A person with diabetes need not fear traveling to most places of the world today, but special measures should be taken before and during travel to ensure a healthy trip.

The main concern for business or vacation travelers with diabetes is the adjustment of insulin dosages and schedules to adapt to changes in blood-sugar levels brought on by shifts in time zones, activities and diet.Dr. Andrew Drexler, a diabetologist at New York University Medical Center, said that when scheduling a trip, a person with diabetes should "envision a worst case scenario - and plan for it."

Close attention to monitoring and maintaining proper blood-sugar levels is of paramount importance, Dr. Drexler said, but the disorder itself should be no deterrent to travel.

Changes in time zones means that meal times and activity times shift - all of which possibly affect the amount and timing of insulin.

"During air flight," Drexler said, "it is helpful to keep your watch set to your home time and to think in terms of `insulin time' - that is, keeping the period between taking insulin and eating a meal constant so that you are eating when the insulin is peaking."

At one's destination, however, adapting insulin to a new time zone and activity level can be more complicated, and Drexler suggested that the traveler discuss this problem with his or her physician as part of pre-trip planning.

For example, people on vacation tend to be more active - to walk more, to exercise more, and may require less insulin or more snacks, he said.

"Coupled with changes in diet and the effects of possible travel-related ailments such as motion sickness, travelers diarrhea or travel fatigue, it can markedly alter ones' need for insulin."

Drexler recommended that pre-planning also should include a visit to the person's physician to discuss, among other things, the itinerary, mode of transportation, differences in diet and planned activities. Because of the risk of dehydration, travelers prone to diarrhea need to plan ahead for their specific travel activities.

"The traveler can learn how to adapt insulin intake, as well as get recommendations on diet, activities and handling of illness during the journey," he said.

He also suggested that the traveler with diabetes drink plenty of fluids during the trip, not overeat and that he or she carry a supply of snacks that contains some form of sugar to counteract the first signs of a drop in blood sugar levels, or hypoglycemia.

"It is extremely important to carry some form of medical identification and to alert traveling companions to the signs of hypoglycemia," he said.

If immunizations are needed, Drexler said, get them at least three to four weeks in advance of the trip since they can put the diabetic person's system out of balance.

The diabetic traveler also should carry an adequate amount of foot-care supplies, especially if he or she is prone to neuropathy, or a loss of feeling mostly in the legs and feet. An injury to the foot, such as blisters from walking, could be overlooked and lead to troublesome infection.

Finally, he added, the traveler's medical kit should include enough insulin and disposable syringes (or pump catheters for an insulin pump) to last in excess of the entire journey.

Insulin supplies should not be packed away in luggage but carried separately by the traveler, since aircraft baggage compartments are subjected to extremes of temperatures that could affect the drug.

Also, there is no guarantee that luggage will arrive at the same destination as the traveler.