When we tied the knot three years ago and took a brief 4-day trip to Cornwall as a 'mini-moon', Jamie and I could never have known how much would change almost instantly in our financial situation. The plan had always been to travel New Zealand for our honeymoon, a dream I'd had for the best part of 10 years. But with the recession, a property which plummeted in value and a redundancy for Jamie things took a turn for the worse, and the honeymoon we had planned had to be shelved until further notice.
Three years on, and with a lot of hard work and saving under out belts, Jamie and I are finally realising that dream and in just under two months time will travel down under to spend nine weeks in New Zealand and Australia, finally enjoying the honeymoon we never had. We've spent months booking flights, researching the best ways to get around, studying travel guides, investing in snazzy cameras and checking out the delights that these magnificent countries have to offer. But as the time to head off to try our hands at being intrepid explorers approaches, the daunting task of travelling with diabetes has started to dawn on us.
At times travelling with diabetes can seem like having an extra person to manage, from catering for the extra bag the insulin pump and CGM paraphernalia demands, to the pre-ordering of 3 months worth of supplies, ensuring we have a plan for hypo treatments to keep on us at all times, and locating hospitals and places of safety abroad, just in case anything goes wrong. And I've learnt that if you plan for Armageddon, you will be somewhere close enough to being prepared for the adventure ahead.
Here are a few of the tips I've learnt:
Flying
We've chosen to fly with Emirates, and discovered the benefit of being able to reserve exit row seats, - albeit ones we may have to give up if anyone is travelling with a baby. Now, exit row seats aren't a diabetes issue as such, but as someone who has found that my blood sugars start to rise as soon as I start to get uncomfortable or frustrated on long distance journeys, having the option of being a little more comfortable and being able to get more sleep - therefore reducing the levels of adrenaline and cortisol flying around my system disrupting my blood sugars - is a god send. Our journey is an eye-watering 27 hours, so the more of that I can avoid my blood sugars going haywire, the better.
Disconnecting during take-off and landing
When I read this article by Melissa Lee at A Sweet Life about why to disconnect your pump during take-off and landing, I was flabbergasted that more is not made of this in initial pump-user training. You see, when the pressure changes inside the plane, your insulin has no way to cater for those pressure changes without pushing air out of the insulin, called 'outgassing'. Think of a can of fizzy drink, when the pressure in the can changes by you opening it, air bubbles are forced out of the liquid. The same thing is happening with your insulin as it forces a bubble out of the tubing in order to cater for the pressure change. That bubble is now sitting under your skin, causing your blood sugars to rise. Then, when pressure decreases again suddenly, the bubbles gathered in the tubing can be pushed back along tubing forcing insulin into the body, leading to what they call 'Baggage Claim lows'. And your pump will be none the wiser.
The easiest and best ways to cater for this are to disconnect your pump on take off, and priming and re-connecting once the plane is above 20,000 feet and levelling out, because it is better to be absent of insulin for 30 minutes than for those bubbles to make their way down your tubing leaving you with 2 units of air at the end of it. And when the plane starts to descend, do exactly the same, to avoid any bubbles lodged in the tubing pushing insulin back out again. Voila!
Keeping Insulin Cool
Insulin is only guaranteed to be 'stable' for 28 days when out of a refrigerated state. After that time it may well still be OK to risk on a personal use basis, but if you are using a three-month old supply and it doesn't seem to be touching the sides anymore, this could well be the reason. I've only ever been away for 2 weeks before, so this is the first time I've had to consider how to keep my insulin supply cool for the second month - particularly as we are primarily camping and using hostels in major cities. I use between 50 and 70 units a day, so am catering for 1 ml a day, just to be safe. That means I will use a 10 ml vial every 10 days. We are there for a total of 65 days and I will take 2 spare bottles. You know, in case of Armageddon. That means I need to take 8 x 10 ml vials with me. Three of those I can keep out, because I will be using them in the first 28 days, but the other five I need to keep cool while not in use. But how, when rocking campsite chic in the deepest darkest 'nowhere' in New Zealand?
Frio have an ingenious cooling bag designed for exactly this little conundrum. The bags are effectively like little picnic cases, and can keep insulin cool for up to 45 hours by immersing the pack in cold water for as little as 5 minutes (depending on pack size). So every couple of days you can dunk and go, keeping your unused insulin cool for that time. Perfect!
Loan Pump
My pump quite literally keeps me alive. It is my most precious possession, even more that my beloved phone or laptop. But it's also just a gadget: a gadget which breaks. If you use insulin pens with background insulin, then you have a good 24 hours before you would be in a situation of dire medical need. With a pump, the moment I pass the three hour mark after I unhooked, my body is without insulin and my blood sugars are already starting to rise. Being without my pump is not an option, and although I am taking pens, syringes and insulin bottles in case the worst should happen, my preferred method of insulin delivery is my pump. If nothing else then to enjoy the trip without doing battle with my bloods sugars, or sitting out of activities because I feel ill.
Most, if not all, pump companies now offer loan pumps, which is a spare working pump you can take away on holiday with you at no cost. Before you go, take a photo of your current pump settings, so that you could programme a new one and bam!, you're covered.
Just contact your insulin pump company a few weeks before you go and ask for a loan pump. Any company worth its salt will have you one in the post within days.
Knowing what's around you
Although I haven't needed a hospital trip for my diabetes in the last 20 years, it's a good idea never to get cocky with diabetes. Only two years ago I found myself on the kitchen floor hallucinating about people being in the house as Jamie called an ambulance, because I was terrified and suffering too aggressive convulsions for him to get the emergency glucagon into me. One little repeat of that, and our trip could be cut horribly short with an emergency hospital stay.
I discovered an app called 'Camper Mate' which is a smart phone app showing you at a glance what is near you in NZ, from petrol stations to free camp grounds, or hospitals. If anything was to go wrong - if we lost my medical supplies or had them stolen by a wily Hobbit; if I was fighting an infection and blood sugars were uncontrollably high, whatever, this app will help me locate nearby hospitals and doctors, and help me feel safe whilst making memories of a lifetime.
Insurance
The person with diabetes who goes away to an unfamiliar country without medical insurance, is a fool. In Europe we have the benefit of the EHIC card, which can get you free medical care at the point of access, but this doesn't work once outside the borders of Europe. But medical insurance, once you disclose type 1 diabetes, can go from 'pricey' to 'cancel the trip' status. I'd always heard that Diabetes UK offered affordable insurance, so called them up for a quote. Much to my horror their Gold Standard package was a jaw-dropping £456! Sinking to their bronze cover was still going to cost me £318, and now came with a higher £70 excess and dropped personal belongings cover to well under £2000, although medical was still £10,000,000.
On the advice of fellow PWDs, I dropped by Insure and Go, and was astounded when they offered me £10,000,000 medical, £2500 personal belongings cover and only £75 excess, for £156. That included 15 days worth of 'hazardous activities' and full coverage of my type 1 diabetes. And did I mention that covers Jamie and his working pancreas, too? It's a no brainer!
Insulin Pump insurance
Until recently it hadn't occurred to me to get my pump insured, because as I wear it 24/7 and any problems I've had in the past have been mechanical or damage covered under warranty, the pump companies I've used so far have switched them out within 24 hours. But on this trip I'll be taking a loan pump, and although my pump is waterproof I may make the decision to remove it during any activities where it could risk being damaged. That means if anything were to happen to either my own pump, or the loan pump, I would have to pay for a new pump. And they are a complete steal at £4,000 each! As I rely on it, quite literally, to keep me alive, I didn't think the £6.99 policy with Insurance 4 Insulin Pumps was all that bad - especially as they cover loan pumps and worldwide travel. Some home insurance policies will cover your own pump, but as someone without my own home insurance, and with a loan pump to care about, this was yet another obvious choice.
And finally...
Continuous Glucose Monitoring with the Vibe
I have been a fan of Dexcom CGM since before I started using it, and deeply in love with it since I first hooked up. I also use a Vibe insulin pump, and although I had to step away from integrated CGM recently due to one too many overnight hypos waking me up with the pump vibrating violently at my hip, I don't want to take any extra equipment than I need to. The idea of this trip is to 'scale down and live it up'. So for the two months I will be away I plan to integrate CGM into my pump, so that I have one less thing to carry. And as the handheld unit costs around £975 in the UK, I think I can deal with the CGM alarms buzzing away at me for just a little while.
Life with type 1 diabetes is about finding a balance between planning, reacting, damage-control and the odd 'hands in the air' moment of confusion. But the purpose of all this is that when Jamie and I take that honeymoon we've always dreamt of, and will tell our children about, we can say we enjoyed every second. The planning is so that when faced with these views, diabetes fades away and experience takes over.
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