So, in just six little days my fiance and I will be setting off for a two week holiday in Thailand, to celebrate the marriage of two of our dear friends. Granted, at the moment those six days feel like FOREVER, but as we all know, it won't be long until we are saying "my, didn't that go quick!" To a non-diabetic, the main concern at the moment would simply be how many sets of bikinis or board shorts to take and do I need factor 20 or 30 suncream? Hmm, dilemma indeed.
For those of you who are diabetic, it is a somewhat different story. After sorting out the logistics of the non-diabetic side of things such as, have we booked the flights, are we confirmed at the hotel, have we arranged transfers and so on, the diabetic plans have to be made and the calculations must begin!
Having never holidayed in Malaysia before, there are a number of things to consider and knowing what hot weather does to my blood sugars, there are various safeguards we have to put in place to make sure I'm 'OK' if my sugars take an unexpected dive. The hot weather thing always mystified me, as some people would report extreme highs, while others, including myself, always experience more lows. I recently found out why - and it explained a lot. The reason hot weather affects a diabetic's blood glucose (BG), is because hot weather makes the capillaries in the body expand, in order to cool us down. As such, the insulin gets around the body much quicker, meaning you can have unexpected lows. And what do we know about lows? They are always followed by a high. So depending on when you are testing, your experience may be that you could be seeing all the highs or all the lows. Chances are you are having both but may not be testing (or sometimes even realising) at the same time.
So now that I know I can be the subject of a number of wobblies, I have to make plans.
First up, insurance. Not only am I the proud owner of a marvellous (but costly) new insulin pump but I also have to cater for the fact that knowing what I know about hot weather, I need to be prepared for a major wobblie. One that could mean hospital treatment or even just a visit from a medic. Insurance is an area where many diabetics fall short, because apparently we are far more risky for anyone to invest in. I would disagree, but only out of principle- I can see why they err on the side of caution with something that can take even its host by surprise. But this means a lot of searching for a reasonable and fair deal, seeing as most companies whack up the price of your policy as soon as you mention diabetes, let alone type one. They always ask those ridiculous questions, such as "have you had a low in the last year". Erm, yes, seeing as if I hadn't, chances would be that I wasn't diabetic, and was in fact filling this out in error! As soon as you answer "Yes", up goes the price! After searching high and low and getting quotes for well over £100, I finally found an insurer who didn't think it was necessary to chase me off with a rottweiler of a quote. Tokio-Marine offered to insure both my partner and I, diabetes considered, for an annual worldwide policy for only £62. Pretty good considering somehow we managed to wangle (yes I know it's not a word, but it works!) 3 holidays this year, spanning the globe and various continents! The only problem was we took out the insurance on 17th March last year and the holiday was reshceduled to end on the 18th! So the last 2 days have been spent haggling (yes, we British are able to, when needs be) in the hope that they would extend the cover by 2 days. Normally this wouldn't be an issue, but thanks to the insulin pump, I am back in the high risk category, because they like you to have been on a new regime for 3 months before they consider you less likely to spring a claim on them! Thankfully, the nice people at Tokio-Marine saw sense (and no doubt did some google searching on the term "Insulin Pump") and agreed to extend the cover. And yes, we will be using them again!
Now, we need to consider the supplies! You've already seen a picture of my cupboard supplies, well holiday supplies get even worse! Because you pretty much have to cater for Armageddon and make sure that in the event of ANY emergency, you are prepared. So, each cannula (the tubing with flexible needle which attaches to the skin and pump) lasts me three days. I am away for a total of 16 days, so I need 6 cannulas to ensure I am covered for the basics. However, if Armageddon is imminent, or my bags get lost, flight gets cancelled, tropical bear climbs through the window and uses them as a chew toy, I need to double this really. Ok, 12 cannulas and I'm happy.
Now for reservoirs (the part that fits into the pump and stores the insulin I will use). Each one seems to hold around 270 units, which will last me around 4 days, seeing as 70 units per day would be at the higher end. I'm going to be there 16 days, so need a minimum of 4, keeping in mind that my insulin requirements will change. Ah, but what about a freak snow storm (if you've seen the Day after Tomorrow, you'll stop snickering now!), or perhaps another bag loss, or another tropical bear..... I'll take ten. Sorted.
Testing strips for my BG meter. Well, at the moment I am averaging around 10 tests a day, so will need 160. What?? That sounds dreadful, but realistic. I may well do more on holiday, keeping in mind the change in temperature, activity levels food and of course, running from a tropical bear or snow storms. I better take 200. That's 4 boxes of strips. A lot, but necessary.
Ok - now for weapons against lows. First, juice. Now I know they will have juice there, it's not the arctic after all. But I like to go well equipped, so will squeeze a bundle of boxes of juice in my luggage, just for peace of mind. Glucagon (a HUGE injection which has a glucose tablet and saline in it which my partner can inject me with if I completely conk out), now this is a must. Do we still have one? Check. Phew, one less thing to cater for.
Batteries. OK this one sounds strange, but the pump runs on a triple A battery, and although it goes for a month, I like to change it as soon as it says it's running out. It's been in about 2 weeks, so I definitely need a replacement. Plus I hear the world is coming to an end, better take 2.
Insulin! Yup, I can take all the supplies I want, but without this, I don't stand a chance. Now, each vial contains 10ml. I get through about 3ml per sitting, which lasts 4 days. So 1 vial should last me 12 days. But, in the event of me dropping one, losing one, breaking one, or a total freeze out in a freak snow storm, I have to take at least 2. You know what, make it three, it IS the most important part. Right, prescription request for another bottle coming up.
Injections. Well, while I hope not to ever have to use one of those blighters again, I have to plan for anything. If my pump conks out, breaks or gets eaten by a tropical bear or goes overboard while we evacuate the plane after the emergency water landing, I need to prepare myself for that emergency. So I need the pens (both of them, seeing as I was on two types every day), the needles (need to be changed every time, better take ten) and the prefilled insulin cartridges. OK, that's sorted.
Next, antiseptic wipes. Now, I use these anyway on the recommendations of the pros, because the pump 'site' where the needle goes in is there for 3 days at a time. But it is worth bearing in mind that I will no doubt be sweating more (it's currently 8 degrees here and 36 in Thailand!), and there will be a whole new set of bacteria and air born critters over there. Better take a box of them!
Right, are we done. Oh! Hang on! I need to prove that I am not a terrorist and am not in fact transporting doses of killer weapons of mass destruction in the form of liquid! I need a letter from my doctor explaining why I need so much liquid and needles and tubes and why I'm connected to something which looks a bit like a pager, but appears to be going into my body. Yup, need one of those bad boys to get through customs. And they are a steal at only £12. I thought it was ridiculous too.
Well, I think I have reached the end of this ridiculously long post. And hopefully the end of my planning for the holiday. Now I get to pack my clothes and do my 'other list'. The non-diabetic one.
My advice - plan early. In fact, I may be going away next spring, I think I need some..........
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