This one’s about travelling, mostly about holidays but some of it also applies to work travel too.
As I am a human being, I go on holidays as often as I can. As an idiotic shambles, I did a job that required quite a lot of travel – much of it on short notice, and all of it ridiculous. Here are the tips and tricks I picked up along the way.
This was my number one rule for going to festivals – and it also applies to holidays, but in a slightly different form. When you go to a festival, it’s ok to feel pretty horrible the whole time – cos everyone else feels like death warmed up too. A combination of heatstroke, hangover, come down, tent sleeping and eating crap will do that to anyone – D or not. Plus it’s only for a few days.
On holidays, you probably don’t want to feel like warm shit the whole time. If you’re sightseeing, you usually get a bit more from it if you don’t have the rebound hypo hangover, and aren’t dashing around looking for toilets to offload excess sugar.
So while it’s a holiday, and you can relax a bit more, try just to slacken the limits a little. Allow yourself things you might not have at home – but probably keep it all a bit tighter than at a festival where the goal is essentially to maintain consciousness.
The actual journey can sometimes be a bit of a pain when you’ve got diabetes. Not only are you trying to take all your holiday stuff, you’ve also gotta get all your diabetes gear in the bag too. Even worse when you’re going cheap-o and trying to get around the luggage restrictions on Ryanair.
It’s worth giving whoever you are travelling with a ring to check whether you can get an exception because it’s medical kit – some are willing to allow you to bring a second piece of carry on for this purpose. Try and keep all the kit together in the bag too – makes life easier if someone wants to look at it. I’ve had varying experiences at airport security – with some insisting the insulin goes through separately to my bag, others happy for it to go through in the bag. If in doubt, always check.
Also, always remember that pumps aren’t supposed to go through X-rays or metal detectors, flagging this to the guards usually is ok and they’re happy to pass it around the outside of the detector. Your GP or Diabetes Clinic will normally provide you with a letter explaining what you’re travelling with and why. This will smooth the way if you get any aggro from security – but they’re pretty good these days.
The pointless ballache that is the 100ml fluid restriction through airport security also means that you won’t be able to get your litre bottle of lucozade through, so bring glucotabs. On the UK side you’ll get lucozade in Boots at the airport, but if you are in foreign facilities can vary a great deal.
Flights in and of themselves are a weird time for BG. You’re crammed in a small space, usually having been up for longer than normal but while doing less than normal. And people keep coming and trying to feed you stodge or booze.
First things first, if you are (like me) lucky enough to have a pump with a separate handset unit that communicates with the pump, you’ll need to put both into flight mode. Bluetooth is one of those things that still seems not to be ok to use during flights. I mean, I’d hope that the handset sending the instructions for a 2u bolus wasn’t capable to taking down a hundred million dollar aeroplane, but you don’t wanna be the person to find that out.
Next, do test from time to time, it’s worth it to keep ahead of the curve that you can be thrown on by flying.
Beyond this – flying is pretty easy.
If you’re only going forward or back an hour or two, this isn’t really an issue, especially if you’re on basal-bolus MDI. You probably won’t notice any difference in shifting your time straight away. Rock on.
If you’re going further (lucky you!) then it can start to be an issue. This is where the holiday/work split starts to come in. If you’re going on holiday, you’re probably gonna be in that timezone for a few days at least – in which case it’s worth making the transition right while minimising your BG buggery. I’ve always tried to make the shift over a couple of days.
For example, if you’re on the US East Coast and usually take your basal insulin at 10pm, then you are dealing with a -5 hour time change. Here I’d shift and take it at 8pm local on the first day (midnight UK), then at 10pm local on the second day, meaning that your routine is normal for the rest of the trip (and repeating on the way back).
If it’s for work, you’re not likely to be lucky enough to be in one place for long enough to do this kind of D-jitsu (Hello London-Australia-London inside 48 hours!). In these sorts of situations (probably anything less than a week where the timezone change is more than +/-2 or 3 hours) it’s worth just cutting your losses and sticking to the time you take it at home, in your home time zone. Timezones can be tricky though, and especially if you change zones multiple times in a short space of time. Here my recommendation is really easy. But two style icon, class, Casio F-91W watches. They’re less than a tenner each. One stays on home time, the other can shift to where you are. You’ll look like a doofus, but you’ll be kicking diabetes ass, so who cares.
If you’re pumping, on arrival you can change the time on the pump and it should adjust your profile accordingly – this might need odd correction top-ups or TBR reductions for the first day or so, but once you’re adjusted to the time difference, you shouldn’t notice too much of a problem.
Stop your Insulin from denaturing
This is super important if you’re going anywhere hot, or indeed very cold. If your insulin goes kaput, it’s game over. On occasion, this can be mildly useful for those around you – for example if you have been on a day cruise to the Bahamas, have been drinking super sugary frozen margaritas in the 35C heat and then realise your insulin is doing nothing while you’re in the queue for immigration, your travelling companions may use this as an excuse to skip the queue.
This also kind of works for you, but you won’t really be that into the fact as you sit in the care chugging litres of water on the way to replenish your insulin.
There is a super easy way to prevent such stupid, idiotic mistakes. Frio make awesome pouches for insulin pens, vials and cartridges – and all you need to keep your insulin cooler than the temperature outside is have access to some water. Since the incident on the ship, the COMPLETE FOOL who did that (ahem…) has used Frio bags all over the world and has shifted his problems from having ineffective insulin to finding a non-sunburnt patch to inject into. PROGRESS!
Stop yourself denaturing too
If you’re going somewhere warm, be aware you’ll probably need less insulin. For the first couple of days especially you’ll be hypoing ALL THE TIME. Of course, this can be complicated by food choices, amount of sleep, drinking, etc – but it’s a pretty good general rule. Hypos in 40C heat aren’t super fun. Especially when you’re staggering around a non-air conditioned roman ruin with no shop.
Keep hypo treatments on you at all times. Try and figure out what good things to buy locally are too – though Coke is basically available everywhere so is a good backstop.
Be aware your carb counting is likely to be a bit off if you’re eating different cuisine than you’re used to. It can also be tricky to guesstimate restaurant food at the best of times, never mind when you’re a few carafes of house red in to the day. An extra careful squint at the plate to inform your guess, and a test a while after eating will never go amiss.
If you’re off with the lads or girls to FALI-FUCKING-RAKI or the like, you might get friendly with a fellow traveller. Be safe. That’s it. Same advice as everyone else. Obv for more on the subject, check out the posts on sex by me and clarentina.
Take enough stuff with you
Basically, take much more than you think you’ll need. Imagine all the scenarios where you can bend a needle, fail a cannula, catch your tubing, smash a vial, repeatedly waste test strips with drops too small. Plan for all of those happening. If you’re in the UK getting spares and replacements is probably not too tricky, but if you’re abroad getting new cannulas and the like could be a nightmare. Avoid it if you can.
And the boring ones…
Get some travel insurance. Replacing stuff that gets lost or broken is enough of a pain without going out of pocket. Paying for medical treatment, ditto. You’ll need to get a policy that factors in your diabetes, otherwise you may not be covered. Insurance is available through Diabetes UK, or you can check out other options through go compare, compare the market, and the other sites like them.
Take contact details for your D-team in case you need urgent advice, or in case you need to go to hospital abroad for any reason.
Hopefully, with a bit of forethought and a little bit of planning you can shamble around the world – I have so far managed to do so and am yet to wake up in a Burmese hospital, so following these tips you can do the same!