As my trip around the world continues, I’m learning more and more about the challenges of taking diabetes with you on the road. This recently became apparent when, for reasons I still don’t quite understand, I decided to try to get a Hemoglobin A1c test performed in Tallinn Estonia — at 7 in the evening.

My thought process, as I recall it, was as follows: it has been nearly three months since my last A1c. I am planning on traveling for the next three months as well, and my destinations — Russia, Mongolia, China — are not known for having the finest medical facilities. Ergo, I might as well try to get one now. I didn’t know so much about how Estonian medical care compared to its counterpart in Moscow, but I decided it was worth a try — so I called an English-speaking medical hotline and was advised to go to an emergency room. When should I try? “You might as well go now,” the guy said. “You’ve got about two hours till rush hour.”

There was really no reason to go right then, seeing as how it was already six in the evening and my A1c was a less pressing cause than dinner. But, figuring there was no time like the present, I called the emergency room and  decided to do it anyway. The following is my journal entry from the waiting room:

August 2nd, 2010

I’m in the Tallinn Central Hospital, waiting for my blood to be drawn for an A1c test. Or at least, I think I’m waiting for an A1c test — I’m not very confident they understood what I was talking about, so I may very well be waiting an hour for a very expensive finger prick.

Getting here wasn’t easy — the cab driver, after trying to overcharge me, dropped me off at a non-descript building in what looked like an apartment complex. Inside, I found a receptionist who, when I asked her where I could go for “emergency,” pointed me upstairs. This seemed odd — there were no ambulances or, for that matter, other patients — just another woman sitting at a desk who took one look at me and summoned an English-speaking colleague. I tried to explain to her that I wanted a blood test for diabetes; she looked at me, confused.

“Why do you need it? I think you should come back tomorrow,” she said.

“But the person on the phone suggested I come in tonight.”

“He did?”she said, perplexed. “Are you pregnant?”

I hadn’t been entirely convinced she knew what I was talking about to begin with; now I was doubly unsure.

“Are you sure you called this building?”

“I am looking for the emergency room,” I said.

“Ah,” she responded, pointing across the courtyard. “That is the building over there. This is the women’s health clinic.”

At least that explained the pregnancy test. We laughed, and I headed over to the correct department, noticing en route a series of large photographs of pregnant women stroking their stomachs that I somehow had missed on the way in.

And so to the emergency department! Here there was a paramedic at the door and a man lying ont he ground next to a bicycle — a more promising entrance, to be sure. The waiting area had several people standing around but no line — and it turned out that these were indeed the people I had spoken to who had instructed me to come in. And . . . they had no idea what I was talking about.

Did I want a glucose test?  No, I wanted a hemoglobin A1c. I wrote it down, using as many variations and explanations as I could think of. “It is three months,” I said. “A three-month average.” I pulled out my own glucometer to try to demonstrate the difference.

“What is that?” asked the nurse, who was a young woman with a stern demeanor who somehow managed to make every question sound like she was yelling at you.

“A glucose meter,” I said, more than slightly disturbed by the question. “This is right now. Hemoglobin A1c is three months.”

She finally took a piece of paper I handed her and read my request out loud to the lab, spelling HBA1c out loud several times before hanging up and announcing “We will do that” before telling me I would wait one, maybe two hours. How much would it cost? “I do not know. Perhaps you can ask the doctor. Room 6.”

I thought there was supposed to be a triage system — which would have sent me to the room frequented by people with minor bruises — but instead, room 6 is labeled “EMO INTENSIV” and has several beds on either side of the room separated by curtains, with vital monitors beeping and bare feet peeking out of the sheets. There’s a table of nurses in the middle of the room behind computer screens. Despite the bare feet, nothing critical seems to be happening — perhaps there’s a super intensiv unit down the hall.

When I arrived, it was very unclear what to do — there’s a waiting bench in the hallway but it’s not visible from the nurses’ station. With no apparent way to “check in,” I just stood in the doorway until someone noticed me — and told me to wait outside. But no sooner had I sat down than someone else called me back in — the woman behind the counter who had suggested I speak to the doctor. Apparently, she was the one who would be drawing my blood. And she didn’t like me.

“Sit on couch,” she said. “I do the test.”

With nothing to confirm that the test in question was actually the test I was trying to get done, I tried to figure out what the best method would be for determining this without insulting her. It reminded me of the chapter in Malcolm Gladwell’s Outliers where he talks about how many plane crashes have been caused by flight crews showing excessive deference to the captain. For example, a crew member will say something oblique, like “Wow, that de-icer doesn’t seem to be working too well!” instead of “Our wings are frozen and if we try to take off right now, we will die.” Then the plane crashes.

But nothing I said worked. “I do the test for you!” she repeated, in response to my question of what test she was talking about. “And after you will wait one hour. Out there!” She pulled out a tourniquet.

This didn’t really make sense, considering that I would have already had the blood drawn. Why not just pay and call them for the results.

“May I call you?” I asked politely.

The look in her eye made it clear that this would not be possible.

“You must wait one hour here.” She pulled out a needle then, thinking twice, recapped it and picked up a bottle of what I really hope was disinfectant spray. She was — both literally and metaphorically — after blood.

I knew I was pushing my luck, but I couldn’t help myself. “Do you know how much it will cost?” I asked, hoping to perhaps get an answer before I allowed my vein to be punctured. (It’s good to know that we’re not the only ones with an opaque pricing system.)

No. She did not. Instead she glared at me, repeated that she would do the test, and reached for my arm. Figuring it would be better to save the follow-up questions for after she’d stuck a needle into my arm, I allowed her to fill two vials from my left arm (after spritzing it with the unidentified contents of the bottle — they did not smell like alcohol) and handed me a paper towel, no bandaid, to cover the puncture.

“Now you wait. OUT THERE!” she said, just in case her earlier message hadn’t made it through.

It has now been one hour and, aside from someone carrying a little orange suitcase with a biohazard symbol out of the room about a half hour ago, I have no indication of whether my blood has actually left the room. Worse, my English-speaking nurse, horrid though she may have been, has vanished. I don’t get the sense that the rest of the staff will appreciate me poking me head back in the room, but I also don’t have any confidence that they know what the test is or are actually doing it. Do I look inside?

It is now several days later and I can tell you, dear readers, that I did look inside — quietly and, I thought, politely — and promptly established hostile relations with the entire nursing staff. Oh, how they did not like me. Eventually I got the nicest member of the bunch — a young man wearing a bandana and white shorts whom I’d seen walking up and down the hallway carrying endless small cups of water to unidentified locations (I think he was bored) — to confirm that I could indeed leave the hospital and call them to find out the result. Could I pay before I left? No. My case was still open. I would have to come back. But at least I was free.

So I left. And when I called back that evening and they told me what it was, I tried again to pay. “May I pay by credit card?” I asked the woman on the phone.

“Yes. But you must come here.”

“May I give you the number over the phone?”

“No,” she repeated. And then, just for kicks, “This is not a hotel. This is hospital.” She was emanating hate — I’m sure I came across, albeit unintentionally, as an English-speaking bitch. But then again, I hadn’t said anything I’d considered irrational. It’s like when I called Iceland Air to ask what would happen if our flight were cancelled by the volcanic eruption, and a customer service representative told me that she couldn’t “call up the volcano and ask when it would be erupting” and then hung up.

Oh, it made me mad — especially because my A1c was one of the worst I’ve had in years (transferred diabetic rage = never a good thing). I considered not going back to pay — I mean, dude, how many times could I try to get them to let me give them money — but morality prevailed, and the next day I walked over with Peter in the middle of a rainstorm to pay for the test and (god help me) try to get an English bill so that I could attempt to get insurance to reimburse me for it. (As anyone who has dealt with international claims forms knows, they are insistent that you give them something in English.)

Needless to say, this did not go well. The woman behind the desk started off friendly, but as soon as I asked if I could see the bill before paying it — a wise move, since there was what appeared to be an entire blood panel on there, with four tests repeated twice — she refused and, to my horror, called back the nurse from the night before.

I tried to ask her what she had charged me for and why there were so many tests. She glared at me and told me to pay. We went back and forth several times before, giving up, I asked if she would please write a sentence — which I wrote on a piece of paper — saying what test I had gotten and how much it had cost, so that I could send it to the insurance company. No, she would not. Instead she started yelling.

“YOUR DOCTOR WILL TAKE THIS!” she yelled. “HE WILL TAKE IT!”

By now, this was becoming a scene; a man suddenly appeared at my left and, with breath that smelled like straight alcohol, tried to help me translate.

It quickly became clear that while she understood what I was saying, there was no way this was going to happen. When I tried to explain that the note wasn’t for my doctor — and besides, I don’t even have one at the moment since we moved from California — she even threw in a little barb (“Why do you not have a doctor IN ENGLAND????”)  before glaring some more.

I finally just handed over my credit card. I’m happy to report that my sodium levels appear to be within a normal range — but less happy to report that, as with the other charges on the bill for tests I did not request, I was charged twice.

A word of actual advice: if you are trying to get an A1c done abroad, make sure that the results they give you are in the correct units — most countries use the mmol/l metric instead of the American mg/dl. The mmol/l numbers inconveniently overlap with A1c measurements (i.e. a 6.7 could be either one) — so I went through a moment of thinking my A1c might actually have been my current glucose number, measured differently.

Traveling with diabetes is always tough. You’ve got a different schedule, different exercise patterns and, above all, different food. I’m in Klaipeda, Lithuania right now, just starting week two of a three-week bicycle trip through the Baltics — and let me tell you: there’s nothing like Lithuanian cuisine to make you appreciate the dietary difficulties of life on the road. I’ve mentioned kibinas before — crescent-shaped doughy dumplings reminiscent of Hot Pockets. But there is so much more.

Take, for example, the cepelin — doughy, greasy potato dumplings roughly the shape of a blimp (hence the name — it’s Lithuanian for “zeppelin”), but with a density that guarantees that they would never remain airborne. Peter and I shared a serving of those the first day we were here, and I was left amazed that a. a potato could be made that gelatinous and b. the normal serving size is two. I ate only part of one, and felt like I could hardly get up from the table.

But the obsession with carbs does not stop there. No, this is the land that worships the potato, and potato pancakes (similarly gelatinous inside, but somehow better-tasting) are available at every restaurant. You’re not safe if you try to stick to, say, a salad — there appears to be a distrust of any dressing that is not sweet.  And oh, don’t get me started on the fried bread sticks. These are a national favorite beer snack, as they’re called, also available on nearly every menu — and after seeing them pop up again and again, Peter and I finally could not resist. I mean, it’s fried bread. Thanks to our biking itinerary, I had a few free carbs to spare. What better way to spend them than to eat bread — not just fried, but dipped in cheese?

It turns out that there are many better ways. Stale and greasy, the bread sticks had been dipped in some sort of ranch dressing (again with the sweet!) and then rolled, Sno-ball-like, in tasteless shredded mozzarella.

The upside of the fried bread sticks was that I was not at all tempted to eat more than one. Instead, I stuck to the cold beetroot soup (which I’ve convinced myself is healthy, though I think it may be made with sour cream). It’s bright pink, contains hard boiled eggs, and has delicious dill-spiked shreds of beet and cucumber. Yes, it comes with potatoes, but in what seems like a gift to diabetics, they’re always served on the side.

But it’s hard to get beetroot soup for breakfast on the road — one trick Peter and I have developed is to boil a bunch of eggs at the hostel or guesthouse the night before, and then take them on the road (one way to make new friends on long-distance bus rides: unpeel hardboiled eggs). When that doesn’t work, I try to stick to a banana or an unsweetened  yogurt. But sometimes even that doesn’t work — and I’m left with choices like this, the Magic Sticks. Please note the condensed milk.

Needless to say, I ate pretty light that morning.

But as I noted earlier, I’m rediscovering that one of the best ways to deal with a carb-heavy diet — or with traveling in general — is to exercise. Right now is a bit extreme — we biked 60 kilometers today, and have done roughly similar distances for five out of the past seven days. I’ve been dropping my basals to 55% while we’re on the road, drastically lowering my boluses, and still have been able to indulge the occasional ice cream cone without any diabetic repercussions to speak of. It’s making me wonder if I could work long-distance bike rides into my everyday life! (Especially if the rewards involved were greater than Magic Sticks. . . .)

I’ve also started to look at national cuisines with a more critical eye. It’s hard to read the menu of restaurants here, look at the body shapes of most Lithuanians over 40, and not think that Type 2 diabetes must be a problem. Obviously, to criticize the Lithuanian diet (or anyone’s diet, for that matter) as unhealthy — when I’m American — is a bit laughable. We are, after all, the country that invented the Double Down — a nationwide obsession with the potato might actually be an improvement. But still, observing a culture and a cuisine from the outside makes me recognize that Type 2 really is becoming a global problem, and it’s exacerbated by the way we eat, whether it’s cepelins or French Fries.

But I’m too tired to do much pontificating at the moment — tomorrow we’re off to a national park that used to house Soviet nuclear missiles (now you can take guided tours of the empty silos). My current plan is to keep biking through the Baltics, enjoy my occasional ice cream cone, keep to the beetroot soup and, above all else, avoid another favorite local beer snack: smoked pig ears. (Some of them still had hair.)

Biking on the Curonian Spit

I just spent an exhausting day visiting the CERN laboratory in Switzerland — you know, the place where they’re trying to get protons to collide to try to figure out how the universe began, and other light subjects. (Many thanks to Karmel for pointing out that even particle accelerators are sensitive to carbs.) I was expecting to learn a little about particle physics and come home no worse for the wear. But instead, it ended up being one of the worst days I have had since I was diagnosed nearly a decade ago.

The problem started at lunch, when, after a snack of bread on the bus (which I bolused for, mind you), my blood sugar was 323. That’s enough to make me want to scream to begin with, but it also happened to be lunch time, and I had fought my way through a large crowd of tour groups and CERN scientists, and wasn’t about to not eat. (After all, we were looking at another 5-hour bus ride home, and I was already starving.) So I double bolused, for lunch and for the correction, even adding a little more since I knew that my inactivity and already high blood sugar were going to make me really insulin resistant.

Then, as one does, I went to check out the hydron collider. Or, rather, I followed my group to a huge warehouse where they store the extra magnets. Now, I’m not really one for particle physics to begin with, but we had a jovial British tour guide who was used to groups of school children, which meant that I actually could understand what he was talking about. I followed along for about 45 minutes and then decided to check my blood sugar, just to see what was going on. This seems crazy in retrospect, but I was a little worried it might drop too low — I’ve had some really scary ones recently that came on unannounced, and I’ve been getting paranoid.

Well, no need to worry this time, because when I pricked my finger, the result came back at 447.

No, that’s not a typo. That is four hundred and forty seven mg/dl and is, quite literally, higher than it was when I was diagnosed nearly 10 years ago. Freaking out, I took a huge correction bolus, waited a few minutes, and checked again. 475.  Twenty minutes later? The glucometer stopped giving me numbers and simply said “Hi.”  Surely that was wrong — so I checked on my backup glucometer. “Hi.” My blood sugar was so out of control that it didn’t even register on the machine.

I was horrified, frustrated, scared, confused — pretty much any diabetes-related adjective you could think of. What was going on? What had I eaten — what had I possibly done — to make my blood sugar go this high? The only possible explanation I could come up with was that I had somehow tugged on the tubing/insertion site when we’d stopped at a rest stop on our way to Switzerland and had pulled the tubing out from my skin — but, thanks to the ingenious design of the Quick-Set, I couldn’t actually see if anything was wrong.

Thank god that I had had the foresight to bring another insertion site — I usually am not good at remembering to do that, and in this situation, it would have meant at least 7 hours more with outrageously high blood sugar. (I had a backup syringe, but no humalog b/c I didn’t want the vial to denature — starting tomorrow, I’m going to pack one anyway.) As our tour guide spoke to our group about how the refrigeration system of the hadron collider worked, I carefully (very carefully) unwrapped the set and plunged it into the skin of my opposite hip, making sure that I could feel the needle going in, before reattaching the pump on my other side. I then took off the problematic site, pulling the adhesive slowly so that I could see if the cannula had indeed come loose.

Nothing. The cannula was securely in my skin. Sure, I had my typical “donut” of puffy tissue left over from the Quick-Set, but there was nothing otherwise unusual that I could tell from the surface. Meanwhile, I checked again — still “hi.”

I’m almost embarrassed to say what happened next — but here goes: as the rest of the group went off to see something called the ATLAS project, I stayed behind in the visitor’s center and . . . burst into tears. I’m not talking like, a little sniffle. I’m talking about full-on crying, the type that is so intense you need to lock yourself in the handicapped bathroom so that you can sob against a wall (and then you need to wear dark sunglasses on your way out so as not to show your red-rimmed eyes to the world). I’ve been frustrated by my blood sugar pretty much continuously on this trip, and this was a tipping point, one of those moments where all the tiny details of diabetes come crashing down on you all at once — the self-control and the attention to detail and the thought required for every single bite of food. As I stood there, alternately crying and talking to myself, I could only really say one thing, a phrase I return to every time the emotions of diabetes get the best of me: “I am so tired of this. I am so, so tired.” And then, something new: “I am so angry about having diabetes.”

It was a funny and surprising thing to hear myself say, because the vast majority of the time I’m really *not* angry about it. It just seems so pointless — who would I be angry at? Whose fault is it? No one’s. What can I do about it? Nothing. But today, all the frustration I’ve been feeling boiled over into a genuine anger at having to live with this goddamned disease every day of my life, with no end in sight. Suffice it to say, by the time I got out of that bathroom and snuck outside to take a walk, I really needed those sunglasses.  And I also couldn’t help but notice the irony of being at a research laboratory that is attempting to recreate the conditions of the Big Bang — and we still haven’t been able to figure out the secrets of something as close to our hearts (literally!) as the human pancreas. If only JDRF had a 20-country partnership and over a billion dollars a year.

As it turned out, it took more than sixteen units of insulin to get my blood sugar to go back down — which it did after nearly six hours. It even threw in a fun trick where, after not working at all for the entire afternoon, the insulin kicked in and I dropped from 293 to 69 in an hour — despite the fact that the insulin technically should have been nearly out of my system.

Anyway, I’m now back in the hotel room, I ate a tomato salad for dinner, and I’m looking forward to collapsing into bed. But I’m confused and upset that, for reasons I still don’t understand, my blood sugar was higher this afternoon than it’s ever been since I was diagnosed — and that it took so much to get it to go down (even the walk did nothing). I have never, and I mean never, gotten that “hi” message on my glucometer. But then again, as my husband pointed out, at least it didn’t say “Bye.”

After a hectic few weeks in Paris, my husband and I have arrived in Turin, Italy, home of the supposed shroud of Jesus, a 19th century anatomical museum and, most relevantly for me, the 2010 Euroscience Open Forum, which  I have a fellowship to attend. It’s a week full of scientific talks on everything from personalized nutrition to the Big Bang, and I’ve been trying to go to as many talks as I can.

It would be impossible to do everything — there are four sessions a day with six simultaneous talks, not to mention the lunchtime lectures, the late afternoon lectures, the site visits, the science parties and the scientific events going on around the city — so I’ve had to pick and choose. Perhaps unsurprisingly, a lot of my interest centers around human health — I went to a really interesting discussion yesterday on how people respond differently to the same exercise regimens (it appears that there’s a genetic component to whether or not exercise will actually improve your health — who knew?). I’ve  also been interested to see that while there are plenty of talks about climate change and a ridiculous number about the Big Bang (CERN is involved in the conference, and seems a little defensive), there is nothing exclusively devoted to diabetes. Obviously I’m biased, but given its worldwide explosion, I would have expected there to be more. Oh well. I’ve already got one pancreas to deal with — perhaps I don’t really need more.

So I’ll leave the conference updates to Karmel (keep them coming!), and instead write an update on our trip so far, since our itinerary has been so hectic that I’ve hardly had a chance to reflect on the whole diabetic aspect of traveling the world.

My first thought? It’s hard. In fact, I’ve been surprised by how difficult it’s been. I know what you’re thinking — you’re away from your normal diet and exercise patterns — of course it’s going to be hard! But hear me out: I’ve done numerous trips since being diagnosed, most notably six weeks in Europe after college, and two months in China a few years later, land of dumplings and rice. I don’t remember either of those trips as being particularly diabetically disastrous. I also spent the summer after I was diagnosed biking across the United States. Sure, I can remember weeping hysterically in a church basement somewhere in Pennsylvania, but I also remember getting to eat DQ shakes without problems (biking 70 miles a day gives you a bit of flexibility).

Right now I’m in Italy, and I’ve had a relatively good couple of days, probably due to the fact that I have been hoarding hardboiled eggs from the hotel breakfast buffet (there’s one in my bag right now, and I’m really hoping it doesn’t break). But in France, some combination of a lack of exercise, a bad cold, and, let’s face it, baguettes, meant that I was a diabetic disaster. I went high after nearly every meal — and then, if I tried to preempt the highs by taking extra insulin, I’d drop too low. I woke up one night drenched in sweat because of a miscalculation at dinner; I even had a scary low in the middle of the Louvre (I’ll attach a photo when I get home). If there’s one thing that can make that museum even more stressful, it’s having your blood sugar drop to 47 somewhere between the Mona Lisa and the Venus de Milo.

I was assuming this was mostly my fault — I don’t normally eat so many sandwiches — but then several days ago, things seemed to regulate back to a relatively normal state, despite my increased bread consumption. It’s yet another trick of diabetes — even when you’re certain you know the cause, there are other variables working behind the scenes. Luckily at  the moment, they seem to be in my favor — but it was a rough few weeks.

On a separate note, before we were in Paris, my husband and I spent two weeks volunteering at a French dairy farm, a location I chose primarily because they produce cheese and yogurt — both delicious and low-carb. The first night at dinner (which included  bread, pasta and rice) I was sitting at the table with the family and pulled out my Symlin needle. I saw the father — a hardy French farmer named Laurent, whose daily activities include tasks like delivering baby cows — blanch.  “Are you okay?” I asked him, jabbing my needle into my stomach as he literally turned away and covered his face with his hands.

“In a minute,” he said. His wife and daughter rolled their eyes and laughed.

He turned out to be the first person I’ve met — in the almost 10 years I’ve had diabetes — who had genuinely been known to faint at the sight of  needles. It became a running joke between us that became especially relevant when, several days later, he had to give a goat a shot of antibiotics in the neck.

Also,  a note on my preceding kitten video post. That was the cat of the family on the farm. In addition to playing with my pump, she also enjoyed being put in plastic bags. (Not kidding.)

I suppose it’s not the best idea to let a kitten eat the tube connecting you to your mechanical pancreas — but it was so funny, I couldn’t help it.

Well, after a week spent in Iceland, where I tempered my indulgences in soft-serve ice cream with lots of hiking (that’s probably my #1 tip so far for traveling with diabetes: walk a lot), I am now in France. Paris, to be exact — a city known for romance, culture, art, coffee, and a shitload of foods that make it very hard to exist with a malfunctioning pancreas.

For example: within a block of the apartment where we’re staying, there are four (4!) bakeries. I can barely walk out the door before I’m hit with the sweet smell of freshly baked bread. I thought I’d be inured to this by now — after all, California has a number of high quality bakeries, and I never was particularly tempted to go out and buy baguettes. But note to California (and all of the US): when it comes to boulangerie science, we will NEVER beat France. There is a secret to French bread making, and it’s probably under guard somewhere in the national archives, with a squad of soldiers who have sworn to protect it to the death.

Point being, those baguettes are damn good. And my resistance is weak.

With avoidance disqualified as an option, yesterday, Peter and I figured out a more extreme bread mitigation strategy than merely walking around: we went for a run. Who cares that I have arthritis under both knee caps and am now having difficulty getting out of bed? We jogged down to the Champs Elysees, took a victory lap around the Arc de Triomphe, and made it back to the apartment just in time for a fresh baguette and a croissant. It was delicious and, dare I say it, totally worth the insulin.

Though that’s the thing about France: it’s pretty much all worth the insulin. I’m hoping I’ll reach a point where my standards for baguettes become so high that, after leaving France, I’ll never want to eat one again. So far, that has not happened. So in the meantime I’m trying to find indulgences that are a little less carb-tastic (cheese, vegetables, even pate), and toting — when it comes to sampling carby foods without guilt — what must be perhaps the best diabetic accessory of them all: a husband who’s willing to share.

It’s official: my husband and I have left the country for a half a year on the road. Our first stop? Iceland, home of ash-spewing volcanoes and a grand total of 300,000 people. (I thought I might have my zero off, but no, it’s true.) The good news: it’s a culture that values public hot tubs. Peter and I have been here for less than 48 hours and have already visited two. And the other good news? The national foods are Icelandic lobster and lamb — both delicious and carb-free. (I also tried a small piece of a local delicacy called hakarl — putrefied shark. It is also presumably free of carbohydrates, but it also happens to be disgusting.) Add in the excessive amount of walking that we’ve been doing and so far, this trip is great for my blood sugar.

It’s not so great, however, for my back: it turns out that packing six months’ worth of diabetes supplies requires carrying an entire separate backpack — filled with everything from insulin and a backup pump to three spare glucometers, syringes, and 7 boxes each of infusion sets and reservoirs. Here’s a photo of me in the Reykjavik airport, after we’d gotten off our red-eye flight (Iceland’s actually only four hours ahead of New York, so technically the jetlag shouldn’t be too bad — but all the flights from New York leave at night, so you automatically lose a night’s sleep).

It’s funny — the photo doesn’t make the bag look so bad. Which, in some senses, it’s not — it’s pretty amazing that that one bag (which I plan on dividing up between three bags, lest someone steal one and leave me screwed) can keep me alive for a half a year. But at the same time, I only have one other bag with me. And it’s not that much bigger. If I didn’t have diabetes, the amount of luggage I have with me would be totally reasonable and uncumbersome (and I might have had the space for more than four pairs of underwear).

So far, though, the hassle is worth it — sure, I had to spend more time on the phone with Blue Shield in the past few weeks than anyone should have to in their lifetime. But you know what? I’m in Reykjavik. This morning I saw a Minke whale. (Tonight I might have the opportunity to eat one — which sounds less appealing.) And at the hot springs, I unhooked my pump, put a cover over the insertion site, and jumped on in. Here goes.

I’ll give you a hint — it’s not constantly freaking out about whether your insulin is cool enough (or, for that matter, whether a fellow hosteller is going to snag it from the communal fridge and hold it for ransom).

It’s all the extra movement. Seriously — I think of myself as a pretty active person, but compared to what I’m like when traveling, my normal life is that of a couch potato. Sure, I exercise regularly — but most of the day I’m just sitting in front of my computer. When I’m traveling, though, I’m walking and moving for much of the day. The result? I can actually have a soft serve ice cream cone. (And as you all know, that is a really pleasant exception to the norm.)

Other interesting diabetes-related observations on the trip so far:

-Frios do not keep very cold if they are not exposed to circulating air. Interestingly, it is difficult to provide a source of circulating air in your backpack. Has anyone figured out a solution to this? I’m worried that in a week from now, my insulin will have denatured and I’ll be screwed.

-it is really, really nice to be untethered once in a while. This morning my pump was due for a change and I was supposed to go swimming. So I decided to do something bold: take off the pump and not change the insertion set until after I got back. I know, crazy, right? Unfortunately, the experiment didn’t go too well — my blood sugar was low when I got in and high when I got out (a combo of a couple of glucose tablets, a delayed rush from breakfast and a lack of a basal for an hour). But wow, was it nice to take a shower afterwards and not have anything attached to my body. I was surprised by how pleasant it was.

-continuous glucometers need to be better designed for hot tubs. I don’t think of myself as someone who often has the chance to go into hot tubs, but Iceland is an exception — there are geothermal pools everywhere you look. As a result, there’s no way I can wear my CGM for this week — the poor sensor would freak out! This has happened to me before — I know it’s supposed to be waterproof, but I just don’t trust it, especially when high temperatures are involved.

Diabetes is definitely an annoying travel companion — I’m already tired of carrying around that damn backpack — but it is inspiring me to try to establish a routine when I get back of taking morning walks. I think it would be very helpful for the rest of the day.

Lastly, I’m enjoying taking pictures of my diabetes equipment in bizarre locations. Here’s me testing my blood sugar next to a naturally warm stream, and another at Gullfoss, one of Iceland’s most beautiful waterfalls, where I discovered a pump at the end of the rainbow.