Traveling abroad with diabetes: Part 2

From msu.edu

Through the eyes of Tyler and his family, planning to attend a two-week long trip to Dominica, a country located in the Caribbean, began early. The trip included two-weeks in Dominica with the science club. The school group made the trip to gather samples of items from the rainforest as well as the ocean.
The first week was set in the rainforest where the weather was warm and humid and the group slept in tents and portable cabins. Tyler dealt with food that was sparse during their stay in the rainforest with an abundance of walking most of every day. The second week of the trip was near the ocean. The group stayed in more of what could be considered a hotel. They scuba-dived for 40 minutes at a time and listened to lectures for most of each day. The food was more plentiful and there were restaurants and small stores available.

7 steps for a well planned trip include:

1. Start planning as soon as possible. Planning for Tyler’s trip began a year in advance.
2. Do not hide the fact that you or a family member has diabetes. Make sure everyone knows what to do if there is a crisis where the student cannot attend to their diabetes self-care. This will include all physicians, teachers, students and the company organizing the trip.
3. Talk to the endocrinologist. Tyler took the initiative to talk to the endocrinologist. This is where scenarios are discussed, what equipment would be needed to manage his diabetes, as well as learning how to handle every possible situation correctly. Tyler used the basal/bolus regime to manage his insulin and found that an insulin pen worked best to bolus (which are figured by a combination of counting the grams of carbohydrate of a meal or snack, and a current blood glucose reading taken before eating the meal) and he used his pump to keep his insulin at basal levels. Basal dosing keeps blood glucose levels at consistent levels during periods of fasting.
4. Keep insulin at a cool temperature. The endocrinologist mentioned not to allow the insulin to “cook.” It has to be kept cool. Tyler brought special packs that cool items when moistened with water since he did not know if there would be refrigerators available.
5. Receive clearance for all activities. Because this trip involved scuba diving, Tyler had to receive clearance from a hyperbaric physician prior to the trip. They went through how to handle every scenario that could arise while scuba diving. Tyler knew what depth he could dive at and that he could dive for 45 minutes at a time which worked well with having his insulin pump off for no longer than an hour.
6. Plan what snacks to bring. Think about the weather, the living conditions and even what types of foods are normally eaten. Try to find out if there are sources of food outside of what meals will be served. Tyler discovered the first week in the rainforest that the food was sparse and primarily simple carbohydrates. The students walked and worked all day with small breaks for meals. Three meals were provided and included porridge with a piece of fruit, watered down soup with a small piece of meat and a root vegetable, rice and beans with a half of a sandwich containing one piece of meat. Being mostly simple carbohydrates, determining the amount of carbohydrates in each of the foods he was eating proved to be a challenge.
7. Have good communication and talk through the trip with all that will be involved. Talk through every situation that may occur. What are all of the worst-case scenarios that could happen? How much insulin could be needed? What is the plan for both hypoglycemia and hyperglycemia? What equipment is needed for managing diabetes?

Even with months of preparation and planning Tyler and his family had some unexpected challenges. Below are some extra diabetes self-management tips that Tyler considered and some things he learned from the experience:

• Wicking clothing, such as fishing apparel, worked best on this trip along with hiking boots and hiking socks.
• Being unfamiliar with the food, counting carbohydrates and increased physical activity was a challenge for Tyler’s blood glucose management. Fruit snacks worked the best as emergency glucose to prevent hypoglycemia. This type of snack handled the humid weather well and was easy to carry.
• Kool-Aid packets were brought to add to a water bottle as a glucose source but there were not enough carbohydrates in one packet. Tyler would have had to drink one liter every 15 minutes.
• Tyler’s glucose tablets, used to quickly bring his blood glucose to normal levels began to melt in the warm, humid weather. They were also dry in your mouth and had an undesirable aftertaste that lasted a long time. These were not his first choice as a sugar source. Fruit snacks served as his first choice.
• Research if there will be refrigeration available for insulin. Insulated cooling cases called ”Frio Packs” were available at the “big box stores.” These packs keep things cool when they are moistened with water.
• Food is crucial. Try to find out what type of food is eaten at the location where the trip will be. And if there is other food available outside of meals. Tyler suggested packing more high-protein/carbohydrate snack bars.

The preparation and tips provided above were items that Tyler and his family found to be helpful to feel comfortable and ensure that this trip would be safe and successful for Tyler. Always talk with your diabetes healthcare team for your individual medical nutrition therapies.
Part 3 of this journey, provides reflection from Tyler and his family.

http://msue.anr.msu.edu/news/traveling_abroad_with_diabetes_part_2