Travelin’ Tips with Diabetes

 DSC00909

                                      At a garden in Tokyo with friends on a rainy day

Last week I received an email from the American Association of Diabetes Educators offering 8 travel tips, “Have Diabetes, Will Travel.” I thought I would post them.

I also asked AADE why there’s no mention of how to adjust your dose if you take a long-acting insulin like Lantus or Levemir. You’ll find that recommendation at the bottom after we had an email exchange.

Have Diabetes, Will Travel

No Reason You Can’t Enjoy Seeing the World – You Just Need to Plan Ahead 

Just because diabetes is your constant companion doesn’t mean you can’t enjoy traveling, whether traversing America in an RV or flying to the far reaches of the globe. Ensuring you stay healthy and keep your glucose levels on an even keel does require a little bit of organization and planning ahead, though.

The American Association of Diabetes Educators suggests a plan of attack for ensuring your next travel adventure is safe and successful.

1  Over-pack your medications – Gone for a week? Pack two weeks’ worth of your diabetes medications in case of travel delays or misplaced supplies (insulin, syringes, testing strips, extra batteries for your pump, a first-aid kit, glucagon emergency kit, etc.). If you use a pump, ask the company if you can bring a backup in case yours fails. Have a prescription from your doctor for insulin or oral medication in case of an emergency.

2  Protect your supplies – Keep your medications and supplies close at hand and don’t put them in checked luggage or in the trunk, where they can be exposed to harmful extreme temperatures (too hot or too cold). If you’re flying, keep them in the original packaging (so no one questions they’re yours) in a bag separate from your toiletries, as requested by the Transportation Security Administration (TSA), which manages airport security. Don’t worry, the TSA allows you to go over the 3.4 liquid-ounce carry-on limit for diabetes medications and supplies.

3  Identify yourself – Wear your medical bracelet or necklace that notes you have diabetes and take insulin (if you do). Bring a doctor’s note that explains you have diabetes and lists your medications, as well as a prescription in case you need more. Carry a health card that includes your emergency contact and doctor’s name and phone number. Learn how to say “I have diabetes,” “sugar,” and “orange juice, please” in the language of the country you are visiting.

4  Carry snacks and low blood sugar treatment  – Low blood sugar (hypoglycemia) can strike any time and food access during travel is unpredictable, so be sure to bring plenty of snacks such as peanut butter crackers, granola bars and  trail mix as well as glucose tablets or gel.

5  Simplify flying – Tell the TSA folks that you have diabetes (they’re used to accommodating people with health issues).  Visit http://www.tsa.gov/traveler-information/passengers-diabetesbefore your trip to learn about current screening policies. If you plan to inject insulin while flying, be forewarned – the pressurized air can make it more challenging to draw up your insulin, if using a vial and syringe, so be extra careful not to inject air into the bottle.

6  Test often – New foods, increased activity and different time zones can throw your glucose levels out of whack, so be sure to test frequently, including before and after meals. If you take insulin, keeping your levels steady can be tricky when changing time zones, so make a plan to adjust your schedule for injecting. Before your trip, see a diabetes educator, who can help you with this challenging process.

7  Favor your feet – Wear comfortable well-fitting shoes and socks at all times – never go barefoot.  Check your feet frequently, especially after a hike or long walk.  Feet and ankles often swell during flights so consider wearing light knee-high compression stockings (20-30 mm Hg) or bring thinner socks to change into if your feet swell.  Wear a shoe that can be loosened if that occurs. Pointing and flexing your ankles during a flight can improve blood flow in your calf muscles and decrease swelling as well as lower the risk of blood clots.

8  Prepare for a health emergency – If you need medical treatment, ask your hotel to recommend a local doctor who treats diabetes. Prior to an overseas trip, get a list of local English-speaking doctors through the International Association for Medica1172l Assistance to Travelers at http://www.iamat.org/.

The secret to any successful trip is to take plenty of time and plan far in advance of your departure – and that goes double when you have diabetes. For more information about how a diabetes educator can help you plan your next trip, visit http://www.diabeteseducator.org/.

Sources: Centers for Disease Control and Prevention (CDC), American Diabetes Association and Joslin Diabetes Clinic

Regarding adjusting your long-acting insulin dose from AADE: “There are adjustments that many people make but we would not recommend any specifics. It’s better to have your HCP guide you. Ask your HCP how to adjust your background insulin to account for the shortened day.

You may also want/need to do extra blood glucose checks during your trip for information as you make insulin adjustments, as well as to account for possible variations in food and physical activity while on your trip.”

I concur. I’d also add, if you’re an old hand and feel confident about adjusting your dose, do a little experimenting. First, use your common sense. Second, keep checking:

If your day is going to be shortened, for instance, by 6 hours, take 1/4 less your normal dose. If your day is going to be lengthened by 6 hours, add an extra quarter. I take that extra quarter before I go to sleep after I’ve arrived somewhere because I take my Lantus at 9 AM. Then I start my usual dose again when 9 AM rolls around wherever I am. And yep, keep checking!

That’s what I do but in all things diabetes what works for me may not be right for you. Mind you, I only take 8 units of Lantus a day and I’m insulin-sensitive rather than insulin-resistant.

The diabetes connection in down under Queenstown

L1000977

Two stories to wrap up New Zealand as our stay here has ended and we’re on to Sydney.

1. The wool story: After days of walking in and out of shops that sell fine Merino wool, a native staple, I was in yet another shop eyeing these beautiful sweaters, gloves and hats with envy for, alas, I am allergic to one thing in the world– wool. Yet, I could not help admiring these products’ beauty. And so I said, plaintively, to the saleswoman, “It’s funny, I feel like a diabetic in a candy store, I am surrounded by these beautiful wool products and I am allergic to wool.” She looked at me curiously and said, “Really, diabetics are allergic to wool?” Of course that was not at all how I meant it. When I recounted this story to the husband, we laughed and agreed I now had a new myth for the sequel to my soon-to-be-published 50 Diabetes Myths book, “Diabetics can’t wear wool.” 

2. The unexpected encounter: Midway during our stay in Queenstown we switched from a business hotel to a Bed and Breakfast. Over breakfast our first day I heard an American accent. Steve from Rochester, Minnesota was sharing how his rental cell phone went off at 5 A. M. that morning and it was a wrong number! That’s all the ice breaker I needed to begin the usual, “Where are you from?” “How long will you be in NZ?” As the conversation wound down from sightseeing, politics and the global economic meltdown, I mention that I just finished writing a book on diabetes myths. Steve’s wife’s face, Julie, lights up. She tells us that she has type 2 diabetes. Well, that is not all that surprising for a middle aged, slightly overweight American woman, but what is surprising, and stirs an engaging conversation, is that she is working with the famed Mayo Clinic as part of a research focus group on behavioral methods for helping patients manage their diabetes. 

She begins to talk about what I have learned through the more than 100 patients I’ve interviewed: you need to understand the context of patients’ lives to help them change behavior. She recants a wonderful story of one elderly patient who tells his doctor that he wants to be put on Byetta. His doctor who would never have thought this man would chose an injectible drug (and so wouldn’t have offered it), asks his patient why he wants Byetta. His patient tells him he is soon going into an assisted living home and he wants to lose a few pounds because he hears there are a lot of available women there! [Byetta helps most patients lose weight as well as control their blood sugar.] We laughed, and we understood what few doctors do: all our choices are embedded in the context of our lives.

Julie shares about herself that after being in denial for some time after her diagnosis, she took some diabetes classes and lost weight and significantly lowered her A1c. My husband asks what her A1c is and she lights up again and tells us, “5.7!” The husband says, “You must be very proud” whereupon Julie says with both elation and sadness, “Yes, I am and I want to tell people but who would understand?!” My belief that you can experience pride because of how you live with diabetes and it can motivate you to continue to do well is confirmed, and the husband whisks upstairs and returns with two of my books, The ABCs of Loving Yourself with Diabetes, in hand for Julie. We witness a smile quickly spread across her face as she skims through the book and she volunteers that as soon as she’s home one of these books will be at the Mayo clinic. It is like an angel named Julie has sat at my breakfast table in Queenstown.

I keep saying (to anyone who will listen) the universe is continually supporting my work by throwing gems at my feet, but that morning it was Steve who said, “This is so amazing. We weren’t intending to stay here but our travel agent “stuck” us here for three days, and look what’s happened.” 

I agree Steve. And so we fly out of Queenstown taking with us the beautiful scenery, rich new memories and new bonds that were woven that morning.

 

Diabetes news from New Zealand

Screen Shot 2015-02-08 at 1.52.01 PM

Well, here I am in Lord of the Ringscountry — Queenstown, New Zealand to be exact, where much of the scenic movie was shot. Exceedingly nice to be here if you don’t count the 24 hours in the air and five hours on the ground it took to arrive. This is a working vacation: time to play, sightsee, visit friends as the husband and I go from here to Sydney, Singapore, Tokyo and San Francisco, and I’ll be meeting up with some folks at JDRF and Diabetes Australia and possibly do a presentation at a hospital in Singapore.

The first picture posted here is from the wharf on our first rainy day. The second, exhibits something that took me by complete surprise on my Qantas flight from Los Angeles to Auckland, NZ. A compartment in the bathroom where you can dispose of your needles. I have never seen this before, and I’ve been around, on airplanes, I mean. 

I was intrigued–is it for diabetics? Anyone with a medical condition? Drug addicts?  I asked the stewardess while deplaning. She looked at me quizzically, her facial features almost saying, “What accusation are you making asking what our disposable needle bin is for?” Was it my New York accent? As I read her face, I geared up to offer just how much I enjoyed seeing the bin because I have diabetes, but before I uttered a word, she said, “diabetes,” and then I told her I have it. She warmed immediately. I told her I’d never seen such a bin on any other airline whereupon she told me it’s standard on all Qantas flights, imagine that! What also happened seeing this bin was an internal shift: I felt free, as though I just stopped holding my breath, not even knowing I had been holding it for the past thirty years. I felt acknowledged and accepted, as if I’d just been picked for the volleyball team and everyone was cheering. I could come out of the closet now, at least  out of this bathroom, without fear of judgment; it was an immediate, rich, sensory feeling.

I have another tidbit to offer re: flying and adjusting your insulin to cover time zone changes, which I am really typically horrible at.  I read about this tactic before leaving home and it worked in this instance.  Since once I landed in Auckland it would be four hours past my usual once daily morning Lantus injection, which I take around 7:30 AM in NYC, I took 1/4 of the amount I normally do when it hit 7:30 AM NYC time (my watch still being on NYC time during the flight.) Once we landed in Auckland it coincidentally was early morning and then I took my full amount of Lantus getting right on local time for my injections. It worked like a charm! But that’s all I can offer because I always struggle with how to dose for different time zones. My usual methodology is just test every few hours and catch up with correction doses until I’m about into the third day of travel.

As I sign off this morning surrounded outside my hotel window by majestic peaks, luckily today the sun is shining over them–I am in the same room number as my street address. The husband thought this was remarkable ingenuity on the part of the hotel, to match guests to rooms that replicate their address. I, of course, thought that would be nearly impossible. When we asked at reception, the concierge told us it was a very inventive idea but no it was not something they do. So, since it’s kismet, I’m taking it as a very good sign for the rest of our travels which I will post as we proceed.