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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
My spot for the night - I was just about warm enough under the stars a 2500m

The Diabetic Snail who ran back-to-back marathons in the Alps

(In the Spring, I was a diabetic tiger. In the Summer I was a diabetic snail – running slow and steady with my house on my back)

I had everything I needed for four nights in the mountains. The diabetic snail was ready to go running!

I had everything I needed for four nights in the mountains. The diabetic snail was ready to go running!

With the cliffs above me blocking the way higher, I eyed up the only way onwards: a waist high stream a few metres across. The water was flowing fast before tumbling down a series of waterfalls dropping into the village I’d left half an hour before. Having scrambled up three hundred metres of imposingly steep grass and rocks I could verify that contrary to what my map told me, there was definitely no path and definitely no bridge. There was also no-way I could risk crossing the torrent without the possibility of plunging to a premature death far below. I cursed at yet another misadventure and turned round to retrace my steps. I slipped, and desperately hung on to my walking poles, digging them into the ground with my life flashing before my eyes. I averted my slide and broke one of my poles in the process. Walking up the 1700m to the next col had just got even harder.

Running

Business travel for the diabetic

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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