Replies to This Discussion

Permalink Reply by Kelly on May 9, 2012 at 1:23pm

Hi Tom,
I've only travelled in Canada and U.S. and I can say it's been pretty smooth sailing. Canada lists carbs the same way you do it the States - on packaged foods and fast food menus, but not at restaurants.

I have travelled on business with my pump and had small hassles at airport security. I have an Animas and they can provide a "loaner" pump for travel.

I choose to leave my pump at home at bring needles when I travel for vacation. I've never had a problem at airport security at all with needles. Plus, on vacation I'm swimming or partying or whatever, and it's nice not to have the hassle of hiding a pump under a bathing suit or a dress.

I've also noticed that my bgs are really good when I'm on vacation. My husband and I went to Vegas last spring and even though I was up all night, eating at the buffets, drinking cocktails, my bgs were perfect. I never went low and I never went above 8. Maybe it's the lack of stress?

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Permalink Reply by FHS on May 9, 2012 at 1:30pm

I start with a checklist of all the diabetes supplies I would need for the duration of the trip, then double the amount of everything. All of that goes in a carry on that does not leave my person as long as I'm in transit. The longest trip out of the country, so far, has been 2 months and I was able to pack all of the needed supplies. I honestly don't know what I'd do for diabetes supplies, or diabetes care, if I had to go longer than 3 months, or the amount of supplies I would receive when filling my prescriptions.

I lived on my own for a lot so that makes things a bit easier when it comes to the usual precautions a diabetic has to take. I'll either stay with or travel with friends so that also makes things easier. I honestly don't know if I would consider an extended trip out of the country if I didn't already have some system of support set up at my destination or going along with me for the duration.

As for carb counts, I supppose that depends on the country. In Scandanavia, it wasn't too difficult to estimate carb content. In Japan, it was a lot more difficult. At no time has it ever been impossible for me to determine an appropriate insulin dosage, but it can be a challenge, especially if you are bound and determined to eat like a native.

Hey, it's an adventure! Maybe a bit more of an adventure if you have diabetes but there is no reason to not go. Do your research, take the appropriate precautions, don't take unreasonable risks. I think those are good guidelines for anybody. They just involve a bit more of everything for PWDs.

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Permalink Reply by Habs fan on May 9, 2012 at 1:31pm

In my experience other countries do list carbs on their food. The only difference is they often list the carbs for 100 grams of the food whereas in North America carbs tend to be listed per serving.
Make sure to wear a medical ID. It's also a good idea to carry a copy of your prescriptions and have your doctor's phone number, just in case.
I also like to make sure I know how to say diabetes in whatever the spoken language is where I'm travelling.

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Permalink Reply by Sam Iam on May 9, 2012 at 2:59pm

I've traveled all over the world. Often alone. Never had a problem. A couple pointers:

Figure out how much N + R would approximate your current dosage with shots. Somtimes these are all that will be available.

Learn how to say "diabetic" in the local language. Also, use a dictionary or have a native speaker write a note explaining you are diabetic and "take me to hospital" something like that. Keep the note in your front pocket.

I always kept my BG a little higher while traveling to err on the side of caution.

Stay safe and have fun.

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Permalink Reply by HPNpilot on May 9, 2012 at 3:35pm

I went on an overseas trip last year, roughly 6 months after being diagnosed.

Here's what I brought:

1) 2 x the amount of supplies and insulin that I expected to need (At the time
I was on MDI so this meant Novolog and Lantus pens, pen needles, swabs, lancets, strips, etc. and a backup meter and batteries)

2) Prescriptions for the above from my Dr., just in case, including a prescription for regular insulin, which may be the only thing available in some countries. I also learned how to use a standard syringe.

3) I carried the extra supplies in a pouch with ice packs that I used till I got to
a place with refrigerators. (Technically not necesary as Novolog and Lantus can stay outside a refigerator for a month)

4) A travel letter from my Dr. explaining that I have type 1 diabetes and what supplies I need , for security personnel, etc.

All the above carried in *hand luggage*, NOT checked bags.

Today, on the pod , I would do something similar... 2 X the insulin, 2 x the pods needed, some syringes or pens as backup, backup meter, etc.

Everything went fine on the trip. No hassles at security. Nothing went wrong. Carb counting I did in my head or with my smartphone (the GoMeals! app). I added up all the early courses and when the entree came I dosed for the appetizers and the entree all at once. Today on the pump, I just bolus for each course as it comes.

It really was no big deal.

I did turn down the basal (say 15%) on the days I was traveling just to provide a little extra margin and to account for the extra physical activity of running through the airports and lugging bags around. And I tested a little more often than usual on the travel days, due to the extra activity and the time zone changes.

It was all good.

P.S. I noticed the same thing as Kelly above, when I am on vacation, my insulin needs drop and my BG is much better.... I think she is right - it is lower stress or something.

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Permalink Reply by Sam on May 9, 2012 at 5:25pm

Traveling a lot has been part of my routine for a lot longer than diabetes has. The thought of worrying about not knowing what I am eating half the time does cause some apprehension, but I am getting better at it every day. I've only been on insulin for a month, but I don't think it will slow down my travelling, which I do for a living. Still have a lot to learn, and it will make managing the glucose more complicated-- but still doable

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Permalink Reply by Spock on May 9, 2012 at 5:45pm

HPN Pilot is on track. Great answer! I travel a LOT for work in the US and over seas. In the states, I take twice as many supplies as required, letter from the doctor, skittles for lows and EVERYTHING goes on the plane with me. Have never needed the letter or extra supplies, but I sure take them. I only had one problem, when my father was ill and I had to stay longer. Only took the pills I needed for the original stay, but it worked out fine.

Overseas I am very careful. I read and PRINT all the TSA stuff and take it in my travel file. I take WAY more supplies than I need (volcano dust, anyone?) I have used the doctor letter to get my carryon supplies through only one time in Paris, but it was in English and they could not read it, so I think the request was for show.

When I go through security, I always tell them I am T1 and wearing a pump and CGM. I always get a hand search, but I am on the road and I love to travel, so..no big deal. I grin and bear it.

Oh, if you know the word for carbs (glucides in French) they are marked on most of the packaging I see, but in grams, so do you research and figure out how to recalulate. On the food front, I do so much better traveling and eating out in Europe. The food is fresher and less processed. In the states, it is much harder to judge.

I have been a road warrior for 16 years and T1 for 50. On my own (worries the h*ll out of my S.O. but he is so wonderful about it) but have never had a problem I could not handle. For him, I call every morning when I get up and every evening so he knows I am safe in the hotel.

Do not let diabetes entrapped you with fear. Life is so much fun if you can let that fear go away.

And as it the nearly the 35th anniversary of Star Trek: "Live long and prosper."

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Permalink Reply by Super_sally on May 9, 2012 at 5:51pm

I travel a lot too, in Asia.
It's not a big deal. The advice of everyone else is spot on.
If it's unknown carbs, estimate and keep the portion small.

Do take extra supplies. Consider worst case if something broke. That's my most important recommendation, as I've been caught running out of supplies while in unfamiliar territory.

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Permalink Reply by peggysue on May 10, 2012 at 7:23am

Hi Tom,
You'r diabetes should not stop you from travelling cause it is a common disease all over the world. I'm a diabetic since 15 years and have been travelling the world for 15 years. Iam a fashion model and when I was diagnosed with diabetes type 1 my doctor told my to stop this job because of the stress it world cause. So was was working at an office for a bit..and hated it..and went back into modelling and I travelled a lot..from Marocco to the most unusual places. Was once very sick in Cuba and I had the best hospital care there..I'm from the Netherlands..I have to say that i was always very lucky..told everyone I worked with I was a diabetic..I'm not ashamed I inject right in front of a stranger, some people are offended but I don't care..I have to live with it..not them. And in most countries all the carbs are written on the packages. I'm from the Netherlands and in our country it's not by law to write carbs on the products..but for example in Germany and France..it is all written by law. So I woud say..good luck traveling!!!

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Permalink Reply by HPNpilot on May 10, 2012 at 8:31am

THe ADA's magazine, Diabetes Forecast, just published an article on traveling:

http://www.forecast.diabetes.org/travel-may2012?utm_source=Facebook...

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Permalink Reply by Oakville27 on May 10, 2012 at 9:07am

Hi Tom,

Lots of good advice on this already!

I just got back from a 22 day trip to India two days ago - I was diagnosed about two weeks before the trip and was terrified at the prospect of going, especially where so much of the food content would be unknown.

However, the trip went well and I was able to enjoy the food (my family lives there, I grew up there for a while, so it's a pretty big part of why I like going back!).

The advice about taking extra supplies is key - a big part of what I had to do was test a LOT - the food, climate, and various activities were all brand new to me so I was extremely conscious of where my BG was whenever possible.

I use Levemir and Humalog - both in pens - so I took all my insulin over in Frio cases which keep insulin at a safe temperature without the need for a power source (you just soak the bag in water, let it absorb the water, and it will be effective for a few days - it's also compact and easy to travel with). Here's their site: http://www.frioinsulincoolingcase.com/

I took one XL case which just fit about 6 pens and one small case which fit 2 pens (had to angle them but it was fine) - I used the small case for my open pens and the XL case for my back-ups.

As far as the food went, it was trial and error. Because I was staying with family, I had the luxury of buying a small electric scale when I arrived and measuring portions at first - I'm still doing this now that I'm home because I'm still very new to all of this, but as I learn how certain foods affect me I've gotten more confident about eye-balling portions and am usually okay - frequent testing (1-hr post-meal, and 2-hr post-meal) was helpful. I used my Calorie King book to estimate carb content for local foods like lentils and certain vegetables that I hadn't eaten since my dx and that was a great starting point - I had to fine tune a little bit, but I felt good about the BG ranges I ended up with by using those figures as a starting point.

I did find some websites like Livestrong that list a TON of foods that you might not find in Calorie King, but the only issue there is that the values fluctuate a lot from restaurant to restaurant and brand to brand, so don't rely on them too literally.

It looks like you've been managing your D since 2005, so I'm guessing you're probably a lot better at knowing how certain foods affect your BG than I am - so it shouldn't be a huge issue. I just avoided (or ate in moderation) anything that I knew to be high-carb/fast-acting carb or was very cautious on meals with a lot of sauces that could be carb heavy - not a big deal at all and way more manageable than I thought it would be.

As far as the nutritional content goes, don't bank on having that at your fingertips. I was able to get that info on some packaged foods and more "western" items such as bread, but most of the local and restaurant food had no information whatsoever. Also, you may find that even if there is nutritional info on the food, the serving sizes might just be 100g or something like that. That's where the scale was helpful since I was used to having nutritional info on items like bread listed by the slice or, in the case of things like cereal, by the cup. Again, easy enough to handle once you figure it out, but something I didn't realize until I got there.

As far as the travel itself goes, I took a Dr.'s note regarding my diabetes along with all my prescriptions. For things like my pen needles, I emptied them out of the boxes and into zip lock bags and also cut off the prescription from the box and included it in the bag. I also folded down my insulin boxes and took those - really, anything that had a prescription label on it came with the supplies just to be safe. I think one person at one security checkpoint (out of many) asked about the insulin and as soon as I said "diabetes" I was fine. The only other question I was asked about my supplies was in regard to some of the food I had carried over.

Speaking of which:

On the flight over I took some home-made sandwiches in a cooler along with a bunch of my favorite granola bars/protein bars/snacks - just to have a good supply of food with nutritional info on it just in case. The sandwiches were for the flight(s) over (25 hrs of travel to get from Denver to New Delhi, and I was not comfortable eating airline food at that point). I took some Pro Bars which can be used as meal replacement if necessary. I was doing some hiking, and took a bunch of Clif Blocks and Clif Shots for exercise and just walking around as well as two big jars of Glucose Tablets to be safe. I actually ended up using the Clif Blocks a TON, especially while hiking - and I calculate each Block to be 8g carbs. They're not quite as good as gummy bears, but they don't spike me as fast as the tablets and are perfect for keeping BG in range while hiking or extended walking around a city. These were the only supplies I even came close to running out of - really, really handy from my experience. By the flight(s) back, I felt confident enough to eat the airline food which, although it tasted horrible, wasn't the impossible hurdle I imagined it to be.

Sorry for the barrage of information - I'll leave it at that for now - but getting as much info as possible (like you're doing) made me feel so much better about heading overseas. In the end, my D didn't get in the way of enjoying the trip - just test a lot to see where you are and make sure you have lots of supplies to react as needed and keep asking questions.

Best of luck - hope you get some awesome trips lined up!

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Permalink Reply by MyBustedPancreas on May 10, 2012 at 9:46am

Yes, I travel frequently and often to places with little access to medical care. There are lots of things to consider but the bottom line is that it can be done!!!

1. Supplies. You need to make sure you have enough to get you through not just the expected duration of your trip, but also for a week or two more in case you're delayed for some reason. 
2. Have a back up plan.  I pump, and when I go on international trips, I get a back-up loaner pump from Minimed.  I also take basal insulin with me in case both pumps should fail for some horrible reason.  I also make sure I know where the closest pharmacies are and, when in other countries, how I could go about obtaining insulin in the event that I lose mine.
3. Medical ID.  Thankfully, English has become a very universal language.  If you need to encounter health services in another country, the chances are good that you'll find someone who speaks English.  Make sure to wear medical ID stating that you are a Type 1 (insulin dependent) diabetic.  Some countries still use the term "juvenile diabetes," although most seem familiar with the term "type 1" in my experience.
4. Know how to handle emergencies.  This means, know how to deal with ketones, trouble-shoot high BGs, handle an accidental overdose of insulin, etc.  It's stuff you should already know, but it's even more important that you know how to do it when in a place you're not familiar with.  I do some backpacking and I've even learned how to mainline insulin in an emergency (never had to do it and hope I never have to!!)
5. Know how to use NPH and R insulins!! The analogue insulins are not widely available everywhere.  In the U.S., R and NPH are widely available without a prescription (and for cheap and all Walmarts).  Know how to use these insulins!! ok, so you're not technically supposed to use R in a pump, but when pumps first came out, R was all we had.  If you need to use R in a pump, you have to change the duration time for IOB to the highest setting and bolus well before eating.  BUT, it can work in an emergency (I've done it). 
6. Keep insulin cool.  Frio pouches work wonders. 
7. Never let your supplies out of your site.  Theft is common, especially in touristy places.  Never let your supplies out of your site.  Make sure you have a back-up plan.  If you're traveling with someone else, have them keep a few critical supplies (Test strips, vial of insulin, etc) with them as well.
8. Doctors Note.  I've never had to use mine, but I keep a note with me at all times from my endo stating what my treatment consists of and what I have to keep with me at all times.  
9. Learn how to swag.  The hardest part of international travel can be food.  Thankfully, most countries use grams and this can make it a lot easier to calculate the carbs in whatever you're eating.  I stick to basic things with only a few excursions as treats.  I have an app on my iphone that helps me calculate the carbs, but I still find that I do a lot of SWAGging when away from home, especially when traveling internationally. 
10. Avoid alcohol.  Like many diabetics, when I'm low, I can sometimes appear drunk.  The LAST thing you want is being perceived as a druggie or drunk, only to really be low and need treatment!!  I'm generally comfortable here in the U.S., but remember that legal systems are REALLY different in other countries.  So you need to be careful and on your guard. Avoiding alcohol is a small price to pay for staying safe.
11. Have medical insurance that covers you abroad.  Everyone should have this, but for us it's more important. 

Traveling with D is hard, but I find that it just adds to the adventure.  Sure, I'd rather not have the extra luggage (literally and figuratively), but it makes me more aware of my surroundings and more appreciative of what I can do!

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