Tales of a back packer – by Scott Brady
My name is Scott and I have been a Type 1 diabetic since the age of 8. Now, almost 20 years on, I have been through the trials and tribulations of living with diabetes during my adolescent years to reach an exciting crossroads in my life.
I now intend to go backpacking across South East Asia with my girlfriend for six months from the beginning of 2016 and would like to share our experiences over this time in the hope that it can help and inspire others to do the same in the future.
Preparing for being on the other side of the world for six months with just one backpack each to fill is incredibly time-consuming at the best of times, so having to also consider my diabetes meant that we started planning our trip a number of months ago. There are a few articles online which gave some good ideas of how to make backpacking with diabetes easier, but there are not as many as you may think and it did not always resonate with my own personal situation.
I inject Lantus on a daily basis as well as Humalog with meals. One of the major concerns that we had when planning this trip was how we could ensure that I would always have access to the medication that I need, including insulin, blood test strips and needles. To start preparing for this, I initially calculated how much medication I would need to cover six months away from home by multiplying how much I inject / test on a daily by the number of days we will be away for. I also made sure that I included an extra 25% as a buffer to account for the change in food and climate, as well as cover for any emergencies (which we hopefully will not have!).
Having researched the availability of my insulin within the countries we will visit, including calling the insulin manufacturers (Aventis and Lilly), we have made the decision to take all of my medication with us for the whole six month period. The manufacturers were very helpful and I am pleased to know that I can purchase their products in most of the places we will be going, but I do not want to spend time worrying about this during our travels. Therefore, to prepare for taking everything with us, I have had a number of discussions with my GP in advance of the trip and he agreed to prescribe my full medication for six months in advance. I am fortunate that my GP was understanding of the situation and I am unsure whether this would be met with the same positivity at other practices, but in the long term the cost to the NHS will be the same as I will be out of the country for six months so I am grateful to his attitude on this!
There are other options available, such as requesting a family member to pick up prescriptions during our period of travel and then shipping it out to us. Although this may make sense for less perishable items such as blood test strips and needles, it did not seem a favourable option for insulin which can only be sent using expensive specialist companies who store it in the right conditions. Therefore, we have instead purchased a significant number of FRIO cooling cases which we will use to transport the insulin wherever we go. I regularly use these cases when I go abroad and we expect this to work well over a six month period. We will submerge them in water every day to re-activate the cooling gel and store the insulin in the fridge at the hostels we are staying whenever possible. Fingers crossed this works!
Taking so much medication also has practical implications and we will certainly have to sacrifice a few extra items of clothing for my diabetes gear! To try and minimise this as much as possible, we have bought some travel cubes to use for all of my needles instead of taking the boxes with us which has made it easier to pack. There is enough space in each blood test strip tube to contain double the amount of strips too, so we have combined two tubes together which has halved the amount of strip containers that we need to take. My girlfriend and I will each be carrying half of the medication in case one of our bags goes missing and, of course, all insulin will be taken as hand luggage on flights so it doesn’t freeze in the hold.
Another concern that we have had is getting through customs with such a significant amount of equipment. Although the standard travel letter from the hospital was kindly adapted to state that I would have enough medication to cover six months, a number of the countries we will be visiting do not speak much English. I have therefore had this letter translated into a number of different languages. Reddit, the Social Networking site, was incredibly useful for this – we posted the wording from the hospital and it was happily translated into 7 different languages by helpful strangers! There is a good Diabetes support page generally on Reddit and I would recommend anyone to have a look at it.
In the past, I have always considered myself something of a “Secret Diabetic”. Although I have always tried to deal with my condition by using the appropriate level of caution and effort that it requires, I have never been one to discuss it in great detail with those around me. I would rather head to a quiet place to test my sugar level or inject insulin rather than dealing with awkward questions or looks. However, in recent times, my confidence has grown significantly and I am a lot more relaxed about the reaction of others. This can be attributed to the support of my girlfriend who has taken such an interest in my diabetes that she now knows more about it than me!
My changing attitude has led me to ordering a medical bracelet for the first time which I will wear on my travels in case emergency contact details are required. There are some quite understated and fashionable ones available now, especially from the United States, and I am feeling OK about the prospect of wearing one. This is not something I would have said a few years ago.
The final consideration we have had is for the food. While I have a fairly variable diet in the UK which involves often eating out in restaurants, my ability to count carbohydrates has been well practised over many years and I am now confident of being able to accurately adjust my Humalog dosage most of the time. Also in the UK, we are lucky that a vast number of restaurants, particularly chains, post their nutritional information online.
In Asia, most of our food will be from street vendors or in small, local establishments where even a menu in English is unlikely to be regular occurrence. However, I do know that my diet over the next six months will be made up of lots of rice, noodles and curries. Therefore, to prepare, I have started cooking a lot of these dishes at home so I can be confident of the dosage I need when looking at it on a plate. Although there will be differences in ingredients and glycaemic index levels, I hope this will give me a good basis to go by.
I hope that the preparations we have taken will really help my diabetes control over the next six months and I look forward to reporting back in more detail. We fly to Thailand on 5 January so I will post on the initial successes and problems shortly.
I hope this is helpful and please feel free to comment or ask me questions and I will do my best to answer them. Goodbye UK!