A year ago Tim Omer picked up his bags and headed off for a world tour, taking as much diabetes kit with him as he could carry. Here he tells us his tale.
Not a holiday or a trip, this was old-fashioned off-the-grid backpacking, and taking care of your diabetes while you do it It’s what faces all of us who are on daily injections or who use a pump and who want to keep a handle on our blood glucose by regular testing. It takes a lot of planning but there’s no point going on a trip like that and having your diabetes let you down. Here Tim, who travelled with a companion, shares his experience.
“As a diabetic what did I have to worry about when travelling? Very little really. Things were normal because the challenges where the same. But, I can share some advice with the benefits of my newly-found hindsight. After approximately 20 flights, 26 boat trips, 15 train journeys, countless bus trips and one canoe adventure I have travelled more than 21,000 Miles around Southeast Asia.
I’m back now and I’m still 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 and after a hospital check-up I can confirm that in a year I am the same height, I have lost 5.3kg and my HbA1c has improved from 6.2 to 5.8 (which was a bit of a surprise!). My diet has improved now I’m back to familiar Western food, though I’m trying to get my background insulin (basal) correct, though I’m sure that in time this will be resolved.
Before I went away I created an amazing spreadsheet to calculate my medical supplies that you can so I was fully prepared, or so I thought. Do not underestimate how much your eating habits may change and you will need more insulin and equipment that you expected. How much? No idea! But have enough spares to last you two additional months, which should be enough to get you out of trouble if needed.
My top tip for insulin care when you are travelling is never to put all your insulin in one place. I came a cropper when I put my insulin in a fridge in the hotel I was staying in and the next morning it was frozen. Freezing insulin really is not good as it can completely deactivate it. I should have put the majority in the fridge and kept at least one bottle left in a Frio bag in my room. Had I done that I would have had enough with me while I looked for new insulin.
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!
Tim is happy to answer any questions or tips, and you can read more of his adventures at his blog. www.hypodiabetic.co.uk
Tim’s Top Trips for Travelling with Diabetes
Keeping cool: Insulin is hardier than you may expect, especially Humalog, but you do need to take care of it. I took a couple of Frio cool bags with me that did a great job at keeping my Insulin cool, but not fridge cool. When possible I stored my insulin in a fridge but this was not always possible, the majority of the time keeping in the Frio bag in the shade did the job. Insulin will not just stop working once it has had enough – it’s more likely that its action will degrade over time — therefore you must keep a close eye on your blood readings and adjust your dose based on the sensitivity of the insulin. If you are 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’ve got.
Storage: Keeping organised with your medical supplies means you can avoid issues and reduce stress so you can enjoy your trip. Seeing it and knowing you have enough supplies is a real confidence booster. I used eBags and waterproof zip bags to organise and easily identify my medication and kit, which was a great help. Surprisingly the heat and humidity while travelling caused no issues with my meds. 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 and it was a great help! But, don’t be silly and keep all your spare medication in this bag, as you never know what may happen to it while you are away.
Diabetes Kit: You may struggle with purchasing supplies as you travel. E=Even if your brand is available you may find its been adjusted to work only for that region. I discovered that was the case with my Roche blood testing strips. Small things like a needle clipper, a spare Frio bag, supplies of Hypogel are a God-send when needed!
Security: Insulin pumps and blood test meters are sensitive medical equipment and it’s advised that you keep them away from the metal detectors and X-ray machines you get at airports. While I think this is possibly unnecessary, it’s not worth the risk of finding out. I had very little issue with getting past airport security or shopping mall or public transport checks.
Showing the insulin pump as a device that was attached to me, could be disconnected if needed handed over to the security staff 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. I’d advise that you keep your calm and be polite but insist.
You will probably find they are more interested in finding out why you need such a device and want to take 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 as if he thought I was carrying a bomb; lucky he was laughing!
Documents: It’s very helpful to have your doctor’s note with details of your condition and equipment written in a few languages to carry with you as well as copies of your prescriptions. Take a photo and also store a copy on your phone. This may 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 month’s supply of medication with you. Some countries have laws on the amount of prescription medication you can bring into a country, even New Zealand has a two-month restriction. Oddly, I had more difficulty on a recent Gatwick Airport security check on a flight from London to Poland. It was the first time I’ve ever had to show my doctor’s note.
Be prepared: Having a backup plan is not enough. You need several. 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 Eli Lilly advised me when I asked the company before I travelled that the Philippines had supplies of Humalog, when it came to the crunch (my crunch!) none was to be found in the country. Situations change, be prepared.
My problem escalation plan looked like the following…
A: Small bag carried with me everywhere, with a week’s 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 test meter batteries, infusion set insertion device, spare pump seals, roll of transparent adhesive film).
B: My partner had two month’s supply of all medication in a bag in her main backpack.
C: I had an additional spare blood tester and insulin pens in my main bag in the event of pump failure.
D: I had friends in Singapore who had a week’s supply of all my medication whom I could contact in an emergency.
E: We always had enough money to book an emergency flight either home or to a country with better medical facilities.
Nearer the end of the trip I miscalculated by sending too much medical kit home so my travelling companion did not have spares; this added an unneeded worry – we should have kept the kit with us until the end.
I would advise that if possible you should get the contact details of your medical suppliers such as Lilly, Roche, and so on in case you need advice but be prepared for the local reps or support groups to be less helpful than you might have expected. I contacted a local diabetes charity and government body in the Philippines for assistance and received no reply. Thanks guys!
This news item first appeared in Desang Diabetes Magazine, our free-to-receive digital journal. We cover diabetes news, diabetes management equipment (diabetes kit) and news about food suitable for a diabetic diet. Go to the top of this page to sign up – we just need your email address.