Diabetes Travel: A Tale of Two Cities and One Insulin Kit

by Elizabeth Snouffer on 10/29/2010

I have been flying out of Hong Kong to other cities in Asia and further afield to the USA or Europe for two years now.  Earlier this week, I traveled from Hong Kong to Singapore with Singapore Airlines.  On this particular trip, I felt as I often do  – that insulin and syringes make me slightly suspect – regardless of my documented illness.  I should note that I have traveled to Singapore before.

Hong Kong is truly a different breed of city from its cousin Singapore

At Hong Kong security, I walked through passenger screening without a glitch and waited for my computer bag and handbag to come through on the other side – or the “free pass to travel” side.  Waiting for clearance is not something that makes me feel particularly anxious anymore, but I often feel as though I am holding a chance card  when it comes to airport security.   Insulin pump supplies, syringes and vials of insulin necessarily provoke security questions and checks.  As the larger bag passed through the rubbery bands of the x-ray tunnel,  the Hong Kong security team asked if I had a letter validating the epipen I was carrying in my bag.

“It’s not an epipen , I have diabetes.”

“Do you have a letter validating the need to carry injections and an epipen onboard?  If you don’t, we will have to confiscate the needles.”   It occurred to me that diabetes wasn’t translating well for this security team, but syringes are syringes so I didn’t argue.

“Yes, I do.”  I keep the official letter from my doctor tucked into the pocket of the case where I keep my diabetes supplies; I don’t separate these items, ever.

Record of illness, name, seat and destination

They looked at the letter which was written in English.  I feel fairly secure suggesting the security team probably did not get the full gist of the letter but understood that the professional signature was a local doctor with an English and a Chinese name.  They proceeded to fill out a form, small enough to be called a ticket.

“What’s that,” I asked, worried about my travel status and rights.

“It’s a ticket we must give to the airline with your name, assigned seat and information related to the fact that you are taking injections on board.  The airline requires it.”

“Does it say diabetes?”


I asked the guard if I could take a photo of the ticket, she smiled, and allowed me to place it on top of my passport for the photograph.  When I saw three other security guards headed my way, I realized that my actions may have disrupted the team who had been huddled behind a glass door.  The man who I assumed was the boss asked me what the problem was and swiped the small ticket out of my view.

“What’s the problem?”  he asked, looking me straight in the eyes.  For those of you who may not know this – looking someone directly in the eyes is a sign of intimidation in Asia.  In a sense, it is a sign of disrespect rather than how westerners often perceive direct eye contact as a sign of honesty.

“No, I just wanted to have a record of your record.”  It was my turn to smile, but he was having none of my attempt to turn our discussion into a lighter moment.

“This is something we must do – the airline requires it, not us.  That’s the way it is if you want to get onboard.  Sorry if this displeases you.”

I nodded agreeably, didn’t say a word, put my iPhone in my handbag, and walked away.

Singapore is beautiful but certain freedoms are limited

The former British Governor of Hong Kong joked that “Hong Kong is the only decolonized place with less freedom and democracy” (Patten, 1997).   The truth is that compared to Singapore, Hong Kong is a veritable Sodom and Gomorrah defined by an obsession with fashion, work, money and late night clubbing in spaces that tower above hostess bars catering to traveling business men.  Singapore is a nominally democratic state ruled by the People’s Action Party (PAP) where certain rights such as freedom of assembly and freedom of speech remain restricted.  It is a country that forbids the importation and sale of chewing gum and utilizes caning as a form of legal corporal punishment.   I had never felt worried about my right to take insulin or supplies into Singapore, but I was beginning to sense that the ticket had more to do with my entry into Singapore than with the airline’s concern for my well-being.  I could find nothing to substantiate the written report and notification to the airline and staff on the airline’s website.  I also looked over Singapore’s Immigration website and found nothing there either.  I stopped wondering about the additional documentation and called Singapore Airlines.  It was not what I would call easy; I was put on hold twice for 20 minutes at a time.  The woman in charge of customer complaints for the Hong Kong office did not want to discuss the policy.  Finally she admitted that Singapore Airlines requires Hong Kong Airport security or AVSECO to document any passengers legally carrying what is considered dangerous material into the cabin with personal details and their seat number.  That information is then handed to the cabin crew.   When I contacted AVSECO, I asked them if this was a part of routine procedure or if Singapore Airline was the only airline to request this kind of detailed passenger information, they told me that only two airlines requested security to identify passengers carrying material like syringes to airline cabin crew and staff – Singapore Airlines and Cathay Pacific.

Is this a case of Much Ado about Nothing?  Perhaps.  Should I care if I have been flagged as either a medical risk or a threat with intent to harm?  In the end, we are all strangers to the airlines with diverse motivations – illness or not.   I seriously doubt any airline fully understands the issues related to insulin and travel.  There is something de-humanizing about being marked as either ill or dangerous – or a comical unwieldy combination of the two.   This all leads me to believe that it might assist the airlines if there were policies set for patients with insulin dependent diabetes other than just access to travel.  I am curious why advocacy groups (JDRF, ADA, Diabetes UK and more) haven’t made much progress about this issue related to travel and diabetes.  On the other hand, maybe it’s the patients who haven’t bothered to make much noise.  I suppose we’ll just have to wait until something adverse happens before policies are enacted to help people (dependent upon insulin) travel.  In the meantime, always carry an official letter documenting your need for diabetes supplies including syringes, and always carry sugar in any form that would prevent hypoglycemia during times when you are stuck (in a line for example) or when staff is not available to help you out right away.  Oh and one more thing, smile when you pass through immigration  – we’re less suspicious that way.

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{ 2 comments… read them below or add one }

Makayla Meyer June 10, 2011 at 08:20

I’m wanting to go on a missionary trip to Nicaragra next year. i’ve never flown before and I have type 1 diabetes. really nervous about it if I am able to go. any advice on what I can do at the airport, while I’m in Nicaragra, and what to expect from security or any other such things? your advice and experience would help me out a lot. Thank you.


Cindy October 12, 2011 at 20:40

I accidentally came across your post here regarding travelling to Singapore because I am researching up on when I will be moving to Singapore for work next month! I have Type 1 diabetes and trying to sort out how to manage my medications etc. But I have had two similar occasions when I was travelling from Hong Kong back to Australia with a stopover in Singapore as I was travelling on Sinagpore airlines. I always wondered why I would be checked in HK and not while I was in Aust and they would be strict having to write out everything like that. Thanks for your travelling insights!

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