by Peter J. Nebergall
You've worked hard for your vacation -- and you're not about to let your diabetes, or any other medical condition, "put the brakes" on your afternoon in the sun. Right. There may be "no vacation from diabetes," but most definitely can have a vacation with diabetes. You just have to do a little planning. Let's break it down.
Your blood sugars
Most of us, on vacation, move a little more than we're used to. Exercise burns blood glucose. On vacation, we travel away from familiar food sources, and eat different things, at different hours than we're used to. We sit a lot, in buses and planes, and then we walk a lot. All this can bounce one's blood sugars around a bit. It raises havoc with your schedule. It's part of the game. What are you going to do about it?
Are you a diligent blood-tester? Do you test regularly, and often? On vacation, you won't have to sit out the fun; you'll just need to test more often. Then you can take the appropriate action when you run low, or high.
Is your blood glucose monitor in good condition? Are the batteries fresh? Will you need spares? Are you sure of your testing technique?
Estimate the number of times you will need to test on your vacation, and how many lancets and test strips you'll need -- and then, most of you, double the number. You will be testing more often, you don't need to waste time looking for more strips in an unfamiliar language; and, if and when you do find them, there's no guarantee they were stored properly; they may not give you reliable results. Carry more supplies than you need -- they won't go to waste.
Think about food
Will you be backpacking food, or buying it? Will you be staying inside the U.S.A., Canada, western Europe? Perhaps you're going to take that African safari? If you're staying within the English-speaking world, you'll encounter many familiar restaurant names. Strictly speaking, their food is not "diabetic," but there are several guidebooks that tell you just how specific items would fit in your meal plan, whether you use the "Exchange System" or count carbohydrates. Best of these, in my opinion, is GUIDE TO HEALTHY RESTAURANT EATING, by Hope Warshaw, RD, CDE, published 1998, by McGraw-Hill. If the restaurant name is familiar, it'll be in there. If it isn't, look in THE DIABETES CARBOHYDRATE AND FAT GRAM GUIDE, by Lea Ann Holzmeister, RD, CDE, published 1997, by the American Diabetes Association.
But suppose you're going to Greece, or some place like that? Here's what I'd do: Before I went, I'd get a few cookbooks of the region's cuisine. Not "gourmet" stuff; I'd want to see what's in the everyday food I'd be likely to encounter. Then, I'd take the recipes to a dietitian (RD), preferably one who is also a Certified Diabetes Educator (CDE), and we'd discuss what, and how much, of the local food I could eat without blowing my meal plan. Be prepared.
Oral medications
Figure out what prescription meds you're going to need, and keep them with you, in your "carry-on" baggage. Don't take chances; one now-defunct airline's initials spelled out: "Sorry, all baggage exited New Amsterdam." It can happen; keep your meds with you. And of course carry copies of prescriptions; it's so important to prove your pills are for you.
If you're in the U.S.A, and you need some more of any prescription medication, you should be able to get it. Overseas, remember pills available in one country may not be licensed in another. Carry more than enough of your medications.
Also, be aware both oral medications and insulin are fragile; they can be damaged by poor storage conditions. A good rule: If it is too hot, too cold, too dry, or too wet for you -- don't store your medications there and expect them to work.
Insulin
Unless you're going to be "out there" for a very long time, you probably won't need to buy local insulin. But it can happen; your supply can be lost, by theft or by accident. What do you do then? Since you have a copy of your prescriptions (see "common sense," below), you should be able to get some more; almost all of the world has insulin on the pharmacy shelf. Problem: It may well not be your brand, your speed, or your strength. The same insulin may have a different name "over there." Just as likely (in Africa, the Middle East, and Asia), it'll be a different insulin: Animal-source, "R" speed, and something other than U-100. It'll work, but you may have to do some computing.
Remember, it's the number of units that matters, not the number of cc's you inject. A U-80 insulin is 20 percent weaker; you'll need to recompute your dose. A U-40 insulin is less than half as strong as an equivalent U-100; you'll need almost 2.5 times as much by volume to take an equivalent dose -- and you'll need to be closely monitored. You can do it, and it beats the alternative, but it's a hassle best avoided if at all possible.
Do you use an insulin pump? Talk to the manufacturer, before you go. Tell them where you'll be, and they'll let you know where's the nearest source of supplies for their pump. I think you'll be pleasantly surprised. But carry enough supplies; that's always easier.
If you're going overseas, talk to your doctor and your diabetes educator first. Discuss your medications, and what your health care team wants you to do. Be informed.
Common sense
If your diabetes is in any way "brittle," or if you have any other medical condition that regularly needs intervention, don't travel the world's boondocks alone. Go with a companion who knows you, knows what your crises look like, and knows what to do about them.
Carry medical ID, to let local authorities know what you're facing. It would be a good idea to get a letter from your doctor "to whom it may concern," explaining your medical ramifications. A surprising number of the world's doctors, when you find one, studied in the U.S., in England, or in France. They can read your doctor's notes.
Carry your medications only in their approved containers, and be sure you have copies of your prescription documents. American airport security (and Immigration Service) staff may ask to see them. Foreign authorities probably will ask. If you lose a vial, or a bottle of pills (and you can; the world has many pickpockets), these documents can save you a lot of time and trouble. If you're carrying syringes, be discreet; what looks like "illegal drugs" to the uninformed can get you treated like a druggie by same -- especially when he/she is wearing a badge. While you're at it, learn a few important medical terms in the local language, in case you need to explain yourself.
The above advice really isn't a lot. Just think about what you're doing; and
be pro-active. Plan for trouble; then if something out of the ordinary happens,
you can deal with it promptly, and get back to the business at hand -- enjoying
your vacation. See ya' there!