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Low Carb Cruise 2015

How am I supposed to summarize a wonderfully magical week full of meeting amazing people, seeing paradise islands and learning superinteresting new information? Perhaps just like that?

This years Low Carb Cruise in the Caribbean at the end of May was a complete success. We were about 200 participants, with a wonderful mix of backgrounds and reasons for being there, that set sail on the 24th May 2015.

Our ship, “Independence of the Seas” is one of the biggest cruise ships in the world, with over 4000 passengers. This made our group of low carbers pretty small, but at the same time feel closer together.

With that big of a ship, the food was definitely not low carb adapted. The sheer mix of sugar, grains and other stuff we know we donät do well with was at times overwhelming before seeing the options before my eyes. Every night was a sit down dinner in the glamourous 3 floor dining room, where you could choose freely what to have to eat from a menu that changed each night. A certain knowledge of how to navigate a menu was required, at least if you are handling food insensitivities (like most of our group are). This sometimes meant that you had to choose something else than what you really wanted from the menu, although the staff were amazing at meeting every single request of special orders that they possibly could.

Food on the ship (and mainland USA, too) is still very calorie based. “Low-fat” and “sugar-free” are still considered “words of wisdom” for most people, without a care in the world that these removed items have been replaced with chemicals and additives that I would prefer not to have in my body.

 

Lobster Night at the Low Carb Cruise 2015

Lobster Night at the Low Carb Cruise 2015

 

As for the Low Carb Cruise itself, we were listening to presentations by the speakers when the ship was in transit at sea. The days on the islands of Puerto Rico, St. Maarten and St. Kitts I spent with other low carbers that had chosen to go on the group excursions as well. It was wonderful to see all these places of paradise that I’ve previously only heard about!

The first seminar day of the Low Carb Cruise had a clear theme: diabetes. This was the whole reason for me to initially actually click “book” on the cruise, so my expectations were high to say the least. Especially with speakers such as Dr. Eric Westman, Dr. Keith Runyan, Jimmy Moore, Jackie Eberstein and Sweden’s own Diet Doctor, Dr. Andreas Eenfeldt.

Both Dr. Runyan and Dr. Westman talked about how eating low carb high fat helps in the treatment of diabetes, the former focused on both Type 1 and Type 2, the latter more focused on Type 2. These presentations were, for obvious reasons, particularly interesting to me! But it can’t be denied that Diabetes was mentioned in a vast majority of the other presentations as well.

 

 

Dr. Westman and I at the Low Carb Cruise 2015

Dr. Westman and I at the Low Carb Cruise 2015

Dr. Runyan and I at the Low Carb Cruise 2015

Dr. Runyan and I at the Low Carb Cruise 2015

 

Amongst other highlights from the first seminar day was Dr. Justin Marchiagiani’s presentation on hormonal imbalances and the blood sugar connection, where thyroid issues were lifted forward as well. And Dana Carpender’s colorful presentation about ADHD and low carb eating. And, brilliant as always, was also Dr. Eenfeldts presentation about the Food Revolution.

For the following 3 days there was socializing and excursions on the menu:

 

Amazing view on St. Kitts

Amazing view on St. Kitts

Orient Beach, St. Maarten

Orient Beach, St. Maarten

Yummy fresh coconut in San Juan, Puerto Rico

Yummy fresh coconut in San Juan, Puerto Rico

San Juan, Puerto Rico is one happy place!

San Juan, Puerto Rico is one happy place!

 

Once we had all gotten some sunshine on our noses, fresh ocean breeze in our hair and were many smiles and laughs richer, it was time to continue the seminars. By this point, the ship was already on her way back to Fort Lauderdale in Florida.

This seminar day was nothing short of amazing, either. Speakers such as Dr. Ann Childers, Jackie Eberstein, Cassie Bjork, Dr. Jay Wortman, Emily Maguire, Jimmy Moore and the founder of Ketonix, that measures the ketone level in your breath, Michel Lundell were responsible for masses of great information, laughs and well-made presentations.

Perhaps not surprisingly, Diabetes got a lot of attention here as well, although it wasn’t explicitly on the agenda. The BIG focus was on Type 2, and how it often comes hand in hand with other health issues.

We were taught about the misunderstandings of a ketogenic diet, why you won’t lose weight although you’re eating low carb, how women’s hormones relate to weight loss and how LCHF is seen in the rest of the world.

The final day of the Low Carb Cruise 2015 was featured by Dr. Michael Fox, who spoke about women’s hormones, fertility and how low carb eating ties into it. As well as Dr. Jose Lozado’s presentation on how certain forms of cancer can be prevented by eating low carb high fat and other lifestyle choices. After that the whole intensively awesome week was wrapped up with a great Q&A session with all the speakers (and a private cocktail party after that).

The whole experience was absolutely phenomenal! I’ve met so many amazingly warm and open people (see some of my heroes that I met below! (I’m still kicking myself that I didn’t get a proper picture with Mr. Moore…)), made new friends, learned so much of the latest research and had such a fun week!

Even if this week definitely wasn’t just fun in the sun and beach life, I’ve gotten to see and experience new knowledge, new places, new food and new, lovely people.

I really can’t wait for next years Low Carb Cruise!

 

Dr. Andreas Eenfeldt, Sweden's Diet Doctor, and I at the Low Carb Cruise 2015

Dr. Andreas Eenfeldt, Sweden’s Diet Doctor, and I at the Low Carb Cruise 2015

Jackie Eberstein and I at the Low Carb Cruise 2015

Jackie Eberstein and I at the Low Carb Cruise 2015

Emily Maguire and I at the Low Carb Cruise 2015

Emily Maguire and I at the Low Carb Cruise 2015

Cassie Bjork, aka Dietitian Cassie, and I at the Low Carb Cruise 2015

Cassie Bjork, aka Dietitian Cassie, and I at the Low Carb Cruise 2015

Travel Checklist for Diabetes

Maybe you’re planning a trip soon and would love a travel checklist for diabetes?

(I made you a travel checklist for diabetes below, make sure to check it out!)

What is necessary to bring along on a long trip with diabetes?

Sometimes I feel like diabetes just has it’s own luggage to bring along, physically as well as emotionally.

The emotional luggage we’ll have to discuss another time, because this time I want to talk about the physical luggage Diabetes brings along. Especially when traveling.

As if packing for a trip isn’t stressful enough (“what shoes should I bring?”, “does this dress go with that jacket?”, “what make up should I bring?” and “WILL IT ALL FIT IN MY BAG?!” – you get the point…), as an added bonus, you also have to haul around on all the stuff that you need for diabetes to keep in line.

I always bring all my supplies in my carry on bag when I fly. That way it’s harder to lose it, and the insulin stays at the right temperature throughout my trip.

The size of said carry-on bag has changed, though, in favour of trying to save my shoulder from falling off from carrying all the heavy stuff. Now I bring along a small, cabin sized wheelie bag where I have all my supplies, from insulin, to pumps, to test strips, to hypo treatment.

I also deposit a few things in my traveling buddy’s, usually my husband’s, bag. At least that way, if I lose my carry on, I’m not completely stranded in terms of diabetes. He has an extra blood sugar meter and test strips, and insulin with emergency-syringes. And glucose tabs. One can never have enough of those.

While I make sure to bring along most things on my travel checklist for diabetes, I don’t always bring everything.

Like ketone sticks, for example. I don’t usually bring those, unless I’m traveling somewhere really remote with no pharmacy within the next hour or so of driving. I figure that I can buy them pretty much anywhere I go.

On the other hand, insulin and BG test strips can get really darn expensive, not to mention inaccessible without a prescription, unless you prepare properly and take enough with you for your whole trip. “Enough” here means way too much, by the way. You never know what might happen, so it’s better to be prepared for most things that may happen.

Food

And, pretty please, get organized and bring your own snacks. Food on the road is generally beyond terrible, and like that you know you can at least eat something. I bring things like nuts and dried meat and other cutleryless foods on the plane, whilst in a car or on the train you can get a little more creative. This time around I’m going to make low carb pancakes and wrap them up in foil to bring along on my long flight, as I know from experience that food on flights is never good.

Another note regarding food, please don’t get fooled by the “need” to snack, which is most commonly masking the fact that you’re bored out of your brain.

Water

Traveling by plane is like sitting in the middle of the desert, although maybe not quite as warm. It’s dehydrating like nobody’s business! Being hydrated can really be one of the keys to better diabetes management, so please do us both a favor and DRINK A LOT OF WATER! (and skip the booze up in the air, but that one is evident, right?)

Security

Getting through airport security can be a lot easier than it’s made up to be. This is of course assuming that you don’t meet an a-hole security agent.

In my 30 years of living with diabetes, having traveled to many different parts of the world (although I have MUCH left to see and visit!), I’ve been stopped exactly twice at security. Once for my test stripes (what, you didn’t mind the syringe full of potentially very deadly stuff in my bag? Ok, then.) And once because my pump set the alarm off. In both cases it was easy to explain, and I didn’t even have to show my medical certificate. Security agents see so many diabetes supplies on a daily basis; they’re barely phased by them anymore. At least within Europe.

Now, I’ve heard that US TSA agents can be a little trickier to handle. For example, they have no problem jeopardizing your super expensive medical equipment and tell you to go through the full body scanner wearing your insulin pump, for example. I would insist on the pat down, not risking any breakages or malfunctions. This of course means that it might take a little longer for you to get through, but it’s worth it, and as long as you know about it, you can plan for it.

The bottom line is, as long as you’re nice and cooperative (enough) to them, they’ll usually treat you with the same respect.

Anyway, let’s check out the goodie in this blog post, my Travel Checklist for Diabetes.

These are the absolute essentials that you need to bring with you (or at least ocnsider bringing with you). If you think “I’ve never needed that before”, you should probably take it along anyway, as traveling can make your body do some funky stuff.

Travel checklist

  • Enough insulin to cover the days you’re gone (this should be a no brainer!) Make sure you bring both basal and bolus insulin, even if you’re using an insulin pump. You just never know…
  • Blood glucose meter & enough test strips, extra batteries (it might even be good to bring an extra BG meter.)
  • CGM sensors
  • Keto sticks (As I said, I don’t always bring them)
  • Glucose tabs (or whatever you use to treat a hypo)  (Bring too much of this, you never know what your body think of your new location.)
  • Snacks. (See above)
  • Glucagon Kit (most airlines don’t have these on board their planes. Better be safe than sorry!)
  • Alcohol wipes (these are great, not just for setting infusion sets and cleaning fingers, but also for wiping surfaces like tables, handles or cutlery that seems unclean.)
  • Other prescription medication and supplements you may be taking (easy one to forget, trust me. I’ve done it before.)
  • If you’re going somewhere really warm (lucky you!), bring something like the FRIO bag to keep your insulin in. (http://www.frioinsulincoolingcase.com)
  • Medical Certificate (This can save you at security checks!)
  • Diabetes ID (If you’re found unconscious somewhere, I’m sure you’d prefer that the EMTs knows what you’ve got.)
  • If you’re going somewhere remote, bring a glucagon set. (Again, you never know.)
  • Your BG diary, if you use one. (Otherwise there’s some great apps for that, for example www.glucosebuddy.com or www.mysugr.com)
  • Address and telephone number of your doctor’s office.

If you are on injections, also bring:

  • Insulin pens, plus back ups
  • Pen needles

If you’re on a pump, also bring:

  • Your pump, as well as possibly getting a back-up pump. (This can be ordered from your pump manufacturer.)
  • Batteries/Power adapter
  • Cartridges (if your pump uses those)
  • Infusion sets, or just enough of patch pumps
  • Syringes/pen for emergencies
  • Basal insulin for emergencies

If you’re planning a pumpcation (vacation without your pump):

  • Your action plan, that you’ve talked to your med-team about
  • Pens and needles
  • Basal and bolus insulin

It’s better to take too much than too little!

I’ve made a pretty print out of this list that you can print out and tick off the boxes as you put the items into your bag.

travel checklist diabetes

travel checklist diabetes

 

Click here to download the list: travel checklist diabetes

What are your best traveling tips? What can’t you travel without? Let me know in the comments!

Travelling with Diabetes

Travelling with diabetes requires quite some extra effort.

And planning. And “in case of” and “in case shit happens” preparation.

Especially if you’re planning to travel far, across the oceans and time zones.

Travelling with diabetes isn’t impossible by any means. I’d say it’s actually the opposite. You just have to know and prepare properly for it.

As I’m leaving on a longer-than-usual trip soon, and as it is my first trip that far with the pump (I really don’t travel enough, clearly!), I went to see my lovely diabetes nurse for some tips and tricks and general good advice.

(Where am I going, you’re wondering?! You’ll find out soon, if you follow me here!)

It turns out A LOT has happened in terms of handling diabetes on the long-go, at least if you’re wearing a pump.

Last time I crossed continents, I was still on Lantus and had very little idea of how to handle it all, with the time zones, different rhythms and change in exercise level. Let’s just say I didn’t handle it optimally well. Partially because I didn’t know how to, partially because I frankly didn’t  care about it then as much as I do today.

As a result, my blood sugar levels were all over the place, I was exhausted, not only because of the time zone change, but also because of the rapid blood sugar changes. Add on to that arriving in a bustling city where I had never been before (NYC that time)  and wanting to explore it ALL in the few days we had there…

Let’s just say that that equation didn’t really add up to work in my favor.

Which is why, this time around, I’m taking much more thorough precautions before setting off.

Hence, I scheduled an appointment with my diabetes nurse.

First of all, I wish everyone had the opportunity to work with a diabetes nurse as awesome as mine is. She has a safely secured spot in my Dream Health Care Team, that’s for sure.

Secondly, she had a really nifty trick up her sleeve for me to use while in transit.

She suggested that I’d set up another basal program on my insulin pump, with a constant basal rate for the first (few) days. Basically as long as it takes me to get over the biggest jetlag factor.

I have pretty low basal rates throughout a 24 hour time period, between 0.4-0.55 units per hour, giving me a total of 11,3 units per 24 hours. Her suggestion was to set up a basal profile with a constant 0.45 units per hour for the first 24 hours, to give my body a chance to acclimatise quicker, and then turn on my normal basal profile (and change the time on my pump) when I either realize weird spikes in blood sugar, or I feel like I’ve caught the worst of the jet lag wave. (Lowering my basal while travelling seems to generally be a fantastic idea…)

This was completely new to me. And, granted, I haven’t tried it out yet, so I can’t tell you how well it works (or not). But it seems a lot easier than the old ways of changing basal injection times and dosages along as your jet lag diminishes…

Perhaps is travelling with diabetes  just that much easier with an insulin pump?  

This wasn’t of course the only advice she had for me. Along with the “usual” tips of bringing (much) more supplies than you need, a doctors note for security checks, an extra blood sugar meter & test strips for it, staying hydrated, getting sleep during night time, paying close attention to blood sugar, bring a glucagon kit and snacks, snacks, snacks, she also showed me the “device” (aka chart on a piece of paper) that she uses to calculate a possible return to Lantus dose.

This is excellent information to have if I ever want to go on a pump-cation (a break from my insulin pump), or, if by any chance against all odds, my whole pump system breaks and I need to take Lantus until a replacement arrives. Because I take on average a total of 18 units of insulin per day, the chart showed that my Lantus dose should be around 20 units per 24 hours. I have no idea about the conversion calculation that is used here, so if you do, please leave a comment below!

I feel really relieved and happy that I’m doing all this preparation work for my trip. Now it’s just to keep fingers crossed that the actual trip itself goes as smoothly as the preparations have done so far.

How do you travel with diabetes? What tricks and tips do you use? Please share them in the comment below!

Traveling with Diabetes

I truly love to travel, it’s one of the biggest passions in my life.

To get to see, feel, sense, experience and smell the smells of a new place, is sometimes what keeps me going through a rough patch.

I try to travel as often as I can, meaning as often as money allows me to. And although I’ve never pursued this passion without diabetes, it still makes sure to keep me on my toes.

Like the other week, when I was traveling back from Stockholm.

You know those low blood sugars that you do e v e r y t h i n g in your power to turn, but they just stubbornly hang on as if they were the ones in danger?

The ones that leave you in full panic mode, because what if your blood sugar doesn’t turn in time? What happens if you pass out and become unconscious?

Normally that’s not really an issue for me, my lows usually respond quite well and fast to my figured out and well-rehearsed treatment.

Just this particular low blood sugar wanted to stay with me. And stay and stay and stay.

So, for a little background info… Ever since I got my insulin pump, every time I fly I have to turn my basal rate WAY down. As in to -85% of the normal dose. It doesn’t matter when during the morning, day, night or evening I fly, unless I basically turn off the basal, I will invariably have a hypo.

The first couple of times when this happened I didn’t understand anything. I asked the company that manufactures my pump if, by any chance, high altitudes could influence it? Of course not was the answer, which was later also confirmed by my lovely diabetes nurse.

To this day I still don’t know why my blood sugar plummets as soon as I’m in the air. But that’s not the point of this story.

So, before this particular flight, my husband and I grabbed something small to eat before boarding the plane, because airplane food is beyond terrible and shouldn’t be eaten by anyone.

My blood sugar then was kind of highish, around 8 mmol/l (144 mg/dl), so I bloused a minor amount for the food, bearing in mind I had to turn down my basal rate anyway. It’s gonna work out, I reassured myself.

We boarded, I sat down, and turned down my basal before having to stow my bag in the overhead bin as we we’re seated by the emergency exit.

The take off was smooth considering the weather conditions. The fasten seatbelt light went off, and I went to grab my phone from my stowed bag to finish an audiobook I had on there. “Might as well take down the whole thing” I remember thinking.

Suddenly, I get a massive urge to just talk, talk, talk to my husband. This should have been my first sign that everything wasn’t right in the blood sugar department.

We talk about a future holiday and where we should go, when I suddenly get vertigo while sitting down in my seat. “Wooow, what’s going on?!”

I grabbed my Dexcom and saw it at 5.9 mmol/l (106 mg/dl) and sinking, fast.

“Oh shit.”

Basal was already basically turned off, so couldn’t do much more there. I grabbed a portion of glucose powder with 10 g carbs and chugged it, as I could feel how fast I was falling.

I waited the obligatory 10 minutes before checking both the Dexcom and manual blood sugar again. Dex said 4.5 mmol/ (81 mg/dl) and still falling. Manual check said 3.6 mmol/l (65 mg/dl).

“Fuck. What do I do?” I asked my rationally thinking better half.

“Have more glucose.” And I did. I had another 2 or 3 glucose tablets, munching on them like they were the lifeline I needed.

Considering my normal, total hypo correction is usually 4-8 grams of fast acting carbs, this was starting to worry me. I was up at more than double.

I was also running out of glucose tablets, as I barely ever need to use them anymore, I don’t carry an endless amount of them around anymore.

My darling husband called the flight attendant, asking her to quickly bring me some juice.

By the time the orange juice ran down my throat, I was in full-blown panic mode. Dexcom was still stubbornly pointing downwards.

This had now gone on for so long that my husband asked if they happened to have a Glucagon set in their onboard medicine kit, just in case. Of course, I hadn’t brought one with me. Why would I, I never need it and it’s one more thing for my poor back and shoulders to carry?

Turns out they didn’t have one. And even if they did, my husband, who has been brainwashed in how to use one of those things, wouldn’t have been allowed to administer it. It would have to be done by a medical professional.

As my blood sugar was still stubbornly going down, by this point at 2.4 mmol/l (43 mg/dl), I started to really panic.

Fast acting carbs were clearly not helping in time, there’s no Glucagon set and we still had 45 minutes until landing. If I pass out and lose consciousness now, I’m as good as dead. I don’t want to die here in an airplane, somewhere over Germany. Shit, piss, fuck.

I hear a flight attendant call out over the intercom: “One of our passengers is in need of immediate medical attention. Do we have any medical professionals on board?

I had to laugh in the middle of my panic, that was a definite first for me. Very rarely have I needed to rely on complete strangers for help in treating a low blood sugar.

The most amazing thing was that on this flight of ca 200 passengers, there were 7 medical professionals. Seven, including a lovely doctor that kept me talking and drinking more orange juice.

The taste of the juice was so repulsive by this point. Eugh, how much I truly hated the taste of orange juice then. But it was my key back to life, so it was just to keep drinking it, especially as my blood sugar was still at 2.4 mmol/l (43 mg/dl).

After what seemed an eternity, panic, too many chalky glucose tablets and way too many glasses of yucky orange juice later, my new doctor friend told me to check my blood sugar again. 4.0 mmol/l (72 mg/dl) – thank all holy powers above, it was moving in the right direction!

By this point we were approaching landing, meaning I would have had to stow my hand luggage again. My husband kindly said that this wasn’t an option, and asked if they could re-seat us somewhere where I could keep my things right by m, in case things got ugly again.

Being a fully booked flight, the only option to re-seat us was in business class. I clearly didn’t care anymore at this point, I just wanted to land and get home to shower, have a hot tea and sleep. The other people in business class weren’t quite as understanding…

The last 20 minutes of the flight I got to sit in business class, which I had never done before. So, in order to lighten the mood, you could say diabetes got me upgraded for free. 🙂

Having buckled up for landing, I checked my blood sugar again. Seriously, my poor fingers. Anyway, it was 5.5 mmol/l (99 mg/dl) and I could finally breathe. Long, deep, oxygen filled breaths, which I hadn’t taken for the past hour or so.

Despite all the glucose and carbs I had had throughout this horror-hour, my blood sugar didn’t start to go up again until after leaving the plane. And it never went higher than 9.5 mmol/l (171 mg/dl), which was remarkable for that amount of carbs, which is guesstimated to be around the 60-80 gram mark.

My husband led me out from the plane on shaky legs, thanking the flight attendants for their amazing help and asking me if I was ok and if he should get me a wheel chair. Being mortified at the fact that diabetes caused me a scene, I told him I’d rather crawl to the exit than get in a wheel chair.

Getting home had never felt so good. Home where I was safe, and where I had Glucagon kits if I needed them. The day after was awful, I had the biggest hypo-hangover I’ve ever experienced, I was pretty much useless all day.

So, what’s my lesson in all this? 

Even though everything turned out ok in the end this time, doesn’t mean it always will. I can’t even fly with active insulin from a previous meal, it has to be off. Completely. Also, always bring your own Glucagon. Airplanes don’t have them.

So, in light of this, let me share my 5 best traveling with diabetes tips with you:

  • Figure out how YOU (and your blood sugar) react to air travel. Do you go high or low? Test, test, test and correct accordingly, either with food or with insulin.
  • Wear something medical alert-y, whether that’s a piece of jewelry or a tattoo.
  • Bring more supplies than you’d ever need for the same amount of time at home. It’s better to bring too much and not end up in the dark forests of Sweden without enough insulin… This includes hypo treatment. Bring L O T S of that. You just never know.
  • Check your blood sugar more often. Is it going up or down? (This is especially where a CGM is truly worth its worth in gold (as they don’t weigh much…))
  • Choose the pat down at security checks that use full body scanners (especially if you’re wearing medical equipment such as an insulin pump or CGM. You won’t get a new one if the scan damages your equipment.)

Although diabetes sometimes needs extra precautions before you set off, I would never ever stop flying and traveling. It’s one of the most amazing things in life, and all the extra work is worth it. You just need to find out how to counter-act it.

I would love to hear your travel tips, with or without diabetes – how do you make sure you stay healthy and well during travel?