The American Diabetes Association estimates that there are 14.6 million diagnosed diabetics in the U.S. and, like a significant number of their fellow Americans, many of these diabetics will be traveling this holiday season.

Although diabetics may have a few additional considerations when they travel, there is no reason they can’t look forward to a safe and enjoyable trip.

Dr. Gerald Bernstein can certainly attest to that. He is the director of the Diabetes Management Program at the Diabetes Institute at New York City’s Beth Israel Medical Center. Dr. Bernstein is also an insulin-taking Type 2 diabetic who has traveled to 45 countries. Here are his personal recommendations for traveling with insulin:

— Keep your insulin stable – Insulin is stable at room temperature in North American and in any other country that doesn’t experience extremes in temperature, so leaving it unrefrigerated isn’t a problem. When you travel by plane, keep your insulin on your person; don’t store it in the baggage compartment. The same is true when traveling by car. If you leave the insulin in the car and the vehicle becomes overheated, the insulin will be destroyed.

— Use a time line to compensate for changes in schedule – Type 2 diabetics who take their insulin before meals won’t experience much difficulty when traveling by plane. However, Type 1 diabetics should use a time line to be sure they are fully protected. On a piece of paper draw a straight line on which you indicate the times you eat and the times you take both your long and short acting insulin. Below that draw a second line on which you indicate when you will be on the plane and when you will eat. This visualization will help you determine what adjustments you need to make to your normal routine.

— Keep snacks with you — Gone are the days when you could ask the flight attendant for something to eat if the food was delayed and your blood sugar was dropping. In fact, Bernstein said, “They don’t have anything on the plane that is suitable.” You should carry snacks that have moderated carbohydrates and good nutrition. The goal is not to be carbohydrate-free, but rather to have foods that have no added sugars. Items like nuts and gorp (trail mix) provide the right blend of sugar and fats.

— Don’t inject yourself until the food is in front of you – Food service can be delayed. Insulin is most effective when taken so that it goes to work when glucose from your food starts to enter your blood.

— Don’t go to the plane’s bathroom to inject – Airplane bathrooms aren’t necessarily sanitary. Bernstein injects his abdomen through his shirt and undershirt while remaining in his seat. He says, “If you don’t make a fuss, other people won’t either. The same is true about blood testing. I take out my meter and prick my finger and put it on a strip, and unless someone has been staring at me the entire time, no one seems to notice. I don’t believe any airline has a policy where you can inject.”

Once you arrive at your destination, you need to exercise some care before you indulge in all the holiday fare. Dr. Christy Valentine, founder of the Valentine Medical Center in New Orleans, offered the following tips:

Never skip a meal, Valentine said, “Eating three small meals and two to three small snacks a day are a must in glucose control. The myth that eating less frequently aids in weight loss is completely false and can be deadly for a patient on insulin or certain oral glucose medications."

In actuality, eating small frequent meals speeds up the metabolism and encourages weight loss. So I tell my patients, they can take a bite of everything over time but they can not have a lot of anything." Watch out for salt — Try to avoid foods known for high salt content. This would include most fast food as well as some Chinese and Mexican dishes. If there is a question, discuss the menu with your server. The chef may be able to create a dish with less sodium on request.

“The main thing to remember,” said Valentine, “is the holidays should be enjoyed. Just because you have diabetes does not mean you should live your life 'on punishment' or 'in time-out.'

Taste those family dishes you may only receive once a year and celebrate wisely. You should respect your diabetes and line well simultaneously."