Noah's Publications & Manuscripts

Daibetes Travel Tips Vol. 1 (9/20/04)

After some minor hassles I've mastered most aspects of traveling with diabetes. The science can be distilled down into one governing word: minimalism. A useful guideline for life in general, but essential when all of one's posessions must fit in a backpack. Thus, size and weight must both be considered. However, minimalism doesn't apply in the sense of decreased attention to diabetes management.

I'm a firm believer in the practice of intensive diabetes management. This means more finger-poking than initially seems necessary and a good analysis of the results. The OneTouch Ultra is the most effective intensive diabetes management meter I have found, and best compliments a minimalistic travel lifestyle. Its testing strip size allows for about 70 strips to be jammed into each individual strip bottle (normally designed for 25 strips). A comprehensive logbook is built into the meter, further reducing the number of things to be packed. The AAA batteries that it requires are much more readily available in South America than the coin-sized, special-order batteries of many other meters.

Novo Nordisc offers the finest insulin and systems for administration, that an adventure traveler could ask for. The reuseable insulin pens make traveling virtually hassle-free. I carry one pen with Novolog, one with Novolin N, and an extra pen in case of an emergency. Using one needle in each pen for the entire day will dull the point, but will dramatically cut down the amount of supplies that must be carried everywhere. No bulky syringes, no mixing insulin, and no large vials of insulin.

By carrying multiple 300-unit cartridges rather than 1,000-unit vials of insulin, there are more back-up supplies in case a vial breaks or the potency degrades with heat. Novolog breaks down at higher temperatures than other insulin (a good quality for insulin to have in a tropical environment), but still must be kept cool. I carry back-up cartridges in pocket-sized Friopacks that utilize a chemical reaction to keep insulin refrigerated for about a week. To recharge the packs I submerge them in water for 5 to 10 minutes. All of my supplies and diabetic accesories for more than two months would easily fit inside a gallon-size Ziplock bag.

Flexibility is another essential quality when traveling. Changing one's management regimen will have to happen on some level with a rigorous traveling lifestyle. Before leaving on my adventure I logged more than two-and-a-half years on an insulin pump. I loved the little gadget with all my heart, but it was not condusive with an extended stay in the unknown. The value, the quantity of supplies for a single month and the possibility of malfunction were just a few of the themes in my recurring nightmares. This is not to say that the adventure would not be possible with a pump, but the mode of travel would be far from minimalist, with an added and unnecessary level of complexity.

While in towns, I treat hypoglycemia with soda from returnable bottles (the most cost-effective). I try not to pack soda on hikes because liquids are always the heaviest part of a load. I carry small packs of hard candy along for the long hikes away from civilization. Skittles, my longtime favorite, house a good amount of sugar compared to weight and size.

One variable that will demand some flexibility while traveling will be timezones. I had heard no shortage of horror stories about trying to balance insulin regimens without the aid of a pump. While I've only had a limited amount of timezone transfers thus far, I've found that they recieve more hype than they merit. The only thing that needs changing is one's sleeping schedule. The insulin regimen that is unique to every diabetic revolves around periods of activity and rest. Although the first day might be difficult, force yourself to wake up at the same hour as back at home and get a god amount of exercise so falling asleep will be easier. The body will adjust to the regimen change astoundingly fast when sleep and activity are regulated for a day or two.

Carbohydrate counting is a dream-come-true in Latin America. In Ecuador, traditional lunches and dinners include, without fail: soup (10-20 g. depending on potato content), rice (45 g.), potato pieces or beans (15-25 g.), juice (20 g.), and meat (the freebie). Of course the quantities differ depending on your language fluency, gender, or visual appeal to the waitperson, but most meals work out to about 100 grams of carbohydrates. One can find any type of food imagineable in areas frequented by tourists, but meal diversity will cost you.

Exercise is by far the most important element in managing my diabetes. Usually there is already a good amount of physical exercise on my agenda, but I'm very neurotic and I like the order that accompanies a schedule, regardless of plans. I have an easy routine of push-ups, crunches and stretching I do every morning and evening to ensure I get physical activity even if I'll be sitting on a bus for most of the day. These exercises work all the injection site areas where lumps from insulin can build up. Many people neglect stretching their muscles, but it is essential when one is on the move all the time. Injuries not only inhibit travel, but will force more changes in an insulin regimen. By exercising every day I dramatically cut down the insulin I need, and my blood sugars keep to the lower end of the spectrum.

After my first logbook entry I had my people thinking (myself included) that sickness would be my ultimate undoing. I have experimented with battle tactics a considerable amount (against my will) and have come to many conclusions that are already well published.

1.) Sugars will run higher while sick, so insulin doses will probably need to be increased.

2.) If you are vomiting and can't hold down food, use Gatorade and soda. The carbonation in soda will help an upset stomach and Gatorade contains electrolytes that the body needs badly. Both also give simple sugars that can be easily absorbed by the body before the liquid is expelled (imperative if long-acting insulin is taking effect and food can't be digested).

3.) Drink plenty of water and change your travel itinerary to include some time for rest and recuperation. I was an initial hypocrite of this point and it cost me dearly.

Most Importantly...
4.) Make sure you have a healthy supply of toilet paper because the bathrooms frequented by diarrhea victims have a BYOTP policy. Nothing worse than looking for creative alternatives...