Travelogue: Travelling time zones with T1D

Summer is here and needless to say a lot of us have made travel plans. This summer I decided to visit my brother for his graduation ceremony in the United States. Planning this 'travelling across time zones' trip had me worked up. I was aware of the extra prep work in planning a T1 vacay. I decided to document my experience to help others. But like in an exam, there will always be some 'out of syllabus' questions. I felt this at various points during this trip, but more on that in a little while.

So, let’s go holiday, guys! T1 style!

Planning the trip

I started off by preparing a checklist of things I needed. Madhura's blog on DiaBag and its essentials helped me remember what to carry. Everything I needed, I divided into two bags.

1.Diabetic supplies bag - In case you forget alcohol swabs, wet wipes are your best friend. I lived with BG as high as 400 for 3 days at a stretch. I didn’t have ketone strips and neither could I buy them from a US pharmacy without a prescription. Do not make this mistake, carry ketones testing strips when you travel. Tip : In flights, keep all diabetes supplies and hypo treatment in cabin luggage and do not put it with checked in luggage.

2. Hypo-kit - with glucose tabs, sugar sachets and other hypo stash. I enjoy    nibbling on these bars from FabIndia. Keep your favourite snacks handy, biscuits, protein bars, whatever works.

3. Libre - I can’t emphasize enough on how having an FGM/CGM helps when you travel. Knowing the general trend is very important. Dealing with a lot of unknown factors like food, weather etc is difficult and manually pricking is a lot of effort. In case you can afford it, do get one.

4. Travel insurance - I had to ask around for this a little. Unfortunately, no policy covered my diabetic supplies, only emergency doctor visits. Make sure you get enough information about healthcare policies at your travel destination.

5. Waste disposal container - Different countries have different rules on medical waste disposal. I carried my used cartridges back home to dispose.

I took an appointment with my doctor and educator and did a bit of reading to learn how to adjust basal/bolus. I was travelling to a country where I knew there was going to be a problem finding familiar vegetarian food. I went back and forth with my friends at Club 1 Diabetes to get a rough idea about how to calculate my Insulin to Carb Ratio and Insulin Sensitivity Factor. Always keep googling the approximate carb count for any new foods you try. You will falter with calculations but will still be better than guesstimating your bolus dose.

And lastly, a whole lot of unicorn vibes that say, “You got this!”

Living the vacations!

The holiday cheer was doubled by the beauty of spring. The colours all around made for such a scenic scene and I couldn’t wait for this holiday to begin!

When I was preparing for this holiday, I thought I had it all covered but like everything else in life, theory and practical are entirely different. I was prepared in terms of the tangibles (supplies etc) and the intangibles (ISF and ICR) but I still faltered. A LOT.

Let me list down below how things went down during the trip and if this gives you any takeaways for your future travels, I would be glad!

Airport security check

I carried ALL the above-mentioned things with me in flight. I always carry the medical certificate with me and security checks at all airports wasn’t a hassle at all. I was asked about the Libre while taking a domestic flight between the states, but the security personnel were aware of the sensor and apart from this I faced no hassles anywhere.

Eating in flight

I am a vegetarian T1D. I spoke to the airline customer care and they advised me to ask for a vegetarian meal because asking for a 'diabetic' meal might not mean it would be vegetarian. I made sure I told the air hostess I was T1D. This helped me in two ways, I was given my meals when I wanted and not when they were serving it. Secondly, they swapped around my meal a little and took off the potato cutlets and gave me a portion of fruits. In my connecting flight for some reason, my request for a vegetarian meal hadn’t been forwarded but the air hostess was kind enough to put together some vegetables and a little bread so that I could have a meal on time.

Adjusting Basal

This was the trickiest part for me. I discussed this in depth with my fellow T1Ds (shout out to Nupur, Madhura, Sagar and Chinmay). We all read extensively online about how to adjust basal especially since I am on MDI.

I was flying east to west, New Delhi to US and my actual number of travel hours (not accounting for the time difference) were 18. I was gaining time and thus when I landed it was still the same day as the day of my departure. I had left at midnight and arrived at my destination mid-noon of the same day.

Here's how I adjusted my basal on MDI : I take my basal at 11PM IST everyday. I did the same on the night of boarding my flight from Delhi, took my basal at 11PM IST except that I took only half my dose. The other half I took at 11PM Chicago time. As soon as I boarded the flight, I changed my watch to Chicago time to keep track of my upcoming split basal dose (the other half).

Even with my best efforts, it wasn’t all hunky dory. Despite giving myself the correct amount of Lantus at the correct time, for two days after landing I lived with constantly high BGs. After frantically calling my friends back home the morning of third day, we decided that changing my Lantus cartridge made sense because I felt my basal was probably spoilt. I was able to come to normal levels thereafter. In hindsight I realize that it could have been due to my impending monthly period cycle as well, which I had forgotten about in all the travel excitement. Change in weather can also affect BG. So, I feel like it was a mix of few things that caused such levels. I was constantly taking correction doses and hence you can see the peaks and troughs in the graph.

While flying back (west to east), I was a bit more prepared. I took my basal on the day of departure at the usual timing. I then took the flight and instead of calculating any difference, I just counted the actual no of hours of travel. It was 19 hours in total. I boarded my flight at night from the US and landed in India early morning. When I completed 24 hours in absolute time (which was again early in the morning in India), I gave myself half my dose of Lantus and watched my levels through the day and gave correction doses, when required. I was back to routine in no time!

Here's how to manage pumps crossing time zones: I got Nupur to decode adjustments on insulin pumps and all you have got to do is change the date and time on your pump to local time when you land at your destination and monitor closely for any changes needed.

Please do your research, talk to your endo and choose what works for you.

Keeping a diabetes bag handy

My brother’s grad ceremony was a big affair and no hand bags were permitted for security reasons. I carried my diabetic supplies in a Ziplock bag. I was told that medical bags like you see in the picture below are permitted. This is a bag by a company called Mybetic and is my absolute fav. I can put all my diabetic supplies in this small bag and it's allowed to be taken anywhere. For the evening ceremony later that day I carried this bag. In fact, I carried it through the trip and was quite satisfied that I didn’t need to keep looking for things in my backpack. It even has space to hold my money (and passport!)

Eating out: Bolus Adjustment

When travelling, you will most likely eat out, though it’s tricky getting the carb count right. I am listing my favourites in Chicago :

Amravati: Located in the beautiful town of Urbana-Champaign, it's an Indian restaurant with a buffet that serves familiar, home style food, preferred by Indian students.

Denny’s: Nothing speaks American culture like breakfast at a diner. All my reference points for US that came from sitcoms like Friends, Gilmore Girls etc featured these diners. Of course, I was going to eat at a diner. Denny’s is a very popular chain across the States and I treated myself to pancakes. I got multi-grain pancakes and ate to my heart’s content. Not suitable for those on low carb but I loved it. I googled the carb count, bolused and didn’t spike.

Subway: Trusted subway was a saviour when my cousins decided to eat at a steakhouse. I ordered a vegetarian sub and a yummy lemon raspberry cookie that was the bomb and it spiked me. I wasn't going to beat myself for it on a holiday!

Veggie grill: This cute little place in the heart of Chicago served vegan food that had me drooling. I had the very filling rustic farm bowl which was super yum and low carb. Had to balance for all the carb intake, after all.

Jetlag

For almost half my trip, I dealt with jetlag and slept at unusual hours. My BG might have also been disturbed because of this.

Travelling in groups

Travelling with a large number of people may get chaotic especially when you might want to alter your meal timings and food according to your current BG while others eat when they want to. Since this was a family trip, it was easier.

ALWAYS keep your travel mates in the loop about the hows, whats and whys of your altered schedule

Expect the unexpected

While returning, I didn’t realize when my libre expired and I was without a working sensor for 5 hours. I should have put on a new one but it slipped my mind in the chaos of catching my flight (I missed my flight eventually). I ended up changing my libre sensor at the airport during my layover!

Things I learnt on this trip

1. Keep yourself hydrated

Managed with super high levels and no ketones only because of water intake. Averted DKA!

2. Test sugars regularly

I manually pricked at least thrice a day even though I was using an FGM

3. Take regular correction doses

Be ready to adjust bolus since there's unfamiliar food and it takes a while to get the carb count and insulin dosage right.

4. Take care of your feet

You are going to walk a lot, please carry comfortable shoes.

5. Carry a medical waste disposal container

6.  Go easy on yourself, you are on a holiday after all!

You can plan your trip all you want but just like life, unexpected situations will come your way but take your time, analyze, put your reading material to practical use, reach out to your T1D community and you will make it through, having thoroughly enjoyed your holiday.

I am going to leave you with this picture from a departmental store because I feel like it sums up my trip the best - I was thrown off track with my BG but I made it through with my spirit animal showing up exactly when I was beginning to lose my calm. And I didn’t. I was on a holiday and I was not going to let diabetes play a spoilt sport. I ended up having a lot of fun!

Happy holidays, everyone!