Right now, as I type, I have a knot in my stomach. It’s a familiar feeling, often accompanied by an inability to take deep breaths, that is my body’s way of telling me that I am very stressed out.
The reason, in this particular case, is that my husband and I have decided to move back to the east coast, and are going to be leaving our lovely Oakland home in a matter of weeks. Before we settle in, we’re going to be going on a big trip — stay tuned to the blog for details — that’s going to include some pretty diabetically unfriendly places. Like Latvia, for example. Or Russia.
I had my last appointment with my San Francisco endocrinologist this morning, and instead of discussing basal rates or boluses, we focused mostly on a checklist of prescriptions for me to take with me while abroad, just in case my supplies get lost or stolen or I find myself in a foreign country with a bottle of Humalog that’s expired. It was actually a pretty funny interaction — I’m quite worried that a Chinese-speaking pharmacist is not going to know what to make of Symlin to begin with, let alone if it’s written in my doctor’s handwriting. So as he kindly created a ridiculously long list of prescriptions for me, I kept gently prodding him to, you know, write a little clearer. (“Thank you so much!” I said, as he scrawled out a prescription for test strips. “Can you just write that a little more neatly?”)
He tried, and I now have a stack of prescriptions for any sort of diabetic calamity I might face. He also gave me some valuable travel tips, including the fact that apparently most insurance companies allow you to do a “vacation override” where you can get more than three months’ worth of prescriptions at a time (I’ll believe it when Blue Shield sends them to me), and suggested that I get a Frio, a carrying case specifically designed to keep your insulin cool. The office even provided me with five copies of a doctor’s letter stating that I have Type 1 diabetes, and that any delay in treatment could result in “serious, even life-threatening, medical problems.” Take that, Mr. Customs agent! You will allow me to receive that shipment of test strips!
I’m now moving into the real planning stages of this trip, and am very frustrated at the fact that, in addition to dealing with normal concerns like finances, plane tickets, vaccinations and the like, I have an entire litany of diabetic concerns that most world travelers don’t even need to think of. Forget the fact that I’m likely going to be in some places where most dishes include noodles — I have to pack a separate bag with enough diabetes crap (and backup diabetes crap) to last till I come home.
I’ll be posting more about my travel planning and adventures as the trip draws close, but in the meantime, I’m interested in hearing from other diabetic travelers out there. What resources did you find useful? What packing tips do you have? Did you bring all your supplies with you, or was it possible to have them shipped from home? What do you know now that you wish you’d known before?
Do tell.
I looks like you have a well thought out plan. The frio is an excellent idea, but if you will not encounter extended hot weather, a soft side cooler with frozen gel packs will work in a pinch. The letter is good – 5 copies, good, if your hubby will be with you, make sure he has one in his carry-on. Good for additional copies if needed, but you should not. Suggest that most if not all supplies be carried in a carry-on. Luggage may not be lost, but I never took that chance.
Most airports are very courteous. Only problem I and a few others have had troubles with had been Heathrow. I was delayed until I missed my flight while they called the US and confirmed everything with the doctor. Another in my party was delayed for another reason and we never did get back together until after we returned to the US. We would have been separated after one more stop anyhow, but this was not what we wanted.
Enjoy your trip, relax – traveling can be fun and does not have to be stressful.
Bob
Amen to all that planning and craziness. I studied abroad for a few months and it was a mess getting everything sorted out. I did the vacation thing and got an extra pump from Animas, took paper prescriptions of everything (note the difference between U100 insulin that we use in the US and other countries) and simply had my doctor write an uber-prescription for pump supplies and such that would last me the entire time there but insurance would only bill it as my regular one–they weren’t able to process more than one refill at a time. I definitely, definitely would not rely on packages arriving or getting the prescriptions you need abroad. Customs never gave me a big deal or security–but I was in Europe and could communicate with pretty much everyone I met. I can imagine there being problems with language barriers explaining all your stuff. Sucks having to take up so much valuable space in your luggage (carry-on, for the most part), but think of it as planning ahead for any gifts you will purchase and then have space to bring back. Having food on-the-go was something I took advantage of in the US. Granola bars, baby carrots, protein bars when the food looks skeptical or you’re sick of trying new things–those were things I missed and was glad I had packed. Pretty much every country will have some sort of candy that you can find everywhere to bring you up in a pinch (be it a hard candy, sweet tart, gummy bear), so use your initial bottle of tabs and then as you find the ubiquitous low-saver, you will be able to use that. Time changes are hard, so make sure you know what your plan is for that with your pump settings. Accept that your readings are going to go all over the place (instead of getting upset with yourself and angry at the circumstances, like I know I did/was) and don’t be afraid to try to explain that you might want something with a bit less pasta or whatever. Never know what kind of friends you can make in that process! I think Kerri at SUM had some excellent advice from when she was in Spain, so I’d check out her posts and the comments, too. http://sixuntilme.com/blog2/diabetes_and_travel/ Phew. The end. :]
Hi Catherine,
Well done for taking the big step! We travel reasonably frequently with our type 1 daughter, and from NZ it means every big trip is at least 12 hours from away. I have found a great carry-on bag that has a waterproof shoe storage place with a separate entry and I’ve found it to be really useful when on the plane and moving from place to place. I put those picnic ice packs in and store the insulin there (we did get questioned at one airport – Brisbane I think, who said that it was technically liquid (the ice) and so not allowed to go on board, but when we explained what it was for they were fine That is when the letter comes in handy. Perhaps some other countries mightn’t be as lenient. ) We always take the frio it is also great. But I don’t rely on it totally. When we go to a guest house or hotel, we ask to put the ice packs in the freezer, and everyone is always obliging when they know what it is for. Don’t put insulin in your checked luggage on the plane, as things in the hold can apparently drop to very low temperatures, and it may destroy your insulin.
I have a small insulated bag that I carry with an ice pack and some insulin and always carry it with me, and the rest goes in the shoe holder space in my carry-on bag if it is not in a fridge somewhere (ie during travel time). We always take twice as many supplies as we need and separate them in different bags so if we lose one we still have enough in another. And I carry some spare supplies with me all the time when out sightseeing – a bit of a hassle, but it has often been needed – like when you can’t get back when you thought you were going to etc. A spare pump in your luggage is a great idea too. Another good idea is to find out some words you might need to know in the languages of the countries you are visiting, so that you have some keywords in an emergency. Write them down, so that you can show then rather than risk mispronouncing them. Better to be overprepared.
We keep our watches, and pump settings, on the original time while taking long flights and test and correct frequently, then when we get to the destination we switch it over. Everyone has their own best way of doing it – testing frequently is the safest!
Oh yeah – and be careful about hotel fridges – some of the small fridges wil freeze, so you need to check that it is reliable. If in doubt – we have asked to store it in the kitchen fridge, and we have never been refused. But again, I never give them all – I always keep them in two places just in case something happens to the first. It sounds a real hassle, bu tit is not, and after a while it just becomes habit. The longest we have been away is for 2 months. Have a great time!!
You should know how to survive on needles alone. If your pump fails, be able to calculate and dose using your Symlin syringes alone. If&when you get down to your last 10 syringes, consider field sterilization and re-use.
Obviously the odds of having to do this are slim – but it’s gonna suck if you can’t do the math.
I traveled for a month in places that included Eastern Europe and rural Turkey. I made sure I had enough pump supplies, which definitely added up to a lot of extra crap even though I still managed to stick to the one bag rule. I also had a list of Minimed offices in the countries where I would be and I resigned myself in advance to a potential one or two day detour, if necessary in case of emergency — basically mentally preparing myself for a somewhat disrupted vacation, although in the end that didn’t happen. Oh and definitely have glucagon with you — short-term, the risk of catching a stomach bug and going low is more dangerous than having pump/insulin problems. Just last month this happened to me — and fortunately I was at home in the U.S., so a quick trip the ER was easy. But it made me realize how lucky I was when I was in, say, Turkey where you’re not advised to drink the water.
Finally, I would say as far as jet lag, I adjust my pump’s clock by one hour per day–that seems to correspond pretty well to my body’s adjustment to the new time zone. For eating and any other activities that affect my glucose (okay, that’s pretty much all activities), I have to pay attention to the time that’s on my pump — that’s going to tell me what my ratios are going to be, for the most part.
As another blogger on this site said, traveling for me involves so much walking and activity that it’s hypoglycemia that is really the danger. Much of the time, I even switch my basal off or reduce it drastically, because I find that even casual walking or standing around museums–or certainly hiking around ruins–pretty much takes care of my needs. Of course everyone is different.