Replies to This Discussion

Permalink Reply by DanK on October 15, 2010 at 8:25am

Leah - this trip is too cool to pass up. January isn't a lot of time, but take the time to learn everything you can about your body's needs and behaviors with regard to carb and insulin sensitivity. Read some of the common books you see recommended on this site, such as Think Like a Pancreas (great read) and there are a few others on my list, like Using Insulin and Blood Sugar 101.

Like you, I'm a newbie. I was diagnosed on 8/7, so I've been living with this for just over 2 months. If someone told me I'd be going to Ghana 2 months from now, I'd be a little freaked out. I love international travel, as I'm sure you will too. Experiencing the ways people live in different parts of the world is one of the few things that can have a profound impact on your own worldview. However, there are a million different concerns that must be racing through your head.

With regards to hitting your carb targets, let me tell you what I've experienced after my first endo visit. Maybe you can get a head start. Just like you, the first doctor I saw in the hospital told me to take a fixed dose for each meal (5 units of apidra). As a result, I had to make sure to hit a certain carb target at each meal, which is a huge nuisance.

The most freeing thing for me so far was my first endo visit where he taught me about insulin to carb ratios (ICR). This is measured in units per grams. For me, I take 1 unit for 8 grams of carbs at breakfast, 1:15 at lunch, and 1:9 at dinner. Knowing your ICR for each meal allows you to eat varied amounts of carbs at each meal. I was afraid to change anything about my dosage before having a doctor tell me to. However, diabetes is different from any other illness I've ever dealt with. It takes a bit of a mental jump, but we can and need to alter our doses based on what we eat at certain meals.

It took me a few weeks (and a few highs and lows) to get this right - you're basically your own experiment lab. However, now that I'm comfortable with this it has made a tremendous difference, and month 2 has been much easier than month 1. There are detailed instructions on how to set your ICR in Think Like a Pancreas, but basics are documentation, observation, and adjustment. You'll also find that your ICR may be different at certain meals. For example, I noticed that when I used the same ICR throughout the day, I was always going low after lunch. The solution was to significantly decrease my lunchtime ICR.

I think finding your ICR ratio will be one of the best things you can do before your trip - freeing you eat whatever comes on your plate in Ghana. It's not easy, but there's time. Use the same ratios you're using now and document when highs or lows occur. If you notice a pattern over several days, you can adjust your dosage up or down accordingly.

The end goal (which I'm FAR from at this point) is to be able to just look at what you're eating and make an educated dosage decision. You might be thrown into that fire a little early - I doubt many food items in Ghana have detailed nutrition facts. However, by eating in moderation at the beginning and getting a feel for the carb content of certain common foods, you'll probably be a pro after a week or two :)

Other things:
Climate/altitude - despite how close it is to the equator, Ghana actually isn't that hot. In Accra, January is a dry month, and the average highs/lows are 23-32 Celsius, with an average of 27. http://www.climatetemp.info/ghana/accra.html. However, you may not be spending the day in air conditioning. Higher temps can cause insulin to absorb faster, so if you notice that it's easier to go low you may have to decrease your dose. Altitude (if you're in Accra) shouldn't be an issue, it's only 60m above sea level, and the whole country is fairly low-lying, with nothing about 880m.

Activity level - if you're running around and treating patients, your activity level is going to be high most days. If it's consistently higher than it is now, you might need to lower your basal dose, and be vigilant checking for lows on those first few days where you're establishing a routine. For me, changing my activity level has huge impacts on BGs. I've learned from a few lows to drink some Gatorade before I start the activity, and take some with me if the duration is a bit longer. If you can get your basal right based on consistent activity levels, you might not need to chug a juice box as you go.

Keeping insulin cool - might want to check out a product called Frio. It activates by soaking it in cold water for about 5-8 minutes, and can keep insulin cool for 7 days, even in a high-temperature environment. Then, when the Frio pack is drying up, just soak it in water again for 5 minutes and you've got yourself another week of life. Your unopened insulin should stay in a refrigerator, of course.

One last thing - bring tons of test strips. There's definitely going to be an adjustment period, and you will probably want/need to test more than normal, at least for the first week.

Most importantly, enjoy your trip! It sounds awesome, I'm so jealous! You can do this with diabetes, and, after you accomplish this goal, a lot of the other daily issues we all face as diabetics may start to feel a little less overwhelming.

Permalink Reply by Mike Ratrie on October 15, 2010 at 8:28am

Leah,

Welcome(?) to TuDiabetes!

Wow, what a challenge! My first take is that you need to work on understanding your diabetes first, because your whole world has just changed dramatically.

I don't know where you are scheduled to go in Ghana. A lot depends on your ability to keep insulin below 29 - 30C, and to have access to additional insulin if your insulin does go bad due to temp extremes. The second point is understanding your Insulin to Carb ratio (I:C Ratio), aka how much insulin to take for the carbohydrates you eat. You are on the right track in that regard, and your current eating can help you figure it out on your own.

First you need to see if the basal insulin (Lantus) is the right amount. Do some searching here to find the results for "Basal Rate Testing". It will involve some fasting so you can see if the Lantus keeps your glucose in range.

Next you need to start testing (a lot). From a meal perspective, you need to test before a meal and then 2 hours after. Using lunch as an example, if you are @ 100 mg/dl before lunch, inject (bolus) your 6 units of novorapid, eat 45g of carb and test out @ around 120 - 140, 2 hours after lunch, then you are doing really well. That would make your I:C ratio = 7.5.

Once you establish the I:C ratio then you start counting carbs (a carb counting book or similar will really help once in Ghana). With an I:C of 7.5, you will take 1 unit of novorapid insulin for every 7.5g of carb you eat. So a glass of milk with 12g of carb would mean you need to take about 1.5 units.

I hope you can go, but get your diabetic basic care straight first!

Fair Winds,
Mike

Permalink Reply by Kristin Johnson on October 15, 2010 at 12:40pm

hey!!
I am in the process of planning a year long trip. 6 months through SE asia and 6 months through South America. you may have read my post in this thread earlier.

FRIO PACKS!!!!!!! - they are AWESOME! i went on a 3 week vacay and they are the best way to keep your insulin cold, and super easy. google it. you just submerse the inner part in water every 24 hours and your good to go.

i ve been on an insulin pump for 10 yrs now and i've found its made it much easier to travel, but since your a newly diabetic and only have a couple months i dont think this would be the best option for you to try out right now.

anyway best of luck on your trip, you'll have an amazing time!

Permalink Reply by djl on December 16, 2010 at 3:48pm

You should ABSOLUTELY go!  When I was a junior in college I decided to spend a semester in Kenya.  Almost everyone told me (and my parents) that I was out of my mind and that it was too dangerous.  I went anyways and it was hands down the best thing I've ever done in my entire life.  If you wants tips or specific ideas feel free to email me directly.  Good luck!

Permalink Reply by Nancy on December 16, 2010 at 5:35pm

You definitely can't pass this up. I passed up my first opportunity to travel when I was first diagnosed but ended up going it 6 years later. I lived in South East Asia for almost 4 years. It was awesome.

This is what I did for my first year; packed with me in my carry on enough insulin and test strips for 1 year. Look at the websites for Lantus and Novorapid and see if they are available in Ghanda and if they are comparable in strength. See what health care is available to you (buy from home before you go?). I got lucky and found an English speaking doc that provided me with insulin & test strips for my final 3 years. Watch the foods you eat, I had a lovely incident with severe food poisoning that hospitalized me! Test very frequently and keep a record of your BS, this will help you figure out if your unit per meal are enough or not.

As for Carb counting, I've been doing it from the get go. Here is a PDF file you'll want to keep on your laptop or print and take with you. http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/nutrition/fiche-nutri-... . It will help you guesstimate some of the foods you'll encounter. Just remember to subtract your fiber from the Carbohydrates for your final carb count.

 

As for your educator telling you that you need to eat 45g of carbs at each meal, how nice of her to be sooo helpful. Each meal can be different and I use to calculate my unit based on a rate me and my educator worked out which can vary. For example, at breakfast I would inject 1.6 unit for every 10g of carbs so if my breakfast was 30 g of carbs I would inject 5 units (30 X 0.16 = 4.8). At lunch it was 1.5/10g so a 40 g meal was 6 units (40 X 0.15 = 6). Basically, find another diabetic educator that will teach you to properly carb count! Just remember, test frequently (before & 2 hrs after each meal) and whenever you feel a little off.

 

Good luck!

Permalink Reply by Leah W on December 31, 2010 at 8:41pm

Thanks for the replies everyone, lots of helpful information...you guys are awesome! Only a week left until I leave for Ghana! Sorry I haven't been online in awhile, been busy finishing off the semester with exams, etc. So for the last month or so I have been on a clinical placement, the increased activity along with the 'honeymoon' phase resulted in me having hypo after hypo so I ended up temporarily stopping my bolus insulin. Over the last couple of days I have started needing more novorapid than ever and my BGL's are still going sky high...so i'm guessing the honeymoon is over, great timing huh! :(   But with a bit of luck it could just be the christmas/new year season and a drop in activity levels.

I'm sure i'll figure things out though, hopefully when I get over there and increase my activity level again, my BGL's will settle down. I was lucky enough to be refered to an awesome dietician that specialises in Type 1 diabetes, so at least I have a bit more understanding of carb counting, etc...she even researched Ghanaian food for me, as well as locating me a 'western' supermarket where I can stock up on some 'everyday' food if my BGL's go the other way and drop. 

I have set up a blog for my trip that I will hopefully be able to update periodically, if anyone would like to check it out here's the link ...there isn't much on there now, but hopefully it'll get more interesting when I get to Ghana.

Anyway thanks again for all your great advice, and I wish you all happy new year!