- 20 - Flights
- 26 - Boats
- 15 - Trains
- (No idea!) - Buses
- 1 - canoe
- 21000+ Miles around SE Asia
I'm struggling with highs and lows, to guess my carb intake, resisting the temptation of high sugar and processed carb foods - I'm still Diabetic, so everything is normal.
After a hospital checkup I can confirm that in a year...
- My HBA1C has improved from 6.2 to 5.8 (little surprised!)
- I have lost 5.3kg, this I'm sure is all muscle
- I'm the same height
With my improved diet now back in the west I'm currently struggling with getting my background insulin (basal) correct, I'm sure in time this will be resolved. May even get my second-hand Dexcom 7 out!
As a Diabetic what did I have to worry about when travelling? Very little really, things where normal, the challenges where the same. But, I can share some advice with the benefits of my newly found hindsight...
With my amazing spreadsheet to calculate my medical supplies that you can get here, I was fully prepared, or so I thought. Do not underestimate how much your eating habits may change, you will need more insulin and equipment that you expected. How much? No idea! But have enough spares to last you two additional months, this should be enough to get you out of trouble if needed.
Medication checkup! pic.twitter.com/XIpsADniLw— Timothy Omer (@tim_omer) February 1, 2014
Insulin - keep cool
Insulin is more hardy than you expect, especially Humalog. My Frio bags did a great job at keeping my Insulin cool, but not fridge cool. When possible I did store my insulin in a fridge but this is not always possible, the majority of the time keeping in the Frio bag in the shade did the jpb. Insulin will not just stop working once it has had enough. It will degrade over time, you must keep a close eye on your blood readings and adjust over time based on the sensitivity of the Insulin. Some may read this and say "just purchase new insulin" but the reality is your in an unfamiliar part of the world, you are on your own and no one cares about your situation - you will have to make do with what you have. Partly working insulin is better than none at all, as I discovered: 5 bottles of frozen insulin and 72 hours to live - Part 1
I really messed up here, never put all your Insulin in one location, I should of put the majority in the fridge and at least one bottle left in a Frio bag in my room, if I did this I would of at least had a few weeks supply with me while I looked for new Insulin.
Frozen insulin, ah, crap... pic.twitter.com/T2NZmFJJt1— Timothy Omer (@tim_omer) July 5, 2014
Plan B, C, D, E, F, G
Be prepared, having "a" backup plan is not enough. You need to be prepared for the failure of your options or situations changing. Also do not underestimate the level of stress you will suffer if you do not have suitable backup plans. While Lilly advised me that the Philippines had Humalog supply, when it came to the crunch none was to be found in the country. Situations change, be prepared. My problem escalation plan looked like the following...
- A: Small red eBag carried with me EVERYWHERE, with a weeks NOT IN USE supply of medication. (2 * infusion sets, 2 * syringes, 1 * bottle of blood testing strips, few finger prick needles, tube of dextrose, spare pump and blood tester batteries, infusion set insertion device, spare pump seals, strip of Opsite Flexifix Transparent Film)
- B: Kinga had two months supply of all medication in an eBag in her main backpack
- C: Spare blood tester and insulin pens in my main bag in the event of pump failure
- D: Our friends in Singapore had about a weeks supply of all my medication
- E: We always had a enough money to book a emergency flight home or to another country with better medical facilities
I failed at this in the last few months by sending too much medical kit home so Kinga did not have spares, this added an unneeded worry.
If possible also get the contact details of your medical suppliers, Lilly, Roche, etc. But, be prepared for the local reps or support groups to be less helpful than expected. I contacted a local diabetes charity and government body in the Philippines for assistance and received no reply, gees thanks guys!
Storage of your medication
Keeping organised with your medical supply will not only avoid possible issues but will also reduce any stress, seeing and knowing your supply is a real confidence booster. As detailed in my What to pack: the Diabetic backpacker post the use of eBags and Waterproof Bags bags to organise and easily identify my medication where a great help. Surprisingly the heat and humidity while travelling caused no issues with my medication supply. One tip as you start to get towards the end of the trip and have collected too many souvenirs to carry, airports and hotels can arrange for storage for any unneeded bags for a few weeks. We did this in China and Burma, it was a great help! But, don't be silly and keep all your spare medication in this bag - you never know what may happen to it.
Stand your ground
Insulin Pumps and Blood Testers are sensitive medical equipment and it's advised to stay clear of metal detectors and x-ray machines. While I think this is possibly over reacting a little, its not worth risking. I had very little issue with getting past airport security or shopping mall \ public transport checks. Showing the devise attached, disconnecting and handing over to security and offering to turn it on was normally fine. At times I hand to be firm to be sure they did not try and put the device into the x-ray machine, keep your calm, be polite. You will find they are more interested in why you need such a device and a closer look at your infusion set! I even had a shopping mall security guard joke with me by making a Kaboom gesture with his arms that he thought I was carrying a bomb, lucky he was laughing!
Its helpful to have your doctors note with details of your condition and equipment written in a few languages if needed, you can grab my copy here.
(Update: I had more difficulties recently at Gatwick Airport security checks flying from London to Poland. First time ever I have had to show my doctors note. Let's just say their new process is a over the top and the staff I had the misfortune to deal with where rude and absolute #@+*$)
Be sure to have a signed doctors note detailing your condition, equipment and copies of your prescriptions with you. Take a photo and also store a copy on your phone. This will be required if trying to access medication from local health centres or to prove your condition (a headed letter and signature appears to be enough!).
Also, if challenged say you have two months supply of medication with you. Some countries have laws on the amount of prescription medication you can bring into a country, lie, they don't know, you have two months supply with emergency spares! This is not a suppressed Asian country with a questionable government thing, New Zealand has a 2 month restriction!
You may struggle with purchasing supplies, even if your brand is available you may find its been adjusted to work only for that region - as I discovered with Roch blood testing strips.
Also small things like a needle clipper, spare Frio bag, Hypogel, Opsite Flexifix Transparent Film are a god send when needed!
Surprisingly I found travelling with my condition no more of a day to day challenge than I do at home. If you are comfortable managing your condition and well prepared, there is nothing stopping you!
Any questions or tips, let me know below!
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The contents of this site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your Diabetes support team or other qualified health provider with any questions you may have regarding your medical condition.Sorry, have to say something like this!