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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?

Lonely Diabetes?

Plus one is the loneliest number.

And my constant companion Diabetes knows exactly which buttons to push to make me feel lonely, alone and isolated.

It’s the time of family gatherings, meeting friends and spending time with those you love.

But if your (involuntary and unwanted) BFF Diabetes doesn’t play along, it doesn’t matter who else is around you.

This post is NOT about diabetes making you different from other people or that you have to things that are usually associated with being a drug addict, like shooting up and (sometimes) being paranoid.

It’s about feeling lonely although you have your best supporters, your true fan club, around you.

The other night, Dexter (my Dexcom CGM system) woke me up from my hazy sleep.

He had just buzzed 3 times, and because I wasn’t quite with it, I couldn’t remember what 3 buzzes meant – was I high or low?

I had only gone to bed 2 hours prior to this (quite rude) wake up call with a great blood sugar level, so I wondered which way it had gone wrong? 

Dex said “LOW”, below 4.0 mmol/l (72 mg/l). I took out Doris (my OmniPod and trusted ally) and checked my blood sugar; 2.1 mmol/l (38 mg/l).

Nothing was making sense to me at this point; I was sweaty, my head fuzzy, I didn’t recognize where I was or what I had to do next.

I told myself I had a pretty low hypo for being me and that I needed to get to those glucose tabs faster than lightning, right after temporarily lowering the basal on my pump to -85%.

In my mind I gracefully climbed over my husband in the sofa bed we were sharing and jetted straight for my suitcase, where I had packed the glucose. (We were on a trip, staying with fantastic friends)

But in reality I was probably half-suffocating my husband, stumbling around like a local drunk and made more noise than I could ever realize.

Anyway. I sat down on the floor to eat some of the glucotabs. The slightly chalky texture and the acidy taste of them only intensified my symptoms.

During some of my lows I need something to chew on after the glucotabs, something that won’t help the hypo, as it otherwise overshoot. But just the feeling to keep chewing makes me feel safer in an unsafe situation.

I found, again in my mind very gracefully, a bar of 85% chocolate in my handbag, and started munching, instantly feeling a little bit better.

To I keep awake, I tried to play some simple games on my phone, none of which were making any sense to me. Playing cards, letters and colors were all a big mumbo jumbo, although it’s actually 3 separate games on my phone.

In this very moment I realized I was feeling really lonely. 

This was despite having my husband snoring right next to me, and some other people sleeping in the same room. And I knew I could wake any of them up to keep me company and make sure I survived yet another hypo.

But I didn’t. Just because I’m not allowed to sleep right now, doesn’t mean others aren’t either, I thought to myself.

So I kept to my incoherent gaming, but couldn’t shake the feeling of being the loneliest person in the world in that moment.

As soon as I saw the number on my dexcom starting to go up, I put down my phone and went back to a hypo-sweat-drenched-sleep.

A few hours later, waking up with the biggest hypo-hangover ever, it made me feel lonely again.

I quickly resorted to some victim mentality thinking with thoughts like “why me?” And “no one understands me or what I’m going through or what it all feels like”, aka Loser-ville thoughts.

While I might have been right after yet another time with diabetes trying to kick my ass, I can’t forget what it has thought me about life.

A few of the useful and positive examples are: Being alone. Maths. Thicker skin. Acceptation. Pain. Fending for my life. Handling disappointment. That life is precious and frail. That I’m not invincible. Gratitude. Appreciation. Friendship. Health. Healing. Happiness. And, above all, the importance of Love.

CGM – should you get one?

It was finally time.

I was nervous, noticeably so.

My hands were shaking, I had a slight sweat and could only concentrate with major effort.

I was sitting at my diabetes nurse’s office, plunger in hand, plaster sitting snuggly on my stomach.

“Come on, Hanna, you’ve done this a gazillion times before”, I told myself.

And then I just did it.

I pushed the plunger and the sensor was in. It didn’t even feel worse than a normal injection (sometimes I hate the fact that I can say that.)

So, I got hooked up to my first Dexcom G4 Platinum sensor yesterday.

I have now become a bionic woman, wearing 2 medical devices/robot parts, my OmniPod insulin pump, and my Dexcom cgm. (and yes, they have names, too.)

 

CGM and Insulin pump - I'm a bionic woman!

CGM and Insulin pump – I’m a bionic woman!

 

I’ve had it on for a full 24 hours, so these are really my very first impressions! And my initial reaction is that it’s beyond amazing! The results have been very accurate (ca 1 mmol/l difference) so far, and I’m hoping it will stay that way.

What is a cgm?

A cgm is a continuous glucose monitoring system, meaning that it measures your blood glucose level in your interstitial fluid every couple of minutes.

This is done by a tiny sensor underneath your skin, which you can keep there for (officially) 1 week, but sometimes longer.

The sensor is connected to a transmitter, sending data to the receiver, on which you can see pretty graphs of what your blood glucose levels are up to.

Although the glucose levels in the interstitial fluid is a few minutes delayed from the level in your blood, it’s an awesome tool to see the trends and where you’re heading, blood glucose wise.

 

Dexcom G4 Platinum (borrowed from the Dexcom website)

Dexcom G4 Platinum (borrowed from the Dexcom website)

 

I love making lists for myself. And so also this time.

The pros with a cgm

–       The Trends

Seeing the trends and where your blood glucose is heading is very handy. It takes a lot of the worry out of your daily care.

–       Security

Hand in hand with the pro above comes the security feeling it brings. I swear I slept better last night, knowing I have something extra that has my back.

–       Analysis

Being able to analyze my blood glucose better, being able to adjust my basal levels more exactly, instead of my usual guesstimation based on “yeah, that sounds good”.

The cons with a cgm

–       Another device

It is, of course, yet another device connected to you at all times.  The transmitter is tiny but bulky at the same time. And together with the OmniPod, I may look like a slighter version of Quasimodo in certain angles… For me it’s worth it, although there are certain items of clothing I should probably get rid of now…

–       Micro management

The chance of starting to micro manage your blood glucose levels is, to a greater extent, a possibility. Seeing those dots on the screen whenever you want to may cause you to act sooner than you have to.

–       Expensive

This toy definitely doesn’t come cheap. If you have an insurance policy that is ready and willing to take care of it, there’s nothing stopping you. But if you don’t, you need to think twice about getting a cgm.

And why, oh WHY, can no diabetes gear holders be at least a little nice? Why does the bag of the device have to make you feel sicker than you actually are? (Or is it just me?)

One more list: my top 5 reasons for getting a cgm:

1. I’ve lost my hypo awareness. Meaning I can’t feel when my blood glucose levels are (sometimes) dangerously low. This can of course be helped in other ways, but the other reasons made this a better choice.

2.  Lately, I’ve gone extremely low every time I’m on an airplane. Weird, I know, as my pump definitely can’t be the reason for it.

3. Seeing the trends.

4. What happens in between the times I normally measure my blood glucose. I normally measure my blood glucose ca 8-10 a day, so it’s not like I’m slacking. But I have no idea when my blood sugar peaks after certain foods, for example. Without sounding too OCD:y, it’s to gain more control.

5. To have less question marks in my life. Life is full of sometimes quite pesky question marks anyway, so why add to them if there is a solution?

So far, I absolutely love my Dex (that’s his name, and no, it’s not very imaginative). I can definitely see that he’s going to be a huge help in my self care, and give me a little more peace of mind in the diabetes jungle. Dex passed the field test today, working at a cafe in town, with flying colours (and I did too, I’ve never seen a better graph! (blood glucose tests confirming this))

 

1st Day CGM graph - not bad!

1st Day CGM graph – not bad!

 

As I see it it’s either a love or hate relationship with this thing. It has huge potential to help you a great deal in your self care, but it can also interrupt you if you already have a great regime going that works for you. But YES, you SHOULD get one! 🙂

But boy, oh boy, we’ve come a long way since the insulin syringes needed to be boiled to be disinfected. Or from my very first blood glucose meter back in the late 80’s , that took several minutes to give an answer to the ever long question “where is my BS at?”

Do you have a cgm? What do you like about it? Dislike? Let me know in the comments!

 

Ps. I also have my first impressions written down from when I got my OmniPod about a year ago. Would you like to read that? Comment below!