flight delays and extended layovers can disrupt insulin schedules, requiring careful management. Keep a supply of rapid-acting insulin and snacks readily available to address any unexpected changes in plans. If a significant delay occurs, consider adjusting the timing and dosage of long-acting insulin to prevent hypoglycemia or hyperglycemia. Staying hydrated, monitoring blood glucose frequently, and having a contingency plan can help mitigate the impact of travel disruptions on insulin management[9].
| Pros | Cons |
|---|---|
| Maintains blood glucose control | Requires careful planning and monitoring |
| Prevents complications like hypoglycemia and hyperglycemia | Can be challenging in unfamiliar environments |
| Allows flexibility in travel plans | Needs frequent adjustments based on various factors |
| Improves overall travel experience | May require additional supplies and resources |
Strategies for adjusting insulin for increased physical activity
Travel often involves increased physical activity, such as walking, hiking, or swimming, which can enhance insulin sensitivity and lower blood glucose levels. To prevent hypoglycemia, consider reducing basal and bolus insulin doses before engaging in physical activities. Continuously monitor blood glucose levels and keep fast-acting carbohydrates on hand to treat any episodes of low blood sugar promptly. Consulting with a healthcare provider can help develop a personalized strategy for adjusting insulin based on the type and duration of physical activity planned during travel.
Managing Insulin in Different Travel Situations
Air travel and insulin storage
When traveling by air, it’s crucial to store insulin properly to maintain its effectiveness. Insulin should be kept in a carry-on bag to avoid exposure to extreme temperatures and pressure changes in the cargo hold. Use insulated bags or coolers with gel packs to keep insulin at the recommended temperature range of 36-46°F (2-8°C)[10]. Notify airport security about your insulin and related supplies to expedite the screening process. It’s also essential to carry a copy of your prescription and a letter from your healthcare provider explaining your need for insulin during travel.
Road trips and insulin management
During road trips, insulin can be stored in a cooler with gel packs to maintain the proper temperature. Keep the cooler easily accessible in the car, and avoid leaving it in direct sunlight or hot areas. Plan regular stops for blood glucose monitoring, insulin injections, and snacks. It’s also wise to carry extra insulin and supplies in case of unexpected delays or emergencies. If traveling with others, inform them about your diabetes and insulin needs to ensure they can assist if necessary[11].
Camping and outdoor activities
Managing insulin during camping and outdoor activities requires careful planning. Use a sturdy, insulated cooler to store insulin and keep it protected from extreme temperatures. Consider using a battery-operated or car-powered cooler for longer trips. Keep insulin and supplies in a waterproof container to safeguard against moisture and environmental damage. Plan meals and snacks in advance, and pack appropriate food options to manage blood glucose levels. Engage in physical activities cautiously, monitoring blood glucose frequently and adjusting insulin doses as needed[12].
International travel considerations
International travel presents unique challenges for insulin management. Research the availability of insulin and diabetes supplies at your destination, and carry sufficient quantities to last the entire trip. Be aware of local laws and regulations regarding insulin transportation and storage. Obtain necessary vaccinations and carry relevant medical documents, such as a prescription and a doctor’s letter, to facilitate border crossings and emergency situations. Consider purchasing travel insurance that covers diabetes-related emergencies and medication replacement.
| Travel Situation | Storage Guidelines |
|---|---|
| Air Travel | Carry-on bag, insulated container with gel packs |
| Road Trips | Cooler with gel packs, avoid direct sunlight and heat |
| Camping and Outdoor Activities | Sturdy, insulated cooler, waterproof container |
| International Travel | Carry sufficient supplies, research local availability |
Dealing with Travel Disruptions and Emergencies
Handling delayed or missed meals
Travel disruptions, such as flight delays or unexpected itinerary changes, can lead to delayed or missed meals. In these situations, it’s essential to have a plan in place to manage insulin and prevent hypoglycemia. Keep a supply of easy-to-carry, non-perishable snacks like crackers, fruit, or granola bars on hand to maintain blood glucose levels[13]. If a meal is significantly delayed, consider adjusting the timing and dosage of rapid-acting insulin to prevent blood sugar fluctuations. Stay hydrated and monitor blood glucose levels more frequently to identify any trends that may require further insulin adjustments.
Managing insulin during illness or injury
Illness or injury during travel can complicate insulin management and increase the risk of hyperglycemia or hypoglycemia. In case of illness, monitor blood glucose levels more frequently and adjust insulin doses accordingly. Keep a supply of over-the-counter medications, such as anti-diarrheal and anti-nausea drugs, to manage symptoms that may affect insulin absorption. If injury occurs, seek medical attention promptly and inform healthcare providers about your insulin regimen[14]. It’s crucial to have a plan in place for managing insulin during unexpected health challenges, such as carrying a sick day management kit with essential supplies and instructions.
Accessing emergency medical care and insulin supplies
In the event of an emergency, such as a severe hypoglycemic episode or insulin pump malfunction, it’s crucial to know how to access medical care and insulin supplies promptly. Research the location of nearby hospitals, clinics, and pharmacies at your destination before traveling. Carry a list of emergency contacts, including your healthcare provider and insurance company, to facilitate communication and support[15]. Consider enrolling in a medical alert service that can provide assistance and information to emergency responders. Always carry a backup supply of insulin and related items, such as syringes or pens, in case of equipment failure or loss.
Communicating with travel companions and local healthcare providers
Effective communication is key to managing insulin-related emergencies during travel. Inform your travel companions about your diabetes, insulin needs, and potential emergency situations. Teach them how to recognize the signs of hypoglycemia and hyperglycemia and how to administer glucagon if needed. When seeking local healthcare, carry relevant medical documents and be prepared to communicate your insulin regimen and any allergies or complications. Consider learning key phrases related to diabetes and insulin in the local language to facilitate communication with healthcare providers in non-English speaking countries.
| Item | Description |
|---|---|
| Emergency contact list | Include healthcare provider, insurance, and family contacts |
| Medical alert identification | Wear a bracelet or carry a card indicating diabetes diagnosis |
| Backup insulin and supplies | Pack extra insulin, syringes, pens, and pump supplies |
| Glucagon kit | Carry a glucagon kit and instruct travel companions on its use |
| Prescription copies | Carry copies of insulin prescriptions and medical documents |
Special Considerations for International Travel
Researching insulin availability and regulations in foreign countries
Before embarking on international travel, it’s essential to research the availability and regulations surrounding insulin in your destination country. Insulin brands, formulations, and concentrations may vary, and some countries may have restrictions on the import of insulin and related supplies. Consult with your healthcare provider and contact the embassy or consulate of your destination country to gather information on insulin availability and any required documentation[16]. It’s also crucial to carry a sufficient supply of insulin and accessories to last the entire trip, as well as a buffer for unexpected delays or emergencies.
Obtaining necessary travel documents and medical certificates
When traveling internationally with insulin, it’s important to carry necessary travel documents and medical certificates to facilitate smooth border crossings and avoid potential issues with security or customs. Obtain a letter from your healthcare provider explaining your diabetes diagnosis, insulin regimen, and the need to carry insulin and related supplies. Keep copies of your insulin prescription and any other relevant medical documents in your carry-on luggage. Research the specific requirements for your destination country and transit points, and ensure you have all the necessary paperwork readily available[17].
Language barriers and communication strategies
Language barriers can pose significant challenges when managing insulin during international travel. Prepare by learning key phrases related to diabetes, insulin, and emergency situations in the local language. Carry a translated medical document explaining your condition and insulin needs to facilitate communication with healthcare providers and emergency responders. Consider using translation apps or pocket phrasebooks to assist with communication in non-English speaking countries. It’s also helpful to have a written list of important information, such as insulin brand names and dosages, in both English and the local language.
Cultural considerations and dietary adjustments
Cultural differences and local cuisine can impact insulin management during international travel. Research the typical foods and dining customs of your destination country to anticipate potential challenges in matching insulin to carbohydrate intake.Be prepared to make dietary adjustments and insulin dose modifications based on the local fare[18]. Consider carrying a food scale and a reference guide for carbohydrate counting to help maintain accurate insulin dosing. Respect local customs and traditions while prioritizing your diabetes management and health needs.
| Category | Items |
|---|---|
| Documentation | Prescriptions, medical letters, travel insurance |
| Insulin and Supplies | Sufficient insulin, syringes, pens, pump supplies |
| Language Preparation | Translations, phrasebooks, medical documents |
| Cultural Considerations | Research local cuisine, dining customs, dietary adjustments |
Technology and Tools for Insulin Management During Travel
Continuous glucose monitoring systems (CGMs)
Continuous glucose monitoring systems (CGMs) can be invaluable tools for insulin management during travel. CGMs provide real-time glucose readings, allowing users to track their blood sugar levels throughout the day and night. This technology can help identify trends, detect potential highs or lows, and guide insulin dosing decisions[19]. When traveling, CGMs can be especially useful in monitoring glucose levels during activities, time zone changes, and altered routines. Some CGMs also feature alarms and alerts to notify users of significant glucose fluctuations, providing an added layer of safety and peace of mind.
Insulin pumps and their advantages for travel
Insulin pumps offer several advantages for insulin management during travel. These devices provide a continuous infusion of insulin, mimicking the body’s natural insulin delivery. Pump users can adjust basal rates and bolus doses to accommodate changes in activity levels, meal times, and time zones. Many insulin pumps also integrate with CGMs, enabling users to make informed decisions based on real-time glucose data. When traveling, insulin pumps can simplify insulin administration, reduce the need for multiple daily injections, and offer greater flexibility in managing diabetes[20].
Mobile apps for carbohydrate counting and insulin dose calculation
Mobile apps can be powerful tools for carbohydrate counting and insulin dose calculation during travel. These apps help users estimate the carbohydrate content of meals, calculate appropriate insulin doses, and track glucose levels and insulin administration. Some apps also provide food databases, making it easier to count carbohydrates in unfamiliar dishes or foreign cuisines. When traveling, mobile apps can assist with maintaining accurate insulin dosing, even in the face of dietary changes and new food options[21]. Many apps also allow users to set reminders for blood glucose checks and insulin injections, helping to maintain a consistent diabetes management routine on the go.
Telemedicine and remote consulting with healthcare providers
Telemedicine and remote consulting services can provide valuable support for insulin management during travel. These services allow individuals to connect with their healthcare providers via phone, video, or messaging platforms, regardless of location. When traveling, telemedicine can be especially beneficial for receiving guidance on insulin adjustments, troubleshooting issues, and addressing any diabetes-related concerns that may arise. Some telemedicine platforms also offer access to local healthcare providers or diabetes specialists, providing a safety net for those traveling in unfamiliar locations.
| Category | Examples |
|---|---|
| Continuous Glucose Monitoring Systems | Dexcom, FreeStyle Libre, Medtronic Guardian |
| Insulin Pumps | Medtronic MiniMed, Tandem t:slim, Omnipod |
| Mobile Apps | MyFitnessPal, Calorie King, BG Monitor |
| Telemedicine Platforms | Livongo, Onduo, mySugr Coach |
Staying Healthy and Enjoying Travel with Insulin
Maintaining a balanced diet and physical activity routine
Staying healthy while traveling with insulin requires a commitment to maintaining a balanced diet and physical activity routine. Engage in regular exercise, such as walking, swimming, or cycling, to help regulate blood glucose levels and improve insulin sensitivity. When dining out, make informed choices by opting for nutrient-dense, low-glycemic meals that include lean proteins, healthy fats, and fiber-rich vegetables[22]. Consider packing healthy snacks, such as fresh fruits, nuts, and whole-grain crackers, to have on hand during travel. By prioritizing a balanced diet and consistent physical activity, you can better manage your insulin needs and enjoy a healthier travel experience.
Stress management and relaxation techniques
Travel can be exciting, but it can also be stressful, particularly when managing insulin. Stress can impact blood glucose levels and insulin requirements, making it essential to practice stress management and relaxation techniques during travel. Engage in activities that promote relaxation, such as deep breathing exercises, meditation, or gentle yoga. Make time for hobbies and interests that bring you joy and help you unwind, such as reading, listening to music, or journaling. Prioritize good sleep hygiene by establishing a consistent sleep schedule and creating a comfortable sleep environment, even in unfamiliar surroundings[23].
Connecting with local diabetes communities and resources
Connecting with local diabetes communities and resources can provide valuable support and information during travel. Research local diabetes organizations, support groups, or online forums that can offer advice, recommendations, and a sense of community in your destination. These resources can help you locate diabetes-friendly restaurants, pharmacies, or healthcare providers, and provide guidance on navigating local challenges. Consider reaching out to these communities before your trip to gather insights and establish connections that can enhance your travel experience.
Embracing new experiences while prioritizing diabetes management
Traveling with insulin shouldn’t limit your ability to embrace new experiences and enjoy your journey. With careful planning and preparation, you can participate in a wide range of activities, from exploring local cuisines to engaging in outdoor adventures. The key is to prioritize your diabetes management while remaining open to new experiences. Be flexible and adaptable, but always keep your health and insulin needs at the forefront[24]. By finding a balance between adventure and self-care, you can create lasting memories and maintain optimal well-being throughout your travels.
| Category | Tips |
|---|---|
| Diet and Exercise | Choose balanced meals, pack healthy snacks, engage in regular physical activity |
| Stress Management | Practice relaxation techniques, prioritize sleep, make time for hobbies |
| Local Resources | Connect with diabetes communities, research diabetes-friendly locations |
| Embracing Experiences | Be open to new activities, prioritize diabetes management, find a balance |
Frequently Asked Questions
Yes, you can bring your insulin and syringes on a plane. TSA allows passengers to carry insulin, syringes, and other necessary diabetes supplies in their carry-on luggage. Be sure to inform the TSA officer about your diabetes supplies during the screening process and consider obtaining a TSA notification card to facilitate communication.
When traveling, it’s important to keep your insulin at the proper temperature, typically between 36°F and 46°F (2°C and 8°C). Use an insulated bag or a portable insulin cooler to store your insulin during transit. Avoid exposing your insulin to extreme temperatures, such as leaving it in a hot car or checked luggage that may be subjected to freezing temperatures in the aircraft’s cargo hold.
If you run out of insulin while traveling, seek assistance from a local pharmacy or healthcare provider. Carry a prescription for your insulin and a letter from your doctor explaining your diabetes management needs. In case of an emergency, contact the nearest hospital or diabetes center for guidance and support.
When traveling across time zones, it’s essential to adjust your insulin doses to maintain stable blood glucose levels. Consult with your healthcare provider before your trip to develop a plan for adjusting your insulin regimen. Keep track of your destination’s local time and gradually shift your insulin doses and meal times to align with the new time zone. Monitor your blood glucose levels frequently and make adjustments as needed.
Yes, you can use your insulin pump while traveling. Inform airport security personnel about your pump and carry documentation from your healthcare provider explaining your need for the device. Keep extra pump supplies, such as batteries and infusion sets, in your carry-on luggage. If you’re traveling to a foreign country, research the availability of pump supplies and contact the pump manufacturer for guidance on international support.
If you experience high or low blood sugar while traveling, follow your usual treatment plan. For low blood sugar, carry fast-acting glucose sources, such as glucose tablets or juice, and consume them as needed. If your blood sugar remains low or you experience severe symptoms, seek medical attention. For high blood sugar, stay hydrated, monitor your blood glucose levels closely, and administer correction doses of insulin as directed by your healthcare provider. If you experience persistent high blood sugar or symptoms of diabetic ketoacidosis (DKA), seek immediate medical care.
Research your destination before your trip to identify diabetes-friendly food options. Look for restaurants that offer nutritional information or menu items suitable for your dietary needs. Consider packing healthy snacks, such as fruits, vegetables, and low-glycemic options, to have on hand during travel. When dining out, don’t hesitate to ask questions about ingredients and preparation methods to make informed choices.
Reference list
- American Diabetes Association. (2021). 15. Diabetes care in the hospital: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement 1), S211-S220.
- Ghosh, S., & Collier, A. (2020). Churchill’s pocketbook of diabetes E-book. Elsevier Health Sciences.
- Shubrook, J. H., Brannan, G. D., Wapner, A., Klein, G., & Schwartz, F. L. (2018). Time needed for diabetes self-care: nationwide survey of certified diabetes educators. Diabetes Spectrum, 31(3), 267-271.
- Kerr, D., Partridge, H., Knott, J., & Thomas, P. W. (2011). HbA1c 3 months after diagnosis predicts premature mortality in patients with new onset type 2 diabetes. Diabetic Medicine, 28(12), 1520-1524.
- Garrison, A. (2018). Screening, diagnosis, and management of gestational diabetes mellitus. American Family Physician, 97(7), 460-467.
- Bantle, J. P., Wylie-Rosett, J., Albright, A. L., Apovian, C. M., Clark, N. G., Franz, M. J., … & Wheeler, M. L. (2008). Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care, 31, S61-S78.
- Unger, J. (2013). Educating patients about hypoglycemia prevention and self-management. Clinical Diabetes, 31(4), 179-188.
- Chan, M. (2017). Diabetic ketoacidosis in adults. Nursing Standard, 31(25), 42-48.
- Farmer, A., Brockbank, K., Keech, M., England, E., & Deakin, C. (2012). Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabetic Medicine, 29(11), 1447-1450.
- Casqueiro, J., Casqueiro, J., & Alves, C. (2012). Infections in patients with diabetes mellitus: A review of pathogenesis. Indian Journal of Endocrinology and Metabolism, 16(7), 27-36.
- Boulton, A. J., Armstrong, D. G., Albert, S. F., Frykberg, R. G., Hellman, R., Kirkman, M. S., … & Mueller, M. J. (2008). Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care, 31(8), 1679-1685.
- Saudek, C. D. (2002). The role of primary care professionals in managing diabetes. Clinical Diabetes, 20(2), 65-66.
- Khan, R., & Abdulrahman, S. (2014). Diabetes mellitus and Ramadan: A narrative review. Journal of the Pakistan Medical Association, 64(12), 1320-1325.
- Hassanein, M., Al-Arouj, M., Hamdy, O., Bebakar, W. M. W., Jabbar, A., Al-Madani, A., … & Hanif, W. (2017). Diabetes and Ramadan: practical guidelines. Diabetes Research and Clinical Practice, 126, 303-316.
- Alabbood, M. H., Ho, K. W., & Simons, M. R. (2017). The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: A literature review. Diabetes & Metabolic Syndrome, 11(1), 83-87.
- Salti, I., Bénard, E., Detournay, B., Bianchi-Biscay, M., Le Brigand, C., Voinet, C., & Jabbar, A. (2004). A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care, 27(10), 2306-2311.
- Bajaj, H. S., Abouhassan, T., Ahsan, M. R., Arnaout, A., Hassanein, M., Houlden, R. L., … & Shah, B. R. (2019). Diabetes Canada position statement for people with types 1 and 2 diabetes who fast during Ramadan. Canadian Journal of Diabetes, 43(1), 3-12.
- Alsairafi, Z. K., Taylor, K. M., Smith, F. J., & Alattar, A. T. (2016). Patients’ management of type 2 diabetes in Middle Eastern countries: review of studies. Patient Preference and Adherence, 10, 1051-1062.
- Rodbard, D. (2017). Continuous glucose monitoring: a review of recent studies demonstrating improved glycemic outcomes. Diabetes Technology & Therapeutics, 19(S3), S-25.
- Pickup, J. C., Freeman, S. C., & Sutton, A. J. (2011). Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ, 343, d3805.
- Boyle, S., Saunders, R., & Terblanche, M. (2019). A systematic review of medical nutrition therapy for the management of diabetes-related outcomes in the inpatient setting. Nutrients, 11(6), 1388.
- Wu, Y., Yao, X., Vespasiani, G., Nicolucci, A., Dong, Y., Kwong, J., … & Li, S. (2017). Mobile app-based interventions to support diabetes self-management: a systematic review of randomized controlled trials to identify functions associated with glycemic efficacy. JMIR mHealth and uHealth, 5(3), e35.
- Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B., … & Weiss, M. A. (2008). National standards for diabetes self-management education. Diabetes Care, 31(Supplement 1), S97-S104.
- Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care, 28(3), 626-631.
