I've had one genuine diabetes emergency abroad.
A severe hypo in a taxi in Hanoi at two in the morning, with a driver who didn't speak a word of English. It resolved. It left me shaken. And it taught me things about managing diabetes abroad that no pre-travel checklist had prepared me for.
DKA is the one I haven't had — and the one I fear most. Precisely because it builds slowly, quietly, in ways that are easy to explain away when you're tired and travelling and already feeling a bit off. I've had the warning signs enough times to know how close the edge can feel.
Most of us who travel with diabetes spend a lot of time planning the ordinary — what to eat, how to store insulin, how to get through security — and not quite enough time planning for the extraordinary. The moments when something goes genuinely wrong, far from home, where no one knows your history and the nearest hospital is an hour away.
This article is about those moments: what they look like, what to do, and how to prepare so thoroughly that they're unlikely to happen at all.
The two emergencies every diabetic traveller needs to prepare for
Severe hypoglycaemia
Hypoglycaemia abroad is more likely than at home. You're walking more, eating at irregular times, miscalculating unfamiliar foods, and often drinking more alcohol than usual. Any one of those things can push blood glucose lower than expected. Combined, they can do it fast.
Mild hypos are manageable. A severe hypo — one where you lose the ability to treat yourself — is a medical emergency. The NHS defines severe hypoglycaemia as an episode requiring assistance from another person, and it can cause seizures, loss of consciousness, and, if untreated, be life-threatening.
Abroad, the risks compound:
You may be alone.
The person next to you may not recognise what's happening.
Emergency services may take longer to arrive.
They may not speak English.
✅ What to do:
- Always carry fast-acting glucose on your person, not just in your bag.
- Tell the people you're travelling with what a hypo looks like and what to do.
- If you're travelling alone, wear a medical ID — MedicAlert bracelets are recognised internationally and can communicate your condition to emergency services even if you can't.
- Carry a glucagon emergency kit: in the UK, Baqsimi (nasal glucagon) is available on prescription and requires no injection, making it far easier for a non-medical person to administer.
👉 Unfamiliar cuisines are one of the biggest variables in blood glucose management abroad — the same dish in a different country can behave completely differently. If that side of things feels uncertain, my article on how to eat abroad with diabetes covers everything from carb-counting in Japan to navigating restaurant menus when no one speaks your language.
Diabetic ketoacidosis (DKA)
DKA is the other end of the spectrum — too little insulin, not too much.
It builds more slowly than a severe hypo, which is precisely what makes it dangerous when you're travelling. You're tired, you feel a bit off, you think it's the heat or the journey. And then you're in hospital.
Diabetes UK describes DKA as a serious complication that occurs when the body starts breaking down fat for energy due to insulin deficiency, producing ketones that make the blood dangerously acidic. Symptoms include excessive thirst, frequent urination, nausea, vomiting, stomach pain, confusion, and breath that smells faintly of acetone.
DKA requires hospital treatment — IV fluids and insulin. It cannot be managed alone at home, or in a hotel room.
✅ What to do:
- Know DKA symptoms to watch for: excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness or tiredness, confusion or difficulty concentrating, breath that smells faintly of acetone (sometimes described as fruity or pear drop-like), deep, laboured breathing, etc.
The tricky thing when travelling is that several of these — thirst, tiredness, needing the loo a lot — can easily be written off as dehydration, tiredness, heat, or jet lag. Which is exactly why checking ketones whenever blood glucose is running persistently high is so important, rather than waiting for symptoms to stack up.
- Travel with ketone testing strips.
- Check ketones any time your blood glucose is persistently high — particularly if you're unwell, or if your insulin has been exposed to heat.
- If ketones are moderate or high alongside symptoms, seek medical attention immediately.
- Don't wait to see if it passes.
The travel prep that changes everything
Know how to say it in local language
"I have type 1 / type 2 diabetes"
"I need sugar"
"I need a doctor"
"I have Glucagon in my bag"
Research and write these down in the local language before departure. Keep them in your phone. Some diabetics carry a printed medical card in the local language summarising their condition, medications, and emergency instructions.
Google Translate works offline if you download the language pack before you travel — invaluable in a rural area with no signal.
Know where to go in case of an emergency
Before you arrive anywhere new, spend five minutes identifying the nearest hospital with an emergency department. Not the nearest clinic — a full emergency department.
In many countries, particularly in Asia, South America, and parts of Eastern Europe, private hospitals provide faster and better care for foreigners than public ones, and your travel insurance will typically cover them.
Save the address and phone number in your phone before you need it.
Know what your insulin looks like when it's failed
Heat damage to insulin is invisible. There's not always a colour change, no smell, no obvious sign — your pen may look identical whether the insulin inside is fully active or completely degraded.
If your insulin has been exposed to temperatures above 30°C for a prolonged period, or if your blood glucose is running inexplicably high despite correct dosing, suspect the insulin before you suspect yourself.
Always travel with a medical-grade insulin cooler.
👉 This is exactly why insulin storage when travelling isn't a minor detail — it's central to your safety. My guide on how to keep insulin cool when travelling covers every scenario worth knowing, from long-haul flights to beach days in forty-degree heat.
Travel insurance for Diabetics: NOT Optional!
I'll say it plainly: travelling with diabetes without specialist travel insurance is not a risk worth taking.
A DKA admission in the United States can cost upwards of $30,000.
Emergency repatriation from anywhere can run into tens of thousands of pounds.
Standard travel insurance policies typically exclude pre-existing conditions — which means a diabetes-related emergency abroad may not be covered at all unless you've declared your condition and purchased appropriate cover.
The key things to look for when choosing your travel insurance policy:
- explicit coverage of your pre-existing condition (type 1 or type 2 diabetes)
- coverage for lost or damaged medication
- emergency evacuation
- 24-hour medical assistance.
Always declare everything honestly — non-disclosure can void your policy entirely at the worst possible moment.
👉 I've written a full breakdown of what to look for in travel insurance for diabetics in the UK — including which types of policies cover insulin loss, emergency hospitalisation, and repatriation. It's one of those articles I wish I'd read earlier.
The diabetes emergency kit belongs in your carry-on, always
Based on my own experiences and Diabetes UK's travel guidance, here's what I consider non-negotiable when travelling abroad with diabetes:
- fast-acting glucose in your pocket
- a glucagon emergency kit
- ketone testing strips
- twice the insulin you think you'll need
- a diabetes travel letter from your GP confirming your condition, medications and medical supplies
- copies of prescriptions
- your travel insurance documents with the 24-hour emergency number
- a medical ID
- a proper travel cooler if you use insulin, Ozempic, Mounjaro, or any other temperature-sensitive diabetes injections.
The bigger picture
Diabetes emergencies abroad are rare. With the right preparation, they're rarer still.
The goal of this article isn't to frighten you out of travelling — it's the opposite. The more prepared you are, the more freely you move.
I've had one emergency in forty countries. It resolved. I've also had thousands of meals, hundreds of flights, and more extraordinary experiences than I can count. The preparation made the difference.
👉 Flying with diabetes covers the specifics in full for airport security and long-haul flights management — what to tell the airline, how to manage blood glucose mid-flight, and what to do if things go wrong at altitude. And if your trip involves a significant time difference, insulin across time zones is essential reading before you board.
💬 We'd Love To Hear From YOU!
Have you ever had a diabetes emergency abroad — or a near-miss that taught you something important?
Or maybe you've found a preparation strategy that made you feel genuinely confident travelling with Type 1 or Type 2?
Share it in the comments below. The more honestly we talk about the difficult moments, the better prepared everyone in this community becomes.
