Arusha Tanzania 2006 Day 14 - Travelling as a Diabetic
I post a lot, of course, about Diabetes, most specifically the technology behind the solutions that I use in my own personal struggle. Diabetes is tough enough in the "Western" world with (nearly) all the technology in the world available, but it's wicked hard, darn near impossible, in underdeveloped nations.
When I travel, as a diabetic, there's a number of things that cause me trouble:
- Time Zones: When you're 11 hours away from home (it's 4:30pm in Arusha right now, but it's 3:30am at home) the body tends to take at least one day per one hour time change to adjust. I'm just literally about now getting my self on local time. I don't mean this in a jet-lag per specific, but from a blood-sugar point of view.
Diabetics have different sugar/carb sensitivities at different times of days. An apple at noon affects me differently than an apple at 9pm. This becomes tricky when you have to calculate "what time it is in your body " versus local time, versus home time.
Diabetics have a marked sugar rise called the "Dawn Phenomenom." Regular folks have this to, it's the body's internal alarm clock as it releases sugar to prepare to you start the day. Some people get it at 3am, others at 9am, but it happens in nearly everyone. What this means for a diabetic is a sudden rise in blood sugar in the morning. Many diabetics set their alarms for very early in the morning just to take a shot, only to go right back to sleep. It's a hassle. Less so with a pump, but still irritating. When you travel across timezones you have to keep track of when the body thinks this is supposed to happen. It'll start moving, as I said, at about an hour a day as you adjust to local time.
This can also cause a problem for diabetics who use long acting insulin that lasts for 24 hours or 12 hours at a time, because shots can overlap and severe insulin reactions can happen if timing is paid attention to.
- Equipment: Every diabetic has their favorite or preferred manufacturer. The farther you are from home, sometimes the harder it is to get the stuff you're used to. South Africa has international manufacturers in-country and fairly decent prices, but when you get farther and farther "out of town" you'll be paying a premium for diabetic supplies. I use a specific brand of supply for my insulin pump and I always bring three times (or more) as many supplies as I could possible need. For example, I change my pump every 4-6 days, but I bring enough supplies to change the infusion set every other day. I brought enough insulin for 6 months. You can always have someone at home DHL you stuff, but it's a LONG 24 to 36 hour wait while you suffer.
Most pump manufacturers have a loaner program where you can bring an extra pump along with you for a simple (and large) refundable deposit. I also packed replacement batteries for everything, including those hard to find watch batteries for my meter.
- Heat: Newsflash - it's hot in Africa. We're 4 degrees from the equator and it's hot as hell. A lovely hell, but hell nonetheless. Insulin is supposed to be refrigerated and lasts about 20-28 days at room temperature. You'll know right away if your insulin goes back because suddenly it just stops working. I always bring many ice-packs and insulated flexible containers to store my stuff in. For example, the power and water were out all day yesterday, but my insulin (I think) stayed cool, even as the refrigerator was without power.
- Sugar: Nothing sucks more than having a low blood sugar reaction and being 100km from anywhere and have no sugar. It's not just stupid, it's damned dangerous. I brought 50 granola bars from the states and packed tubes of glucose tablets in each bag so there's always glucose nearby.
For those that live here with Diabetes, fortunately there's many organizations promoting diabetes care in Africa like the IDF and there was just a Next World Diabetes Congress meeting last week in South Africa. Access to insulin and glucose strips is the first step along with education. I'm very blessed to have the financial means (mostly insurance) to have a pump and sufficient test strips to manage my blood sugar tightly.