Traveling while Pregnant with T1D: Our Babymoon in Greece

When I found out I was expecting a baby in January, one of the things that popped into my head was whether or not we’d be able to go ahead with our trip to Greece, which we had planned a few months ago and would be taking place in May. I did some quick mental math and figured out that I would be in the middle of the second trimester which is often considered the best time to travel, but I wasn’t sure how diabetes and a high-risk pregnancy would factor in.

At my first diabetes and pregnancy appointment, I asked my doctor if I would still be able to go on the trip and was told that as long as things were going well, there shouldn’t be any issue from a diabetes point of view. I asked the same thing at my initial OB appointment and was told that it should be fine, but we’d know for sure closer to the time of our trip.

Thankfully, at my 20 week anatomy scan and check-in with the OB and endocrinologist we got the all-clear and were approved for our travel plans (which took place the following week, so thank goodness it all worked out!). Since I haven’t seen many people talk about traveling while pregnant with type 1 diabetes and managing all of the variables that it brings (and it’s a lot of variables!), I wanted to share my experience to provide a perspective for others considering a similar trip.

Preparing to travel

Admittedly, there was a lot to do before our trip to prepare everything. At my OB and endocrinology appointments before the trip I asked them for any specific recommendations, which I’ve detailed below. As always, make sure to ask your own provider before taking any trips yourself, as this is quite individual to each mom, baby, and pregnancy.

Diabetes

From a diabetes standpoint, the guidance was largely the same as for a normal trip: pack lots of supplies, order a backup pump to have on hand, and set my pump to the new time zone when landing. Since being pregnant I’ve had my pump in “sleep” mode as it keeps your blood sugars in a tighter range when using Control IQ on a Tandem pump (a continuous loop system). My doctor recommended taking my pump off of sleep mode when we landed as we’d likely be doing more walking and eating at different times and this would help my pump know to keep me at a slightly higher range.

I was also advised to keep my meal times as close to normal as possible, but not to stress about it too much. This was fairly easy as being pregnant in the second trimester makes you hungry all the time, so remembering to stop for meals and snacks was no issue. I was also advised to turn on “exercise” mode when doing a lot of walking to prevent my pump from trying to keep my blood sugars lower than they needed to be while walking.

OB

From the OB side of things, there wasn’t too much to consider (thankfully!). They recommended knowing the location of the hospitals at each place we were visiting, and taking lots of breaks when walking and doing activities. They also advised not being outside for too long in hot temperatures (Greece can get HOT) and drinking lots of water. All fairly standard stuff, nothing too different than what I’m sure they recommend any pregnant person do on vacation.

Food

To help navigate any potential food issues, we brought a TON of snacks from home. I was able to put them in my carry-on since I had my diabetes travel letter, but I actually never needed to show it. I brought protein bars (mini Clif Bars and RX Bars), prepackaged sachets of peanut butter (Barney Butter), a few protein powder packs (Vega), and lots of Rockets and Jolly Ranchers to treat lows. This was very helpful as these were snacks I had eaten many times before and knew how they impacted my blood sugars, and they allowed me to always have both carb and carb-free food options available depending on how my blood sugar was in a given moment. On past trips I’ve brought some snacks to tide me over but nowhere near as much as I did for this trip, but since I was pregnant and still trying to keep my blood sugars in a fairly tight range, having a ton of familiar snacks was very helpful.

My Experience on the Trip

Let’s get to the good part! We traveled to Greece for ten days at the end of May and spent three days in Athens, three days in Santorini, and three days in Milos. It was a great trip and thankfully, fairly easy to manage with my diabetes while being pregnant.

We flew from Toronto to Athens on an overnight flight of 11 hours and sat in Economy on the way there. I sat in an aisle seat to ensure I could get up easily to stretch my legs and prevent blood sugar spikes, and also because I was advised to continue drinking a lot of water while flying. I ate before getting on the plane and opted not to eat most of the meals provided, as historically I've found it hard to manage my blood sugars with carb-heavy airplane food while flying. Instead, I ate some of the lower-carb snacks that I brought and tried to stick with my usual meal times. We always use the Timeshifter app whenever we fly international and it’s great to help prevent jet lag, and it also provides a good idea of when I should eat so my blood sugars are steady when landing.

That being said, the flight there was by far the hardest part of the trip. I found the seats to be very uncomfortable (no surprise), but having a baby bump made it extra difficult. I wasn’t able to get much sleep between people walking by in the aisles and having to get up regularly to stretch my legs, and I noticed this caused my blood sugars to be a lot higher when we landed and also made me quite crabby (haha). I’ve always found that a lack of sleep causes my blood sugars to be stubbornly high the next day. As a result, we decided to bid for discounted upgraded seats for our flight back and were successful, so I was able to lie down and sleep on the 12-hour flight on the way back. It was definitely a luxurious experience and something I’m sure I won’t do again for a long time, but it made flying while pregnant and with type 1 diabetes a lot better. If you have this option, definitely take it if you’re flying for a longer trip.

The face of a woman excited to go on a trip but who has no idea how painful the next 11 hours are about to be 🤪

We structured our trip to have one to three activities per day, with most activities not having set times so we could play things by ear. The activities we did included things like visiting the Acropolis, seeing museums, taking boat tours on the islands, and wandering the streets of each spot we visited. I’d definitely recommend this approach of lots of flexibility to rearrange things or take an afternoon off depending on how you’re feeling. That being said, I found I was able to manage the trip like almost any other trip and was fine with the walking tours and lots of sightseeing. The exercise also helped with managing blood sugars. My doctors recommended erring on the side of keeping my blood sugars a bit higher to prevent lows, so I ate more carbs than I would have otherwise on days with lots of walking.

In terms of diabetes, I did have more lows than a normal week back home, but I was still able to maintain about 85% in range between 3.8-7.8, which was honestly much better than I thought I was going to be able to do. My endocrinology team advised me to enjoy the trip and not stress too much over blood sugars, but of course as someone growing another human, it was hard to put the perfectionist mindset to the side. However, I found that diabetes didn’t take up too much brain power and didn’t complicate the trip much more than a normal international vacation, so I was pleasantly surprised.

Overall, I wasn’t sure how the experience would be having to navigate so many variables (different food options with minimal/no nutritional information, a tight blood sugar range, unpredictable exercise, heat, hormones from pregnancy, etc.) but I’m so glad I went through with the trip and would recommend any other T1D moms to consider it as well! With a bit of planning, it’s totally possible to have an amazing, relaxing babymoon with type 1 diabetes. Below are a few recommendations I’d share with other women considering a babymoon!

Recommendations for Other T1D Pregnant Women on a Babymoon

Keep your itinerary flexible so you can do more active things on days/times when you feel up for it and can relax at the hotel when you’re feeling tired.
Bring lots of snacks that you’re familiar with so you know how they impact your blood sugars and always have something to eat.
Try to stick to your usual eating patterns so your basal rates match as closely as possible to what you’re used to at home. However, this isn’t crucial and sometimes you’ll have to eat at different times (especially in Europe where they eat later), but I found it helpful whenever it was an option.
Research 1-2 restaurants in each location you’re staying where you feel comfortable with the food choices as a backup for days when diabetes is being difficult or you want something easy. I often look for smoothie shops and salad bars as those are places I can often easily get customizations that are blood-sugar friendly.
Try to plan out food “splurges” and time them with active times in the day. For example, there was a donut shop in Athens everyone told us to check out, so we walked 15 minutes there, I prebolused only after I saw the portions (about 10 minutes in advance of the food), and then we walked back 15 minutes to help prevent a big spike.
Unlike when you’re at home, be careful with prebolusing. This is a tricky spot to be in because prebolusing while pregnant is often rule #1 to prevent spikes, but when you’re eating out regularly in a foreign country it can be hard to know exactly what you’re ordering. This got me in trouble a few times when I assumed something would be bigger or more carb-heavy than how it ended up being. I found that ordering and prebolusing half the amount of insulin I anticipated worked well, and then giving the remaining insulin only once the food arrived and I had a good idea of the carb count.
Err on the side of slightly higher blood sugars rather than having constant lows as this can really put a damper on your trip and energy levels. For example, I would sometimes bolus 3 units rather than the 3.5 I would at home to give myself some wiggle room, even though it was annoying to sometimes see a bit of a spike afterwards. Going for a walk to bring things down was always a good option as well.
Unlike when you’re at home, be careful on adjusting basals and carb counts while on vacation because each day is often different. I’ve been told to modify things after two days of a pattern (e.g., lows after lunch), but didn’t do this as much while away since it was hard to determine what was a basal/bolus issue and what was just food or another variable. Do whatever you feel comfortable with, but know that you might need to wait to get back home before doing your usual tweaks.
Prioritize your vacation and have FUN! Diabetes and pregnancy is hard, and we deserve the break! If you’re feeling anxious over a lack of tight control (I know I was), remind yourself that the occasional high or low isn’t a big deal for you or baby. You’ll likely be able to manage much better than you might have thought. You’ve got this!

These donuts were delicious and worth the extra diabetes math!

All in all, we LOVED our babymoon in Greece and I’m so glad we made it work, even with lots of considerations. If you’re on the fence, know it’s totally possible to have a wonderful babymoon and manage your diabetes well at the same time. Trust me, this is such a special trip and well worth the logistics!