Lessons learnt backpacking – by Scott Brady

Scott_Brady-150x150We are now almost two months into our six-month backpacking trip and thought that it was a good time for an update on the lessons learnt since leaving the UK. The good news straight away is that we haven’t really experienced any major issues and confidence in backpacking with diabetes is only ever growing by the day. As I previously described, we made the decision to take all of my diabetic supplies with us for the six months from the outset. This means that we certainly are not packing lightly and I am very lucky that I have someone to share the burden. All of my equipment is split equally between my partner and I.

We each have a fairly large bag full of pen needles, blood test strips and glucose tablets which stays in our main backpacks wherever we go. This is also checked luggage if we are taking a flight. My insulin, made up of Humalog and L
antus, is split between six large Frio bags which we share and is always carried in our smaller day rucksacks. Of course, this is taken as hand luggage when flying. I also have a little bag of emergency needles etc in my hand luggage in case our main bags disappear temporarily!

Talking of flights, these have passed through without any incident at all. In truth, I have never been stopped at an airport and questioned about insulin or needles that I am carrying. I did think the amount we have with us on this occasion would cause some raised eyebrows but, having flown both internationally and on smaller domestic flights already, nobody has mentioned it. I always take my Frio bags out of my rucksack to put them through the security scanner, like you would with smaller liquids, so maybe this works. Either way, I am armed with my translated letters from the hospital should a Cambodian security guard want to know more!

Insulin storage was always my main concern, but so far I have not experienced any negative effects from the regular travelling. My insulin is always either in a fridge in our hostel room or a Frio bag (when travelling or in the odd remote place where a fridge in the room is not possible). It has been very rare for us not being able to find a cheap hostel room which includes a fridge.

There are two tips I have learnt in this regard. Firstly, in relation to Frio bags, they need to be regularly refreshed under cold water to stay in working order. However, specifically with new Frio bags which are being used constantly, refreshing is a fine art! We found at the start of the trip that if you put Frio bags in the sink every day to refresh, and you leave it in too long, they expand so much that you can’t fit anything in them. We have finally got the hang of this by timing how long each one soaks for, which is normally no more than 20 seconds per day. It is also important to let them dry out on a window ledge on the days they are not being used so they shrink back to a more natural size.

The second tip is in relation to the fridge itself. One of the things that must absolutely be avoided is accidentally freezing your insulin. We had heard incidents of some fridges effectively acting as freezers, which is normally very refreshing if it is for a nice cold water but not as ideal for insulin storage. On arrival at each hostel, we immediately put a bottle of water in the fridge and often turn the temperature setting down. If after a few hours the water is cold but not close to freezing, we know it is safe for my insulin to go inside and stay there for the duration of our stay. We have started putting the insulin inside the fabric wallets provided with the Frio bags and then into the fridge as well, which makes it easier to redistribute back to each Frio gel pack on departure and stops any nosey cleaners taking an interest in them!

One of the first obstacles to tackle when travelling across the world is time zones. Southeast Asia is currently seven hours ahead of the UK, so managing my Lantus dosage was always going to be uncomfortable. There is plenty of advice online about the best way to do this. From my perspective, had I been travelling to a country behind the UK time zone, I would have taken the hit in one go and simply waited for my usual Lantus injection time (which happens to be 8pm). You may not read this in most of the advice books, but going a few hours without Lantus is easy to manage with additional testing and short-term insulin to keep you stable. It is my preference as it then only impacts you for one day.

Coming the opposite direction, it isn’t quite as straight forward and I opted to slowly move my Lantus back to its usual 8pm slot over a couple of days. As 8pm in the UK equates to 3am here, on my first day I injected at 1am, then 11pm and then 9pm before getting back to my usual time. For me, as long as the “overlapped” hours were monitored, it was a safe way to do it and I was back injecting at my regular time in a couple of days.

One thing that has changed is the amount of insulin I am injecting. My Lantus dosage itself has reduced from 23 units to 21 as I was experiencing low sugar readings during the day and, in particular, when I awoke in the morning. If you intend to backpack for six months, it is important to be confident at self-adjusting dosages without hospital consultation. Having had diabetes for almost twenty years, this comes fairly naturally to me and shouldn’t be something to fear.

One of the main reasons for a reduction in insulin amounts is the food. It is very difficult to have a meal here without eating either rice or noodles. While working out the correct Humalog dosage for this can happen quite quickly as it is similar from place to place, the impact of having rice also effected my Lantus. White rice has a high Glycaemic Index rating, meaning that it only impacts blood sugar readings for a short period. Therefore, if I have rice for tea, I may go to bed at a good sugar reading having had the correct Humalog amount, but I will then drop overnight. To combat this, the drop in my Lantus and a small snack before bed has been the best remedy.

I read a lot about people adjusting insulin dosages based on hotter weather when abroad but this makes me slightly uncomfortable. What happens if you wake up in the morning and it is raining outside? The weather in Southeast Asia has of course been very hot most of the time but there have been occasions when it has dropped, particularly in the north of Vietnam. A reduction in Humalog, as well as the Lantus as described above, is fairly unavoidable given the food being eaten and the amount of exercise being done (walking everywhere here instead of sat behind a desk at work when home). However, adjusting for these things, which I have control over, seems to work and I don’t make specific changes based on the weather.

Despite the general meals being quite different to the UK, getting convenience food for snacks before bed or hypo treatment is very easy here. Specifically in Thailand, there are 7-11 convenience stores everywhere. And I mean absolutely everywhere! A quick internet search tells me there are over 8,500 in Thailand alone and these become a bit of a Mecca for tourists as you can’t walk along the road without passing one. These are great for cheap bottles of water (14p) and, more importantly, carbohydrate snacks such as bread, biscuits and crisps. A particular favourite is a biscuit packet called Creamos, which you will see all backpackers eating as they are sold for 10p for a pack of 6! These have been great for bedtime snacks, although always carry spares as I once found ants, to my horror, finishing off my last half-eaten packet that I had left open on the table. While there is no universal chain in the other countries we have visited so far, there are always cheap cornershops selling the essentials.

I hope this blog has been useful and provides some tips for people travelling with diabetes. If anyone has any questions that I can answer, please comment below and I will be happy to respond. We now move towards the North of Vietnam before back over to Thailand followed by Malaysia and Indonesia.

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