Traveling Around the World with Diabetes

Some of you who have read my blog for a while may remember that my current ruptured quad tendon wasn't my first medical issue.  After a fairly healthy life, it seems that in my 50s, things began to catch up.  In early 2011, just three months before beginning a sabbatical trip, I was diagnosed with type 1 or childhood diabetes.  I thought I was a little old for that, but something had gone haywired in my pancreas and it wasn't producing nearly enough insulin.  This is the story about my disease and my travels as I headed off around the world (I flew to Indonesia and rode trains around Java), then flew on to Sinapore and stayed on the ground (trains, boats and buses) to Europe and came back to the United States on a ship.  The picture to the left was taken of me on board a train in Indonesia.   Since I didn't blog at Sagecoveredhills while traveling, this might provide a good introduction to my A-Z challenge that starts in April.  I'll be writing about places still on my bucket list.

Mt. Meripa, Indonesia

 I hike through the ruins of Kinah Rejo at mid-morning, making my way toward the smoky summit of Mount Meripa.  What used to be the main street is now a steep trail.  Lava and ash cover the town, leaving only a few rock walls standing.  Where the town had been six months early, there are a few enterprising merchants selling drinks and snacks to tourists like me, but I’m the only Western to be seen.  Most sightseers are Indonesian, although there was a group Japanese who spoke a little English.  Leaving the town site, I continue on the trail as it climbs even steeper.  The sun is bright and hot and the air, so close to the ocean, humid.  Although sweating profusely, it feels great to stretch my legs in this strange landscape.  I’m shocked to see banana trees and shrubs already growing out of the black soil.  By mid-day, still a long ways from the mountain, I realized I needed to take a break.  I’m breathing heavy.  There are no longer tourists in sight.  I drop my daypack on the ground and sit on a rock, when I suddenly feel lightheaded.  I drink some water and check my blood sugar.  I’m at 70 and feel as if I’m dropping fast.  I eat a candy bar and drank more some water as I rest.  In fifteen or twenty minutes, I feel okay again, but I decide to turn back. 

I’m in my first week of a four month sabbatical with plans to travel overland, from Southeast Asia to Europe. 

In early 2010, I was presented with the opportunity to take a sabbatical.  Excited with possibilities, I began making plans.  But then, in February 2011, four months before setting out, I find myself fatigued and rapidly losing weight.   My physician orders a battery of blood test.  Although I’d never had problems with blood sugar before, my fasting blood sugar came back at 315.  Within an hour of receiving this report, his nurse has me back at the lab for more test.  The second test indicated that my A1C was 15.4.  Something has happened.  Two days after that first blood test, I’m on insulin and seeing an endocrinologist.  I’m worried I might have to forgo my plans, but both my primary care physician and my endocrinologist encourage me to continue planning but also to learn everything I could about my disease.

Over the next few months I took advantage of every available educational opportunity as well as read books about diabetes.  My endocrinologist has me met with several diabetes educators, one who has extensive mission experiences, most recently in Haiti, after the earthquake.  She explains how, in just days, people unable to get insulin were dying of ketoacidosis.   This is frightening, especially since I was unsure of my ability to obtain insulin.  She assures me insulin will be available, but it might be different from what I am using.  She reviews charts of different types of insulin and their usage.  She shares experiences of diabetic patients in Africa who are dependent on mission shipments of insulin.  These shipments are what’s available. The patients often find themselves changing types of insulin. I had begun my insulin intake using dial-up pens, but she teaches me how to draw and inject insulin with a syringe.  I leave the office with a sample vial of insulin and a bag of syringes so that I can become comfortable injecting myself.

In addition to dealing with my diabetic needs, my primary care physician suggests I make an appointment with the county health department travel nurse.  During my visit, we go through my proposed itinerary and she gives me needed vaccines and completes an international health card that I carry with my passport which contains my immunization record and medication needs.  My primary care physician provides prescriptions for a number of antibiotics for various infections with instructions for use, just in case.  I packed two kits, one with insulin and another with general medical supplies.  Because I’m going to be traveling around the equator and in hot areas, I purchased an extra-large water activated cooling pouch to store my insulin.  This pouch needs to be soaked in water every few days, but does wonders in keeping medicine cool.  Wanting to try it out before hand, I soak it in water and place it on the dash of my truck on a sunny day.  Late in the day, after sitting in a parking lot where the temperature inside the truck had soars to 140 degrees Fahrenheit, the temperature inside the pouch was only 80 degrees Fahrenheit!   I also wear a diabetic “UBS” necklace.  The UBS port could be plugged into any computer and my medical information would pop up.  Knowing I would often be traveling alone, wearing this provides comfort that someone might be able to help

            My trip was wonderful.  With the exception of a head cold that I had early on in the trip, I had no medical problems and returned home with all my antibiotics.  I did have a few swings in blood sugar levels, but nothing out of the ordinary.  However, it required planning.  I began my trip with a four-legged flight to Jakarta, Indonesia.  As I had been on an evening shot of long-acting insulin (insulin glargine), I just changed to taking the shot in the morning (as I was on the other side of the world).  When I left home, I carried a small six-pack sized cooler in which I had extra pens of insulin and gel cooling packs.  Due to refrigeration issues, it was impossible to carry enough insulin for the entire summer, but I had enough for two months.  When traveling on the longer flights, flight attendants were more than willing to keep my insulin in their refrigerators.  After three weeks in Indonesia and Singapore, where I boarded a train through Malaysia, I decide I can no longer keep the insulin refrigerated.  I give away my cooler and only use the water-activated cooling pouch to keep my supply cool.  Knowing that most insulin pens are designed to be kept at room temperate for a month, I knew I would have to resupply while traveling, which I did in Vietnam.  After seeing the types of insulin available, I emailed my endocrinologist and we decide to try a 70/30 premix vial of insulin, which would be taken twice a day, before breakfast and dinner.  This worked well until I obtained insulin in Europe. 

            Although worried about traveling with diabetes, I had no problems.  I was able to carry enough supplies to get me through (I did have extra test strips mailed to a hotel in Beijing along with a guide book for the Trans-Siberian railroad).  However, I found test strips were available almost everywhere.  Along the way, I often stopped and talked to pharmacist about the availability of insulin.  To my surprise, many of the smaller pharmacies didn’t stock insulin.  Some could obtain it (a few day wait), but most suggested I go to a hospital.  Larger pharmacies did carry insulin and in most places I would not have needed a prescription to purchase it.

The train from Hanoi to the Chinese border

            I always made sure that I kept insulin on me.  I knew the danger of not having it.  Even when I stepped off a train at a station stop, I had insulin and my test kit on my body (I often wore a vest with convenient pockets or cargo pants with large pockets on the thighs, both of which were ideal places to stash my test kit and extra insulin).   However, traveling with so much medication also had me worried.  As I walked down the corridor to customs in Indonesia, I couldn’t help but notice a large sign reading “Death to Drug Dealers.”  Knowing that I had several hundred needles for insulin pens in my bags, I was concerned that they’d question me.  But it wasn’t a problem.  Taking the train from Hanoi into China provided another scare.  Those of us changing trains at the border were told to go to our berths and leave our luggage out.  When the custom agent came into my compartment, he immediately pointed to the top pocket of my pack and asked that I open it.  I did and he reached in and pulled out a bag of syringes.  His eyes opened wide as did the Australian guy who was sharing the compartment with me.  I immediately said “diabetes” and he responded, “Insulin?”  Yes, I said and showed him the vial of insulin I’d purchased the day before in Hanoi.  He smiled and didn’t look any further into my pack, signed my form and moved on to the other passengers.  

Scenes from the Chinese side of the trip from Hanoi to Beijing

            Traveling with diabetes provided occasions to meet local people.  I was in the waiting room of the train station in Nanning, China, getting ready to eat breakfast that consisted of several pieces of fruit.  Quickly counting the carbs, I proceeded to give myself an injection.  A Chinese man sitting across from me smiled and pointed and then pulled out a little kit from his pocket with a test meter and filled syringes.  Although he didn’t speak English, we had connected, which is the best part of traveling.