I’m lucky enough to meet some of the most incredible, inspiring, interesting and downright crazy people as I travel the globe. You learn that everyone has their own story to tell, and some just amaze me with how tenuous they are in their pursuit of adventure. Travelling with diabetes is something I cannot imagine to be easy at all, so when I met Amanda Quill in the Balkans last summer I absolutely loved her spirit and her inability to allow anything to stop her doing what she wanted.
Hey, I’m Amanda, a keen Kiwi traveller and a Type 1 Diabetic (T1D); I am blessed to have ticked off 34 countries across four continents, a mixture of travel with friends and solo. My longest stint abroad was for four and a half months; I spent four months in Europe visiting 24 countries and two weeks in Asia visiting three countries.
Having wanderlust and being a spontaneous traveller don’t always go hand in hand with being a T1D (type one diabetic for those not in the know). The thought of being carefree doesn’t really work when you’re a pack mule of needles and medication. The blood sugar effects of temperature changes, time differences, different foods and day-to-day activities can seem daunting, but it’s way more fun battling diabetes in a tapas bar in Barcelona than it is at home. Knowing your tell tale symptoms, listening to your body and testing are the key to smooth sailing; or more accurately a pretty bumpy ride but not a full blown diabetes tsunami.
The first time I set off overseas was one week after being diagnosed and later released from hospital. My parents had an adage that my diagnosis wouldn’t stop me from doing anything and so went ahead to take my siblings and I to the Gold Coast. Honestly, they just didn’t want to tell seven year-old me I didn’t get to go to theme parks! The packing for that trip was anything but logical. For a two-week trip, the entirety of my three-month prescription of needles, insulin, test strips and emergency supplies came away. Thankfully, from more experience as a T1D and a few more adventures under my belt, I have learnt the appropriate supply levels to take to avoid looking like a drug mule.
Overall, I have had many highs and lows (excuse the pun) that are part and parcel to being a T1D traveller. I share the good, the bad and the ugly stories below to bring some comedic relief to the travel stresses and to hopefully help you on your own adventures.
The Good, The Bad and The Ugly
The Good (Wholesome Diabetes Experiences)
Meeting Other Diabetics
Sitting at a wee café in Vienna, Austria, the waiter asked me what the sensor on my arm was. I sheepishly explained to him I was a T1D and that the sensor meant I had up to date monitoring of my blood glucose. After our conversation the guy at a table over from me asked if he could join me for coffee. He then revealed his insulin pump and told me about how he was a General Practice Doctor. I sat with this GP discussing diabetes and travel for two hours, drinking coffee and connecting over our shared and differing experiences of living with diabetes. Although I have no idea what his name was, the experience of connecting with another diabetic abroad helped me build confidence in being a T1D and a T1D traveller.
For my four and a half month trip that saw me in 8°C up to 44°C, I had one suitcase. To see me through my trip my 18kg suitcase was half-filled with diabetes supplies. As each week passed my supplies depleted, creating more and more room for me to shop for trinkets and clothes. Also, there is no better excuse for stocking up on foreign sweets than the fact that it will be medicine for you at some point.
The Bad (Unfortunate Side-Effects)
I visited Dubai, United Arab Emirates in July and during Ramadan. The temperatures exceeded 40°C and you aren’t allowed to eat in public between sunrise and sunset. My levels are particularly sensitive to high heat and I was armed with glucose to sneak in the bathrooms if need be. What I was not prepared for was the number of pump sites I would need in this time. The sweatiness from being in 40C and constant jumping in water made the glue on my pump sites absolutely useless and so my sites continuously fell out. I managed to use a week and a half’s worth of supplies in three days as I battled against the melting sites!
Spending a week on a Turkish Gullet sailing the southwestern coast of Turkey is one of my travel highlights so far; I was in awe of the beauty, culture and cuisine that Turkey has to offer (I cannot recommend a visit enough). The sanitation on the boat however was not designed for a T1D and by the end of the week I had the nastiest infection I have ever had, with a massive abscess under my site spot. On the plus side, it’s way easier to get random (and effective) medications over the counter in Turkey than it is in New Zealand. Overall, sanitation is something we need to be mindful of and relying on alcohol wipes isn’t always enough.
The Ugly (Near Death Experiences That Are Funny To Look At Now!?)
Change of Environment
For the 4-day EDM festival Tomorrowland I packed six tubes of glucose, two packs of glucose jellybeans and a ten pack of glucose gel; enough to treat 37 lows! And I used it all, before the end of the festival. At Tomorrowland, I was walking approx. 40kms a day, dancing and in mid 30°C temperatures. As the confetti fell to close off the end of Tomorrowland I could feel the adrenaline and excitement pumping through me was intensifying. While everyone around me was also having fun, I had a light bulb moment that I was super low and barely able to see/stand. Unfortunately, when I got to the drinks vendor, they had stopped serving. In one of the few times (in my adult life) I played the good ol’ diabetic card. The first server had absolutely no idea what I was talking to but thankfully another did. I was quickly handed a pack of glucose and they even opened a can of soda for me. I still have no idea how low I was at that time, but when I finally managed to get back to my tent my blood glucose was still a meagre 2.6mmol/L.
At the end of my four-month European adventure I stopped in Asia. My insulin had travelled all the way from New Zealand with me and had been in and out of Frio packs and fridges along the way. After two days in Chiang Mai I came back to my room and discovered my water bottle had frozen in the fridges. As only the water was placed by the freezer compartment I checked over my insulin and it all seemed good, turned the fridge temperature up and continued on. A week later, after a night out in Bali I awoke early to catch the ferry to Nusa Lembongan for a day trip. In my hung-over state I managed to leave almost every diabetic supply I had behind. I was not feeling my best self and vomited a number of times before making it across the rough sea. My friends were also hung-over, so we all thought I had a case of alcohol poisoning. The day continued on with me looking very worse for wear and vomiting off balconies, on the beach, off the boat and moving vehicles (shout out to good friends pulling my head in to the back of the caddy when other vehicles were going past).
Nearly ten hours later, I was only getting sicker, I had another light bulb moment of ways that I could get sick that others might not. When we got back to our villa my tester read HI and my blood ketones level was 5.8. This was my first ever case of diabetic ketoacidosis (0/10 do not recommend). I started chugging water (and vomiting it back up) to flush my system and injected a ludicrously large amount of insulin. Once feeling slightly less zombie-like I went to bed, knackered, with a blood glucose reading of 14.5mmol/L and a blood ketone level of 4.2mmol/L. I assumed that during the night the ketones would fall. When I woke the next morning my blood glucose had risen to 15.4mmol/L, however the ketones had also risen to 5.5mmol/L. I gave myself an hour and as my levels continued to rise I got a taxi to the local hospital. It took about 20 minutes to get the doctors to understand what I needed and they then administered three bags of IV fluids and kept me on a heart monitor. My heart rate had been at above 160bpm for over 24 hours. My blood ketones reduced to a reading of 1mmol/L, my blood glucose was 9.5mmol/L and my heart rate was back to normal! As my organ function was returned to normal it dawned on me how out of it I was the day before in making the decision to go to sleep instead of to the hospital.
What to Pack
· Frio cooling wallets – these nifty wee packs are activated by water and keep insulin cool for up to 30 days. Refrigerating your insulin whenever possible assists in the longevity of the insulin and can be transferred to the reactivated Frio packs the next time you’re on the move;
· Glucose tablets, glucose sachets and glucogen jellybeans are super easy to stuff into a bag or jacket at any point. Having a pile in your suitcase allows you to stock up your day pack;
· A letter from your doctor listing out ALL your diabetic supplies. I take a copy in my wallet, a copy in my carry-on and a couple of spare copies in my suitcase;
· Alcohol wipes to prep your skin, best way to try and minimise infections;
· And of course, always wear your medic alert.
How to Prepare
· See your doctor prior to leaving, make sure your blood work is up to date and your diabetes is in control;
· A back up insulin plan – I am on an insulin pump and always travel with long acting insulin as my back up plan (this has been discussed with my diabetes doctor);
· Always get travel insurance and make sure to include diabetes as a pre-existing condition. Most insurance providers do not cover diabetes related instances if you do not declare it prior to taking out your insurance!
Tips and Tricks
· Travel with some supplies in your hand luggage. Personally, I keep approximately one third of my supplies in my carry on in case my suitcase were to go missing;
· Learn the word for diabetes and insulin in the mother tongue of the countries you are visiting (or have these written down; a literal lifesaver for me in Bali);
· Don’t place insulin next to the freezer compartment of fridges you don’t know. Try testing how cold the fridge settings are with a water bottle before putting your insulin in;
· When travelling most people pack an absurd amount of underwear. Instead do this with your diabetes supplies – I tend to do 1.5x what I would use for the same time period at home.
And by All Means, Travel
Being a T1D has its own set of headaches, particularly when it comes to the additional requirements for travelling. There will be times you misplace items in customs because you’re getting the full pat down (RIP my kindle) or your skirt will be lifted in the middle of an airport to check out your insulin pump (dear customs officers please just ask) or you will go low 23 times in one day and feel like death. However, sleeping under the stars in the middle of the Mediterranean Sea, watching your favourite artist perform, or trying pizza where it was first made, will unanimously outweigh these ill experiences! The challenges of travel with T1D are nothing compared to the excitement and fulfilment that travel brings.
Although I have had my fair share of disasters while abroad, it has also helped me learn to be in better tune with my body. Finding myself in the stickiest of situations on the other side of the world helped me to build a confidence I didn’t realise I have..
Travel, in spite of your diabetes. Travelling helps you to learn so much about yourself, and you get to see beauty in so many new and exciting ways. There is no reason to let diabetes hold you back, sure it may be hard – but that’s life in general. You may as well get out there and see all the beauty that the world has to offer!
Disclaimer: all of the above is based on personal experiences and does not in anyway replace the recommendations of your healthcare or insurance providers. Always seek professional advice with regards to your diabetes management and travel plans.
Article by Amanda Quill, New Zealand