Sláinte to Ireland & type 1 diabetes

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The twelve of us ready to embark on our journey.

This article is not about writing. This article is about traveling with type 1 diabetes. I thoroughly understand that if you are here for my book updates, this might not be for you. No worries, Look Past will be out 10/4, and I’ll be promoting the heck out of it before then.

Additionally, this will be a long article, because I’m going to discuss every aspect of type 1 management that I implemented with my daughter and myself while we were recently traveling in Ireland. Therefore, if you don’t want to read the entirety of the article, I understand and have bulleted the “takeaway points” at the end.

Now, the article…

Daily management of type 1 diabetes is akin to triage therapy, but traveling with type 1 is more like disaster preparation. In spite of this, the planning and strategizing are what make the trips successful. However daunting creating backup therapy can be, in the end, seeing the world is a worthwhile goal for everyone, including us with type 1.

Recently my family and I traveled to Ireland. This was our first International trip with type 1 (for the uninformed, both my youngest daughter and I have type 1). To be honest, I was scared for how I would manage everything, but with a bit of strategy and a lot of support from healthcare professionals, I was able to get my act together and see through how to manage a six-hour flight with a five-hour time change, and a week of variable activity levels and an entire culture of different food and beverages. In short, I walked away with this approach: Plan for imperfection, but enjoy the ride.

Planning and Preparation

Fortunately, I had months to plan for the trip, as it was a Christmas present, and we didn’t leave until August. This left me with months to research and to have endocrinologist visits and discuss best practices for while abroad.

Tip #1: Have backup plans for monitoring and insulin delivery.

My daughter and I both use Dexcom G5 and Omnipod. Therefore, my first step was to make sure I had working apps and receivers. All was good there, and so I reached out to my connections and picked up two back-up PDMs (this is an unlikely scenario for most, so I wouldn’t plan for it.) My first back up, should the PDMs succumb to the rain of Ireland, was our previous pumps. We both used Animas Pings, and they and the reservoirs and infusion sites were set aside. Knowing that they hadn’t been used for over a year, I also asked my endo for pens (Levemir and Novolog). Drug reps drop off samples all the time, so this was a no-cost solution that guaranteed my daughter and I would be able to get insulin into our bodies. Now, for this to work, however, I also had to convert our basal rates into Levemir injection. I didn’t simply look at the total daily insulin intake, but rather looked at the basal percentages from the Omnipod PDM and calculated a daily Levemir injection for both of us. Obviously, the boluses would then be covered by Novolog injections. Bam, insulin delivery covered.

I brought three back up test kits, lancets pens, lancets and test strips. Fortunately, I still had non-expired strips for the One Touch meters, but I’m sure I could have obtained some from my endo, should that have not been the case. Monitoring covered.

Then went in all the other essentials like Glucagon, glucose tablets, juice boxes and snacks, alcohol pads, chargers, batteries, Lidocaine, Skin Tac, Sensors, Pods, pen needles, an additional Luxura pen, our typical insulin vials, and importantly, a note from our endo stating that we did, in fact, need all this stuff. Apparently some customs officials get a little concerned about black market product sales. We didn’t need to produce this letter, but still, it was vital insurance.IMG_2799IMG_2800

 

 

 

 

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Now, to pack it all.

Tip #2: Know what products cannot go through airport security X-Rays and what liquid and gel medications will need to be separated from your luggage.

I travel a bit for writing conferences and school visits, so I know how deal with TSA agents and that made it easier, but not exactly pleasant. For us, sensors, pods and back up pumps and PDMs could not go through the X-Ray. Also, the insulin, Lidocaine and Skin Tac would need to be handled separately. That’s a lot of stuff to juggle with, most likely, a line of anxious travelers behind you. So, I separated the non-X-ray products into a shopping bag, so that I could simply pull it out of my luggage and hand it off to the TSA agent and then put the rest of my luggage through the X-ray. Great idea, I thought, and indeed, it was…in Ireland.

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Note the checklist. I really am neurotic. Or safe. You pick.

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See. It really did fit. I looked like a drug rep.

 

 

 

 

 

 

We flew out of JFK, an airport I’ve never been to. All seemed great as we waited in line, but then came the actual, face-to-face interaction with TSA agents. Hands down, they were the worst I have ever dealt with. I explained that my daughter and I couldn’t go through the full body scanner because of our medical products and was met with an eye roll. Nice. Next, I explained that I had a bag full of medical products that also couldn’t go through the X-ray. The agent, annoyed, took my bag and called for a hand check and then had us walk through the X-ray. Now, my daughter was with me, because we’re a bit of a duo in this. Once we passed through the X-ray, I waited for the hand check of our product, because every single time, that happens immediately. From a security standpoint, I understand why. So I stood there. The TSA agent looked us up and down and said, “Why are you standing there?”

I answered, “We’re waiting.”

“For what?” she asked.

At this point, because of her tone, I knew this wasn’t going to be good. My daughter turned to me and told me she was scared. I calmed her, but had to speak to the agent. I said, “My medical products. You have to hand check them.”

Unfortunately, the TSA agent became very aggressive and yelled at me, telling me I had no business standing there and to move on and that she would get to them. My daughter was on the verge of tears at this, so we moved, and I situated her with my family, and then I went back.

Tip #3: Never take your eyes off your medical products and medication. I stood back from the angry TSA agent and found another one and asked him to help me. He ignored me. And then I got loud and yelled to another agent that he needed to check my bag because it contained medical products. He tried to ignore me, but I got louder and asked again. I was polite, mind you, because I’m not stupid. TSA can ruin your trip, but so can losing your back up plan and products. Fortunately, he agreed, got our goods, wanded them for explosives and then turned them over. I repacked and we were on our way, but with my heart slamming inside my chest.

Flying

I’ve read about people experiencing baggage claim lows, and so when we landed in Ireland I was sure to watch for this. Both my daughter and I were fine. However, on the way home, we took a different type of plane, and take off was more like launching a rocket. We went straight up to almost 40,000 feet, and then we both suffered the worst lows we have in a long time. The pictures below demonstrate our drop as the plane rose. I ended up suspending both our insulin for an hour and we both ate 3-5 glucose  tablets each, and 40-50 grams of carbohydrate just to turn things around. I have never experienced this on commercial flights, and so I can only surmise that the increased altitude, combined with the ascent, forced a bolus via the pressure. Therefore, Tip #4: If you’re traveling Internationally, or even just as a safeguard on any flight, reduce or suspend insulin for the hour after takeoff. You don’t want to be like I was, separated from the rest of my family, with my daughter next to me, her at 45 mg/dl, and me at 50 mg/dl, through shaking hands trying to provide glucose and juice.

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The beginning, just before 2:00.

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Just ten minutes later.

 

 

 

 

 

 

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The drop just won’t stop.

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Finally turning it around.

 

 

 

 

 

 

On the ground

Tip #5: Become a walking pharmacy.

I wore a backpack the entire trip, filled with back up supplies, because you never know, except for the half hour trip to the hotel. And do you know what happened then? My daughter had a pod failure. Not an hour on Ireland’s soil and we had a medical issue, and me, stupidly, had allowed our driver to put the products in the trunk. We changed the pod and I shifted products to my back pack, which I wore through all of Ireland, including walking along the Cliffs of Moher. And it came in handy for glucose and snacks and for a dry place to store PDMs.

Pod failure. But those pants!

Pod failure. But those pants!

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Tip #6: Recognize that you are traveling and will be most likely walking a lot. Plan ahead and create a new basal profile. Both my daughter and I took a LOT less insulin because of the activity involved with sight-seeing, and in spite of a new basal profile, we still had to reduce often. We kept the new profile on for roughly two days after as well, and transitioned to the previous profile when we noticed our numbers popping up.

Trials and Tribulations

Tip #6: Prepare for things to go sideways.

At some point on the trip, as we were pulling into our hotel and a new check-in, I realized my pod was falling off. We checked in and then I put a new pod on before we were out the door. Also, I went on the dreaded ??? a few days into the trip, in spite of timing a sensor change so that I had a relatively new one on when we left. My wife changed it while we traversed Ireland’s countryside. Not the worst view to take in while making the swap. Both my daughter and I had unexpected highs and lows. We had double arrows up and down and every which way. We bolused and increased rates, ate glucose and drank juice. The trick was constantly checking receivers to get ahead of things. Fortunately, neither of us hit a true HIGH or bad low while in Ireland, and by the grace of some higher power, our overnight numbers were flat.

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Food for me was no issue. I love to try new things and ate with abandon. My daughter, not so much. So it was tricky to avoid carb-only meals, but as I said at the beginning, perfectly balanced meals are ideal, but when traveling, roll with it.

Also, my daughter gets motion sick, which, through Dramamine and Sea Bands, was no issue. However, when we returned nothing kept her sickness at bay. I say this because her vomiting once we were home wasn’t remotely scary. We monitored and hydrated and proceeded as usual. Had this occurred while we were arriving, we would have had to plan accordingly. An upset stomach is no joke for someone with type 1, and so I would definitely suggest whomever has type 1 be medicated if motion sickness is an issue.

Sense of Adventure and Independence

It is so alluring to stay within your comfort zone as someone with type 1. You do the same things, day in, day out, in order to keep your care as straightforward as possible. But the entire point of traveling is to experience new things, which means you have to set aside the rigid schedule and be flexible to the world around you. Fortunately, the Irish we encountered made that easy. They were gracious and accommodating, and more than willing to point us in the right direction for food, beverages, attractions, and entertainment. In part that is because we weren’t focused on perfect care, but rather immersing ourselves into the country. Now, that wouldn’t have been possible without all of the planning and prep work that went into the trip, so it truly is like gearing up for a disaster. Be ready if it hits, but chances are, it won’t. Therefore, enjoy the scenery. It goes by so fast.

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Braveheart! Oh, you meant the movie. Yeah, that was here, too.

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The payoff for all the hard work.

Side note

We traveled with Hammond Tours and they were an exceptional tour group. They don’t only tour Ireland—although it is our true love—so if you’re looking for the best while you are out in the world, juggling your awe and diabetes, let Hammond show you around.

For those of you tl;dr folks, here are the bulleted takeaways 🙂

  • Plan for imperfection, but enjoy the ride
  • Have backup plans for monitoring and insulin delivery
  • Know what products cannot go through airport security X-Rays and what liquid and gel medications will need to be separated from your luggage.
  • Never take your eyes off your medical products and medication
  • Know how to deal with aggressive TSA agents
  • Suspend or reduce basal rates for steep altitude climbing flights
  • Become a walking pharmacy
  • Prepare for things to go sideways and avoid motion sickness
  • Abandon your rigid care and enjoy yourself
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