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 for days. And it taught me things about managing diabetes while travelling that no pre-trip checklist had ever come close to preparing me for.
DKA is the one I haven't had — and the one I think about most. Precisely because it builds slowly, quietly, in ways that are easy to explain away when you're exhausted, jet-lagged, 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 keep insulin cool, how to get through CATSA with our diabetes supplies — and not nearly 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 emergency room is an hour away.
This article is about those emergency moments: what they look like abroad, what to do, and how to prepare so thoroughly that they're unlikely to happen at all.
👉 Eating abroad is one of the biggest variables in blood glucose management when you travel. If that side of things feels uncertain, our guide on eating abroad with diabetes covers everything from carb-counting in Japan to navigating restaurant menus when no one speaks English.
The two emergencies every diabetic traveller needs to be ready for
Severe hypoglycaemia
Hypoglycaemia abroad is more likely than it is at home. You're walking more than usual, eating at unpredictable times, miscalculating unfamiliar foods, and often a bit more physically active than you'd be on a regular Tuesday in Toronto or Vancouver. Any one of those things can push blood glucose lower than expected. Combined, they can do it fast.
Mild lows are manageable. A severe hypo — one where you lose the ability to treat yourself — is a medical emergency. Diabetes Canada defines severe hypoglycaemia as an episode requiring assistance from another person. It can cause seizures, loss of consciousness, and, if left untreated, be life-threatening.
Travelling abroad adds layers of risk that simply don't exist at home:
- You may be alone, or further from your travel companions than usual.
- The person next to you may have no idea what's happening.
- Emergency services may take longer to reach you.
- Paramedics may not speak English — or French.
✅ What to do:
- Always carry fast-acting glucose on your person — in your pocket, not buried at the bottom of your bag.
- Tell the people you're travelling with what a hypo looks like and exactly what to do. Don't assume they'll figure it out under pressure.
- If you're travelling solo, wear a medical ID. MedicAlert bracelets are recognised internationally and can communicate your condition to emergency responders even when you're unable to speak for yourself. MedicAlert Canada operates one of the most widely recognised medical ID programmes in the world.
- Carry a glucagon emergency kit. In Canada, Baqsimi — the nasal glucagon spray — is the number one prescribed glucagon product and is Health Canada-approved for adults and children aged 4 and older. It requires no mixing, no injection technique, and no medical training to administer, which makes it far more practical for a non-medical travel companion in a genuine emergency. The traditional injectable glucagon kit has been discontinued in Canada, so Baqsimi is now the go-to option for most Canadian travellers.
👉 Our guide on CATSA rules for diabetic travellers covers exactly what to pack in your carry-on — including glucagon and supplies — and your rights at the Canadian airport security checkpoint.
Diabetic ketoacidosis (DKA)
DKA is the other end of the spectrum — too little insulin, not too much.
It develops more slowly than a severe hypo, which is precisely what makes it dangerous when you're on the road. You're tired, you feel a bit off, you figure it's the heat or the long travel day or that questionable meal three hours ago. And then you're in a foreign hospital on an IV you weren't expecting.
DKA occurs when the body starts breaking down fat for energy due to insufficient insulin, producing ketones that make the blood dangerously acidic. Diabetes Canada identifies DKA as one of the most serious acute complications of diabetes. Symptoms include excessive thirst, frequent urination, nausea, vomiting, stomach pain, confusion, weakness, and breath that smells faintly of acetone — sometimes described as fruity, or reminiscent of nail polish remover.
🚨DKA requires hospital treatment — IV fluids and insulin. It cannot be managed alone in a hotel room. If you suspect DKA while travelling abroad, get to an emergency room. Don't wait to see if it passes.
✅ What to do:
- Know the symptoms: excessive thirst, frequent urination, nausea and vomiting, stomach pain, weakness, confusion, acetone-smelling breath, and deep or laboured breathing.
- The difficulty when you're travelling is that several of these — thirst, fatigue, frequent bathroom trips — are easy to write off as dehydration, jet lag, or a long travel day. That's exactly why checking ketones whenever blood glucose is running persistently high matters, rather than waiting for symptoms to stack up.
- Pack ketone testing strips. They weigh almost nothing and can be the difference between catching something early and ending up in emergency care.
- Check ketones any time your blood glucose is persistently elevated — especially if you're unwell, or if your insulin may have been exposed to heat.
- If ketones are moderate or high alongside symptoms, don't wait. Get to an emergency room.
The travel preparation that actually changes everything
Know how to say it in the local language
Before you land anywhere, write down these phrases in the local language and save them to your phone — and to something that doesn't require battery:
- "I have type 1 / type 2 diabetes"
- "I need sugar"
- "I need a doctor"
- "I have glucagon in my bag"
Many travellers carry a printed medical card in the local language summarising their condition, medications, and emergency instructions. It sounds like overkill until you're the one who needs it. Google Translate works offline if you download the language pack before you leave — genuinely invaluable in a rural area with no cell service, or in a country where the medical system uses a script you can't read.
Know where to go before something goes wrong
Before you arrive anywhere new, take five minutes to identify the nearest hospital with a full emergency department — not a walk-in clinic, an actual ER.
In many countries across Asia, Latin America, and parts of Eastern Europe, private hospitals offer faster, better-equipped care for foreign visitors than public ones — and your travel insurance will typically cover them. Save the address and phone number before you need it.
It's also worth knowing that Canadian consular offices abroad can help connect you with local medical resources and assist with emergency contacts — though they cannot pay your medical bills. The Government of Canada's Registration of Canadians Abroad service is worth signing up for before any significant trip.
👉 Travelling with diabetes without the right insurance is a risk not worth taking. Our guide on travel insurance for diabetic travellers breaks down exactly what to look for — including coverage for insulin loss, emergency hospitalisation, and medical evacuation.
Know what compromised insulin looks like — and when to suspect it
Heat damage to insulin is not always visible. There may be no colour change, no cloudiness, no obvious sign — your pen can look completely normal whether the insulin inside is fully effective or completely degraded. If your insulin has been exposed to temperatures above 25°C for a prolonged period, or your blood glucose is running inexplicably high despite correct dosing, suspect the insulin before you suspect yourself.
This is exactly why a medical-grade insulin travel cooler isn't optional — it's a safety item. After years of improvising with hotel ice buckets and damp cloths, switching to a proper medical-grade cooler was one of the most consequential changes I made to how I travel. My insulin arrives viable, every single time.
👉 Everything worth knowing about keeping insulin at the right temperature on the road — from long-haul flights to beach days in the heat — is in our guide on how to keep insulin cool while travelling.
When Travelling Abroad with Diabetes, A Good Insurance Is NOT Optional
Let me be direct about this: travelling abroad with diabetes without specialist travel insurance is not a risk worth taking.
Your provincial health plan is designed to cover you at home. The moment you leave Canada, that coverage becomes limited at best and effectively non-existent at worst. In some countries, hospitals will not even treat you without proof of insurance or immediate payment.
A DKA hospitalisation abroad can run into tens of thousands of dollars. Emergency medical evacuation back to Canada can reach six figures. Standard travel insurance policies often exclude pre-existing conditions entirely — which means a diabetes-related emergency may not be covered unless you've declared your condition and purchased the right policy explicitly.
When choosing a travel insurance for diabetes, look specifically for:
- Explicit coverage of your pre-existing condition — Type 1 or Type 2, declared upfront
- Coverage for lost, stolen, or damaged medication and supplies
- Emergency medical evacuation back to Canada
- A 24-hour medical assistance line with translation services
👉 Crossing time zones adds another layer of complexity to insulin management that catches a lot of travellers off guard. Our guide on managing insulin across time zones is essential reading before any trip involving a significant time difference.
The diabetes emergency kit to pack in your carry-on — every single time
Based on personal experience and Diabetes Canada travel guidance, here's what I consider non-negotiable for every trip abroad:
- Fast-acting glucose — in your pocket, not your bag
- Baqsimi nasal glucagon (Health Canada-approved, no injection technique required)
- Ketone testing strips
- At least twice the insulin you think you'll need
- A diabetes travel letter from your GP or endocrinologist confirming your condition, medications, and medical supplies
- Copies of all prescriptions
- Your travel insurance documents with the 24-hour emergency number — written down somewhere that doesn't require a charged phone
- A MedicAlert bracelet or equivalent medical ID
- A medical-grade travel cooler if you use insulin, Ozempic, Mounjaro, or any other temperature-sensitive medication
👉 For a full pre-departure checklist covering medications, documentation, and getting through CATSA, our complete guide to travelling with diabetes has everything in one place.
The bigger picture
Diabetes emergencies abroad are rare. With the right preparation, they're rarer still.
The goal of this article isn't to put you off going anywhere — it's the opposite. The more prepared you are, the more freely you can move. Preparation isn't the thing that limits your travel. It's the thing that makes it genuinely possible.
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 know how to count. The preparation made the difference — not by preventing every difficult moment, but by making sure that when difficult moments came, they were manageable rather than catastrophic.
Don't let the fear of an unlikely moment keep you from the extraordinary ones.
💬 We Want to Hear From You!
Have you ever had a diabetes emergency abroad — or a close call that taught you something important? 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.
