Travel with diabetes

Type one diabetes shouldn’t stop us from pursuing our dreams. And it shouldn’t stop us from more mundane things like going out for dinner or getting on a plane. But travel does bring its own challenges for a diabetic, particularly one with as small a brain as mine.

(I wrote about my first diabetic travel experience here)

Kit faff

When traveling, one has to remember to bring all one’s kit. Do I have enough test strips? Do I have enough insulin in my pen? Do I have spare insulin in case I lose my pen? Do I have enough long acting insulin? Do I have spare batteries for my blood tester? Do I even have my blood tester?

Remembering the diabetes stuff is only half the battle of course. After the triumph of packing my diabetes stuff, my brain is liable to let its guard down and forget something equally as important. Like my passport. This is where marriage comes in. “Have you packed your passport?” says my wife. To which I reply “OMG no! That was close. I’ll never do that again.” Which shows that my lack of memory is matched by my lack of self-knowledge. Of course I’ll do it again!

The next challenge is to remember to take my diabetes stuff off the plane with me. I seem to be incredibly inept at this simple task. I flew to New York in September and left my insulin pen on the plane. After spending about an hour on hold to various different lost property offices I gave up, and (with relief) fell back on the spare insulin pen I’d brought with me. I vowed never to leave my insulin on the plane again.

Undeterred by this fiasco, I returned to the US this week: to Houston, Texas. I took my insulin off the plane this time. But left my blood tester behind! What an idiot! Since my diagnosis, I’ve tested my blood before bed every single day. The risks of a night time hypo would be much higher if I inadvertently went to bed with low blood sugar and no midnight snack before hitting the sack. So I was scared to go to bed, sans test, after a meal out and a total guess at insulin dosage.

Luckily they have 24 hour pharmacies and blood sugar testers are available without a prescription. They are also cheaper and suffer from the American insistence to persist with imperial units. My first year result was 138. What the hell is that supposed to mean?! Is it high? Low? Enter Google. Apparently it should be between about 75 and 145 so that was pretty good for bed time!

Blood sugar of 106. What the hell does that mean? Turns out that 106 is spot on. Which is more than can be said for most of my readings later.

Blood sugar of 106. What the hell does that mean? Turns out that 106 is spot on. Which is more than can be said for most of my readings later.

Food

Armed with my new blood tester I could go bravely into new culinary lands, dosing myself up with insulin as I went. When at home, I always make my own breakfast and normally make packed lunch and my own dinner too. So most of the time I know exactly how many grams of carbohydrate I’m eating. Eating out is more difficult because I don’t know how the restaurant has prepared the food. Have they put sugar in it? What’s the sauce made of?

Eating out abroad is often a different kettle of fish because the cuisine is less familiar, meaning the carbohydrate estimate is even more of a guess.

I’ve really enjoyed the food in Texas here. But boy do they love sugar! For example, we checked into the hotel and they gave us a freshly baked cookie. That’s a lovely touch, but not healthy. I used mine as emergency hypo treatment so ate two small bites one morning.

The first full day in Houston was an amazing culinary experience. For a start, the service in an average American restaurant is far superior to what we’re used to in Europe.  We started the day with breakfast burritos. Yummy! Then for lunch on to a very unpromising looking Vietnamese place in an old industrial unit

next to a dilapidated parking lot. The egg rolls (kind of like spring rolls) and fried rice were mind blowing. And the noodle soup with chilli, herbs and bean sprouts was also delicious. Dinner was Tex Mex. Another massive pile of meat, with sauces, tacos, washed down with copious tortilla chips.

As usual, I avoided sugar where I could. But nonetheless I used over twice the insulin I normally do and still had off the charts blood sugar most of the time. I’ve really enjoyed being in Houston, but it’s no surprise that it’s not just the buildings and cars which are twice as big as everything back home.

Exercise is always important, but for a diabetic all the more so because it increases insulin sensitivity and blood sugar control. So I’ve squeezed in yoga (Americans love yoga!), running and lapping the stair case of my 20 storey hotel. Not as beautiful as a mountain but still good fun in a weird kind of a way. And it has definitely helped me weather the sugar onslaught later that day.

Working hard in the stair well.

Working hard in the stair well.

Rodeo!

We managed to time our trip with the opening night of the rodeo. What an experience! We joined 72,000 others in an enormous stadium set around a muddy field where cowboys performed the most extraordinary stunts.

There was a lot of riding angry bucking animals like bulls and horses. Teams of two cowboys would race reach other to lassoo a baby cow (a steer). The most extraordinary one was a race to gallop after a running steer, jump off the horse onto the steer’s back and then wrestle it to the ground by its horns. Insane mentalism! The commentators loved to point out how much money these guys had won: they are multi million dollar athletes! One guy had won $600k the week before just from holding on (reeeal taaaiight) to a bucking horse.

Some of the best entertainment was a load of young students (none of them athletic looking) who had to chase down a steer each from a group of fifteen steers released into the football pitch sized ring. The crowd roared as each unlikely looking student somehow managed to wrestle a bigger faster steer to the ground! The commentator proudly announced “all these students are members of the FFA.” That’s Future Farmers of America.

The best bit was the young cowboys. These are tiny (think six years old) boys and girls who compete at holding on to a running sheep (reeeeeal taaaiight). They were braver souls than me. Many were trampled as they came off the sheep.

I’m writing this on the plane to a snowy New York. My book, notepad, phone, insulin pen and new blood sugar tester are all in the seat pocket in front of me. What are the odds of me getting them all safely to my hotel??

Diabetes Management Uncategorized

A snapshot of diabetes care in the UK

I watched the History of Everything last night. It was a brilliant film, and another reminder that there are plenty of things in life worse than having type 1 diabetes.

I watched the Theory of Everything last night. It was a brilliant film, and another reminder that there are plenty of things in life worse than having type 1 diabetes.

I had my annual eye scan last week. After missing my first appointment due to diarising it for the wrong day (cue pangs of guilt), I turned up at Homerton hospital on a damp Thursday morning to have my eyes photographed.

Retinopathy is a common problem for diabetics. High levels of sugar in the blood vessels damage the eyes over time, eventually leading to blindness. A 2002 study showed that almost all American adults with type 1 diabetes for 20 years and 60% of adults with type 2, had retinopathy. It is the leading cause of blindness in the under 65s. What horrific statistics!

Diabetes Management

Run, think about diabetes, eat, think about diabetes, sleep, repeat

The Bedside table of a type one diabetic: water, insulin (fast and slow acting), JDRF pencil case to carry it around in, emergency jelly babies, old needle packets!

The Bedside table of a type one diabetic: water, insulin (fast and slow acting), JDRF pencil case to carry it around in, emergency jelly babies, old needle packets!

I spend a lot of time thinking about diabetes. When I run I’m thinking about how I’m feeling, do I need to test my blood to avoid the risk of hypo, does my level of effort mean my liver is releasing glucose into my blood or not? When I eat I obviously think about how many carbs I’m about to eat and how sensitive I think I’m going to be to the insulin (my wife will say “you’re not being very sociable.” And then, “oh, you’re doing maths” as she sees me looking at my plate). During the day at work I’m often wondering if I’ve got symptoms of high or low blood sugar or whether I’ve just drunk too much coffee. I should give up the coffee really, but there is only so much self discipline one can impose on oneself.

Despite thinking about diabetes a lot, I think about lots of other things too, and there are sometimes crucial points in the day where I forget that I’m diabetic. One happened this morning when I left the house. Without my insulin. The picture above is my bedside “table” (it’s a cardboard box) where my insulin stayed all day.

I realised after I had made myself a big bowl of muesli and banana. In fact, I only realised after I had started eating. Minor alarm – “I haven’t taken my insulin yet” – turned to major alarm – “I don’t have my stupid insulin!” Cue pouring the bowl of cereal into the bin and marching upstairs to buy fried eggs, bacon, sausage (5g of carb, but I thought I could handle that) and tomato. Blood sugar only mildly up after all that luckily, and it returned to 5.7 (perfect!) after a couple of hours.

I was also out for a work lunch. Luckily the special was swordfish and salad so I could order a carb free lunch. One of the people I was lunching with gave me a knowing look when I declined to order a side of potatoes. He knows I have a huge appetite, and knew exactly why I was abstaining! I even had to eat a cereal bar (30g carb) over the course of the afternoon to keep my blood sugar from dropping too low. This requires another act of will power. Someone as greedy as me finds it really difficult to eat only half a cereal bar in one go.

By home time blood sugar had dropped to 4.1 so I even had to eat some jelly babies before running home.

This is all part and parcel of being a (forgetful) diabetic. Luckily I’m still in the honey moon phase, and I’m no longer ill, so I got away with it.

All's well that end's well. The ideal range for Blood Glucose is between 4 and 8 mmol/litre. Mine was briefly over 9 this morning (I'd already eaten too much cereal before I realised I didn't have my insulin), but has been very well behaved since then.

All’s well that ends well. The ideal range for Blood Glucose is between 4 and 8 mmol/litre. Mine was briefly over 9 this morning (I’d already eaten too much cereal before I realised I didn’t have my insulin), but has been very well behaved since then.

Diabetes Management

Self control – or how resisting cake makes me worse at my job

Interestingly when I googled "resisting temptation" the most common images were of sexual temptation, followed by sweet and fatty foods. Sweet foods are the problem for diabetics of course.

Interestingly when I googled “resisting temptation” the most common images were of sexual temptation, followed by sweet and fatty foods. Sweet foods are the problem for diabetics of course.

Temptation makes me test my blood

I get an increased desire to test my blood if I’m feeling hungry, or am tempted by food. I’ve noticed this recently. If I’m feeling hungry in general or, as happened yesterday, am offered brownies for tea when staying with the family, I have to wrestle with my self control. All diabetics will be familiar with this – “I know that sugary snack is bad for me, but it will taste so good!” I seem to use blood tests to reinforce my powers of will power. If I’m tempted, I test, and if my blood sugar is high (above 7), then I don’t have any excuse to eat the snack. And in general I don’t! But I have expended mental energy thinking about it.

Diabetes Management

My second honeymoon

If you told me last October that I’d be having a second honeymoon within a year I wouldn’t have believed you. But here I am enjoying the “honeymoon period” in type 1 diabetes. The photo above is from my first honeymoon to Patagonia. I put it in the post cos it’s more interesting to look at than all the charts!

When I first got diabetes, I thought I’d be able to do loads of clever things with my data to get good at managing it. I’ve been collecting data enthusiastically, but making sense of the mountain of data I’ve produced is difficult. Plus I spent two weeks not recording anything at the start of November because I was sulking. Sulking because my smartphone app which I use to record all my data was bought by another company and they seriously dis-improved the user experience as a result. I was shocked at the emotions I experienced when something I use and depend upon every day was changed: I was more angry and upset about that than I was about being diagnosed with diabetes in the first place! So were many other users if the number of horrendous reviews on Google Play were anything to go by. Luckily they fixed the problems, but that explains the gap in my data below.

Data Diabetes Management What is type 1?

Business travel for the diabetic

image

I’m currently travelling for business for the first time since my diagnosis. (The picture above was taken whilst wondering round Montreal.) The challenge of managing diabetes in this scenario is best explain by way of example.

The first morning of the conference started with a “continental style buffet breakfast”. It’s an opportunity to meet the other participants whilst getting fed. I first had to identify some suitable to eat. I’d been running for an hour just before so was starving. The selection looked pretty poor for a diabetic though: granola (way too sugary), muffins (ditto), various other cakes and brown bread. Bam! Perfect. I piled my plate high with bread, and added pineapple, melon and a cup of coffee for good measure.

I was doing all of this whilst introducing myself to assorted central bankers and academics. Bluffing that one is an expert in one’s field, desperately trying to remember that bloke’s name, holding a cup of coffee and a plate and trying to eat (conference organisers always cater for people with three arms but I’ve never actually seen any three-armed people turn up) is hard enough. Then try remembering the carb content of bread, pineapple and melon and estimating how much it all weighs simultaneously.

I do all the calculations. I factor that I’ve just finished exercising, am eating 100*0.45 + 7 + 10 grams of carbs so need: 1 unit of insulin! As I’m halfway through congratulating myself on how clever I am, I’m aware of silence falling. I tune in again, and realise that a question is being repeated: “So what’s your view on the issue, Alex?”

There’s another silence while I ponder my options. I decide to bluff and give my view of the issue I’m guessing they’re talking about. I also whip out my insulin pen and stick it in my stomach. I have no idea whether this puts off the group. I’m multitasking on injecting myself, looking at people’s faces to see if they’re surprised about me injecting myself, looking at people’s faces to see if I’m answering the right question, and actually talking.

Like most men, I can’t actually multitask, so I achieve none of those things. I have no idea what expressions are worn on the earnest faces around me, I have no idea what dribble is coming out of my mouth, and I stab myself in the finger whilst trying to put the top back on my insulin pen.

I’m relieved when the spotlight of conversation illuminates someone else. I take a bite of my bread. It’s banana bread. Great. Six months ago I would have loved it but instead I’m inwardly cursing the organisers for putting on such a spectacularly unhealthy breakfast. I’ve got no idea how much sugar is in banana bread, but a lot more than normal bread so I recalculate carb content and leave half of it.

Things got a lot better after that, but travelling and meeting new people when one has diabetes is a challenge. Firstly I have to guess how much carb is in food all the time. Then giving blood tests and injecting is a bit more awkward in front of total strangers. I’ve decided that I’m just going to be open about it and not worry about people reactions. But I am testing myself less while I’m away. The main thing is that I haven’t had a bad hypo. Although my blood sugar has been a little higher than usual, which I find mildly irritating in my impossible quest to achieve the same glucose control as a healthy person.

On the plus side, the running training is going well, and I’m in near the best shape of my life. I also found out today that my brother has also been accepted to run the London marathon for team JDRF. Go team Collins!!

Diabetes Management