The Airport Security pat-down/throw-down/interrogation experience

I love to travel.  And although I find aeroplanes claustrophobic on account of my control-freak tendencies and there being 300 people on board, I find air travel exciting, terrifying and amazing in equal measure.  What I find less enjoyable is the veritable lottery of what kind of  frisk, detention, terror-threat suspect, 'experience' I will have at the passenger security check thanks to the diabetes paraphernalia I cart around in hand luggage.  Bizarrely enough when travelling with a pump six years ago, I rarely encountered problems.  I made it to Thailand and back to a friend's wedding on my first ever with-pump journey, without incident.  A usual 'show it, explain it, politely decline to have it x-rayed' mantra was enough to make it on board without an MI5 security team interview.  In recent years however, this has changed.

At Heathrow in July this year, a well-meaning-but-having-none-of-it security guard insisted repeatedly that, "Even pacemakers are fine in the full body scanner".  His persistent claims got louder and louder and more animated until it felt like there were exclamation points at the end of every sentence. It gets hard to be polite when someone wants to disappear with your pump after refusing to accept that it couldn't be scanned.  After losing sight of my pump he returned with it and confirmed, once again, that pacemakers can go through it.  I will of course bear this in mind - if I ever get a pacemaker. 

My journey home from Frankfurt involved three women taking me into a 'detailed check' (kit off, sans dignity) while they appeared confused, befuddled, horrified by my CGM sensor.  This was followed up by someone shouting 'random bag-check' as they carefully selected my bag from the conveyor belt, at 'random'.

The Dubai chapter of the book was inexplicable. Voices were raised, arms were waived and scowls were given.  None of the above perpetrated by myself.

Somehow I made it to America, post 9/11, with 42 hypodermic needles and enough insulin on board to hygienically murder and entire crew while my friend got stopped for a corkscrew, and yet an insulin pump and CGM sensor bemuses most security staff. And I know that one of these days as it is whisked away from my view (against my requests) it will be put through an x-ray machine.

I understand it, of course.  Only 7% of people with T1 diabetes use an insulin pump, and there are currently at least five separate types of pump on the market right now.  There are hundreds of other pieces of diabetes equipment alone and there are God knows how many for every other condition which get seen daily as the thousands of people come and go from the country - millions worldwide.  With terror technology modernising as fast as - if not faster - than medical technology, I can understand why a safety first approach is necessary.  And I'm glad they raise concerns, frankly, because I can feel safe in the knowledge that when someone comes through with a device which on closer inspection is suspicious, I know they won't be on my flight. 

But the question has to be asked, if medical technology of any kind does come through airport security on a daily basis, why is there not a single policy which is part of regular, standardised training?  And why is it not worldwide, in the same way that airport security is standardised worldwide? Yes, there are hundreds of medical devices out there, but when pump companies and hospitals produce letters about the handling of these items, why are their hosts under fire of multiple questions, in different ways, dependent on the day of the week it is, and who is on shift that day?

The issues are that the damage - or possible damage - done by the full body scanners to an insulin pump - which is effectively a small computer - is largely unknown.  I have watched a fellow blogger go into one wearing their pump without incident.  But the warnings are clear, and are agreed upon by all the major insulin pump companies (Omnipod is not affected).  Going through any surveillance procedure which uses this technology with a pump carries a risk.  But as it becomes more commonplace to use full body scanners as the go-to security measure in airports, this places people with diabetes using technologies which are growing in popularity in a difficult position: refuse and raise questions of your suitability to travel, or go through and risk your pump being exposed to potentially damaging x-rays. Just how global can your pump company deliver a replacement pump?

The good news is that change is afoot, with your help.  This topic was recently raised at the Animas Hero meeting a group I have the honour of being part of, as a number of people raised concerns over the mandatory introduction of full-body scanners at UK airports from December 2016.  The following conversations uncovered that Rachel Humphrey at the Universal Freight Organisation was working to raise the profile of this issue at an international level.  Rachel is in contact with the Head of Training at Airports Council International (ACI), who are in turn going to raise this issue in May 2017 at the ICAO (The UN agency for Aviation).  ACI have said:

“The information has been forwarded to ICAO (The UN Agency for Aviation) for their consideration and advice on the best way to raise the issue globally to screening authorities."

ACI will present the issue to the ICAO Aviation Security Panel in May, requesting that it is included in global guidance material. Additionally, ACI will continue to raise awareness with its members through its committees and circulars to airports."

Although many people travel daily without incident, many are also subjected to arguments, questioning and the process of having pumps removed and taken out of sight, due to the varying degrees of training as to how to approach the issue of unfamiliar (should be familiar) medical technology encountered at airports.  I have a 100% record for botched security procedures inn 2016, and as someone who can hold my own but gets deep uncomfortable at the through of being one of 'those' passengers, it's clear this isn't just a one-off situation. And for those using technology which is becoming more common place year-on-year, this has to change. 

If this issue is important to you or someone you love or care for, please visit the links below and look in particular at the petition linked in. And if in doubt, contact your pump/CGM maker for a copy of their letter explaining how their device should be handled.

The official position of Diabetes UK on airport travel with diabetes can be found here.

The petition for a standardised approach can be found here.

The current protocol for security when travelling from the UK can be found here.

Everybody loves Frio!

If you have type 1 diabetes and need to keep insulin cool, then you will undoubtedly have heard of Frio.  When travelling New Zealand at the beginning of the year my Extra Large Frio case became my best friend for keeping my meds in happy holiday mode.

When Frio UK contacted me to ask me to take a look at some new products I was glad to because, frankly, I heart their products.

Here's what I thought!

Check out their shop here.

If you have any questions about their products feel free to drop me an email at anna@insulinindependent.com.

Control Freaky

This picture gives me the shivers. Not the butter compartment, well-known as the des res living accommodation of insulin, but the fact that this butter compartment is in a communal refrigerator of a public campsite inhabited by up to 100 people at any one time. 

I'm a self-confessed control freak about most things - no doubt a result of 28 years of having words like 'control', 'in-range' and 'compliant' (*shudders*) a part of my lexicon since diagnosis. But I'm especially control freaky about my diabetes. I feel safer that way. Anything I don't have control over with regards to my blood sugars, medications - even complications, unnerves me. 

In England, leaving your insulin at the whim of any would-be trouble-maker is a big no-no,  and I would rather leave my car open with a sat nav on display and a large sign saying 'take me', than leave my insulin out for the taking. 

That said, I am currently at the beginning of a eight-week trip around New Zealand, and while my Frio case is doing a good job at stopping my insulin from warming up, it doesn't feel as though it is keeping 'refrigerated' exactly. With its chemical stability comprised after 28 days, and my trip lasting 65, I am trying to keep mu insulin in as good a condition as possible and trying to keep it refrigerated. This means embracing the public fridge now and then, come what may. 

Let's hope New Zealand lives up to its name of being a safe place. And let's hope leaving my insulin on display is the turning over of a new relaxed leaf for me. 

Although there is a chance that the total control freak in me may also have 2 bottles stashed in my emergency, 'goes everywhere with me' travel bag, and one more cheeky bottle hidden in my handbag. I'm also insured up to the hilt and have an app which shows me all the nearest hospitals and doctor surgeries. You know, just in case. 

Loans without interest

If Charlie has one cannula which lasts two days, a bottle of insulin which lasts 10 and a bottle of 50 test strips, how quickly will Charlie travel 15 miles on a train travelling at 60 miles per hour?

I finally understand the point of those seemingly inane classroom maths quizzes.

As we plan for the big trip, and the possibility of Armageddon, my brain turns to mush at the mind-melting mathematics I have to do in order to make sure I have all the equipment, insulin and general diabetes paraphernalia I am going to need to successfully navigate my way across the other side of the world for just two short months.  As I do so, it reminds me how vital each link in the diabetes armour I wear really is: without cannulas, the tubing is pointless; without tubing, the insulin is redundant; without the insulin, I can expect only to get to know the hospitals of New Zealand. If any one piece of this equipment fails, the rest is rendered obsolete.

But above all, none of the equipment has any use at all if my pump pops its little Animas-shaped clogs while down under.  Animas, like many pump companies, offer a loan pump service if you are going away for a while.  As I ticked the final boxes on my checklist of travelling to-dos, I called them up and ordered my loan pump.  I'd already ordered my pump insurance (mainly because loan pumps are covered on this ample policy), but on the off-chance that something should happen, I wanted to make sure I could just switch pumps and carry on enjoying the trip of a lifetime.

Once again Animas' customer service impressed me when they agreed to let me use a loan pump for two months, as opposed to the couple of weeks they normally offer one.  They did have to check this amount of time would be OK, and carried and a couple of checks to make sure their stocks were high enough to ensure other customers could also use a loan pump if needing to, but my spare pump, in New Zealand pink (other countries are available), arrived today, shiny and boxed up ready to go on a journey of its own.

It is worth remembering if you are going away to check that your pump company does offer this kind of service, and that an extended trip won't be a problem.  I'm also taking pens, insulin and needles with me just in case, but having this little safety-net on board while I'm away makes me feel even more safe while honeymooning in an unfamiliar land.  Thank you, Animas.

Down Under with D: Travelling with diabetes

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.

Medtronic holiday pump loan: Old dog, new tricks

Thankfully Medtronic, my favourite (and only) insulin pump company, have chosen to replace yet another pump belt clip after mine went camping with us in the New Forest and never made it home.  I'm losing count of how many times this has happened now but luckily for me, Medtronic don't seem to mind.

So there I was, ecstatic that the new clip had arrived in time to come away on holiday with us when something in their letter (normally binned without a second though) caught my eye:

Perhaps it was just the word 'holiday' that stood out because in just two short days Jamie and I jet off for our first anniversary two week Scottish Highland adventure, but out jumped a little sentence that may be of interest to anyone who's been on holiday and packed as though Armageddon is coming, just in case their pump dies in on them mid Pina Colada (or Hagis, whatevs).

According to the letter Medtronic, who customer service I have raved about before, now offer a 'Holiday Loan Pump' service.  It seems if you are heading off on your holidays and normally sport your own insulin pump, all you need do is drop them a line 4 weeks before you go and they will help you out with a loan pump as peace of mind, in case yours packs up for any reason.

All you need do is contact the Product Support Helpline on 01923 205 167 and there you have it, simple as can be.

Medtronic, you never fail to impress me!

And thanks for the clip, I'll be in touch again shortly, no doubt.

Looking back: A year with a pump at my side

There are many things which will change your life. Literally. Choices you make and experiences you encounter can be both the making of you and the breaking of you. Perhaps these milestones are different for all of us, or perhpas we share many of the same. For those who have children the moment you conceived was no doubt a moment that changed the path of your life forever. For those who travelled, maybe the things you experienced while emersed in another culture will be the motivation that underpins some of your most crucial decisions in life. Perhaps a particularly good - or bad - relationship has changed the way you view your life and the expectations you hold because of what you learnt about yourself. But whether we all share the same 'moments' or not, one thing is for sure: For each and every one of us there are moments - not just one - but many, that change your life somehow, be it for better or worse.

For me, one such decision began to emerge in my mind in 2009. A seed - tiny and barely nurtured - was planted in my head while I was on a JIGSAW (Juggling Insulin for Goal Success and Well-being) course and involved something about an insulin pump and how useful they could be when you suffered with poorly controlled diabetes. Something which at the time, I rejected without a second thought. But this one little idea began to gather momentum and cause the curious button in my head to need pushing. At first, the thought of an insulin pump with its crude wires and constant glaring presence was something which repulsed me. Even disgusted me, dare I say it. How, when diabetes had already drained so much of my life could this BOX (!) solve any of my problems?

But that's the funny thing about a seed; even in the most harsh and hostile landscape a seed can flourish and develop into the the most breath-taking of plants.

That seed, nestled in my hostile head surrounded by negative thoughts and stubborn ignorance began to flourish. With the wonder of the internet at my fingertips, I nervously started looking up images of insulin pumps and finding forums to piggy-back on and see what people were saying about these pumps. Pretty soon, I stumbled across a blog which would water that seed in my head. This blog was written by a lady I could really associate with. She was my age, she was also diagnosed in 1986 and she was pregnant, which when it came down to it was the only reason I was willing to give this contraption a go. Because one day I wanted to bring a child into the world with the man I had come to love. This blog, was Six Until Me.

This blog was honest, open, beautifully written but most of all, real. The stories Kerri told were not about the horror of wearing a pump or the restrictions it placed on her life. In fact it didn't sound at all like she was mourning the loss of a former life, which was the way I felt when I thought about the pump. It talked of fashion, friends, the diabetic community (something I too was about to stumble on), the promise of a future and of the creation of a new healthy life - one her readers came to know as BSparl (her kiddo!).

It wasn't long before that button in my head began to throb again.

Push me, PUSH ME!

I'd estimate it was about a week after that I first emailed my DSN with a million pump-related questions in my head. My new found fascination with an insulin pump had begun. And once the idea was there - I wasn't about to forget it.

On the 25th January 2010, my life changed forever.

Attaching the pump initially was - I imagine - like watching a monkey use tools for the first time. I was 'all fingers and thumbs', shaking a little and convinced I was doing it all wrong. For the next 24 hours I had this immense awareness of my new pump, almost like when you get a new phone which barely leaves your hand - let alone your handbag - for the first few days after you get it. I started to navigate my way around the menu learning at the speed of light about boluses, basals, daily totals and carb ratios. I imagine you would learn slower if you joined NASA or MI5! But nevertheless, something which only 6 months before had terrified and repulsed me, became interesting and engaging. I started talking to my friends and family about the pump, tricking them into guessing where it was hidden today, because unlike my mistakenly ignorant first impression, the pump can be hidden, isn't a monstrosity and doesn't take over your life.

But no one can go through this alone and surrounded by my team of supporters, I began to explain the pump to anyone around me who would listen. My fiance, who had to earn his degree at the University of Insulin Pumping pretty darn quick, took this challenge in his stride, learning terminology like cannula, bolus and "Darn, I didn't re-fill before we came out!", quicker than you can say 'I love ya'. My mother, who for years held me up when I couldn't manage myself, took delight in hearing that I was reaching my pre-pump goals for the first time in 20 years. My friends, who I have no doubt were intially freaked out by the idea (mostly because their faces told me just that), could not have been more supportive or accepting, when it came to me whipping an insulin pump out from my chesty area!

Before long my own blog, one which began as a project to help me negotiate the psychological and emotional adaption that life on a pump requires, began to connect me with my own diabetic community. It led me to the Diabetes UK facebook site, which in turn led me to some of the most talented, creative, positive and go-getter type people you could imagine. Some shared my story, some had a whole different perspective on things. Either way, I went from being someone terrified and beaten down by my own condition, to someone feeling more in control than in the previous 23 years of having diabetes. I began to learn that blood glucose testing didn't have to be about pot luck. I began to learn that waking up in the morning having had a good night's sleep without hypos, hypers, loo visits and fridge raiding, was something everyone - even me - could expect. No, could demand!

I also began to learn that I was allowed to have far higher expectations of what my range of blood sugars could be. When people used to tell me that us diabetics should be aiming for 4-7mmol (80 -120 mg/dl) I would have laughed (and cried a little, inside), because in my whole adult life I had never had a day, let alone a week when I had acheived those kinds of numbers. At my very best clawing at 'control' with every last shred of energy I could muster, I had never achieved an HbA1c of less than 9.6%. Within 6 months, this had fallen to 8.2%. And I use the word 'fallen' because I wasn't doing any more than normal. Granted, I had begun doing more tests, but tests alone won't change anything. This, had happened simply as a result of my pump. My last A1c was 7.9%, and with the kind of readings I have been having in the last 2 months thanks to adapting my diet to a lower carb system, I have every confidence in the world that my next A1c will be in target.

The last year of my life has been a roller coaster. I have learned about the triumphs of conquering goals I thought were impossible to reach and how it feels to give diabetes a swift kick in the stomach, just as it did to me for all those years. I have learned about the pitfalls of kinked cannulas and packing for holiday with what feels like the worlds biggest collection of diabetes supplies, just in case armageddon comes a knocking.

But the greatest and most significant lesson I've learned, is that there is a vast community out there experiencing all of those highs and lows that kept me in a dark and isolated place for so many years. The friends I have made in the last year and those relationships strengthened by people's acceptance and even interest in this pump and how it has changed my life is a lesson that has changed my life forever. And for the better, much, much better.

I can only hope that the next few years of my life, as I plan my own family and move on into new and daunting challenges, will bring me even half as much knowledge and excitement as the last year has. I can only hope that my circles of friendship will expand beyond those I have already found. I can only hope that this disease which for the first time in my life I feel I have conquered, will bring me as much as it has in the last year.

I am thankful that I no longer feel like the pump is a contraption, a box or a hindrance. Quite the opposite in fact, it is part of me. It is a significant part of me, as it has helped me have the quality of life I deserve and has allowed me to grow, flourish and enjoy life again. I am also thankful that having just passed two enormous milestones, those being 24 years of having diabetes and of having celebrated my first anniversary of joining the 'pumping club', I can honestly say that the latter came from one of the best decisions I ever made.

I am thankful for what I have discovered, conquered and experienced - even in the face of the adversity that comes with this condition.

My condition.

Our condition.

Holiday highs and lows

Well, Thailand is perhaps one of the most breathtaking places I have experienced. Until now, the hottest places I have been were Florida and Spain. Being hot and dusty places, I wasn't quite expecting the unbelievable and unparalleled beauty of the landscape, the limestone cliffs, the stunning coral reefs surrounding each of the hundreds if islands or the tireless hospitality of the locals. Crystal clear water, cloudless skies and beaches only movie sets could mirror.

But enough about the perfection, this blog is about one thing. Diabetes and how to cope with it. In the past, holidays have been something which have brought a mixture of both good and bad. Great to get away from the grind and enjoy some peace and quiet, an opportunity to let my body reset and get back to a healthy state. On the other hand, the minute I am eating food which isn't perfectly weighed and carbohydrate calculated, those sugars start having a party. Mix that with a time difference, hot temperatures, alcohol and even sleeping in, and you have yourself the perfect concoction of trouble. A mix of trouble which would make even the most well behaved diabetes would fall off the wagon. So many variables that the diabetes runs off like a spooked horse which has no intention of stopping!

There were certainly some challenges which arose with the pump. Of which I will concentrate on only one. Mainly because this was the biggest problem, and because it would be quite a long blog if I listed all the challenges.

For those who read my previous blog about the planning which goes into packing for holiday from a diabetic's point of view, you will know that I planned for every possible eventuality, including tropical bears (!) when I calculated how many cannulas I would need for holiday. Well, it turns out I forgot one. The fact that I would be in the pool or ocean everyday and would be sweating more than normal. For those reasons, my first cannula fell out, or rather tugged out with ease after just one day of wear. Now, I took 10 cannulas, which was enough for one month. I figured that this was enough before I left, but in my new knowledge about the wear that water could cause to the sticking plaster, if I continued to lose them at one a day, I would run out after 10 days! I decided to try my hand back at injections, because I knew I had enough insulin and needles to last.

BIG MISTAKE.

After just two days, I had had more sugars over 20 than I could remember, lost a whole day to sleeping because my BG (blood glucose) and was so out of control that my body gave up. So I got myself back on the pump quick smart, having never been so grateful of being attached to it. And guess what happened? At 11pm when I re-attached the pump I was 23.2mmol, by 9 am, once back on it, I was 5.6mmol.
So I decided to stick with the pump but to try and keep the site as dry as possible, which meant checking it a lot and having a little tug now and then, just to make sure it wouldn’t pull out in the middle of a trip or god forbid, the middle of my friend’s wedding! Now it was still a challenge, especially on days when we went snorkeling, because of the constant water contact to the cannula. But somehow it all came together ok. I just had to ensure that I was mindful of the time so that I didn’t stay in the water much over an hour. Those who are on a pump should only ever be off it for around 30 minutes – 1 hour. This may sound like a lot, but when you have some of the best snorkeling Thailand has to offer, 1 hour is not enough. But I’m still here and despite some ups and downs, I obviously made it through the holiday, so no harm done. And even though I hit some high highs, and some low lows, my sugars were still nothing like they were when I was on MDIs. I would still wake up with sugars of around 5mmol everyday, and I didn’t worry nearly as much as I used to. Perhaps that one dodgy cannula at the beginning was a fluke, or a faulty, or perhaps I had knocked it on something and caused it to become a bit loose. Whatever it was, I eacked them out to the very end and they lasted. Phew.

The moral of this story (blog)……it may still be rough, but the pump makes it a damned sight easier.

Thought train of a pre-holiday diabetic (Armageddon is nigh!)

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..........