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Traveling With Type 1 Diabetes
Is your mind spinning with details just thinking about travel How to get there? Where to stay? What will it cost? What are the food options? What activities or sights to see? What clothes to pack for the climate? Who will water the plants and take care of the pets? All of my diabetic supplies are packed all the time. Yes, I keep my bags packed and ready to go because really, who wants to worry about another thing when you have so many other details to coordinate before travel? I travel frequently, and often for long lengths of time. Due to this, I’ve developed a 3-tier packing system based on the amount of time I’ll be traveling. The System I’ve Developed A small eBags packing cube to carry 2-14 days worth of supplies A carry-on business shoulder bag for up to 3 months of travel A carry-on roller suitcase for all of my remaining diabetic supplies (This is what I use when traveling for more than 3 months and for international moves.) Plan Your Supplies When starting to plan, always account for double the supplies that you would normally use at home. For example, over 7 days at home, I would use 2-3 insulin pump infusion sets depending on when I last changed it. For 7 days of travel, I’d pack 4-6 infusion sets. If you might not need an item during your time of travel (for example, a Dexcom transmitter that should last for 3 months), pack a spare just in case. I use both an insulin pump and Dexcom CGM, so your necessary and preferred supplies may be different than mine. Here is what I pack for a 7-day trip: DEXCOM: Dexcom Transmitter (spare) Dexcom Sensors (2) Dexcom Receiver (if you use one) Charging cord for Dexcom receiver (and adapters if needed) Opsite Flexifix, precut to fit over Dexcom Transmitter (4) Skin Tac wipes (4) Uni-Solve wipes (4) PUMP: Pump Infusion sets (4-6) Infusion set inserter (if you use one) Pump reservoirs (2-3) Extra battery or charging cord for pump Spare parts if your pump comes with them (battery cover, collar, etc) Pump carrying methods (holster, waist belt, thigh belt, etc) GENERAL: Emergency syringes (4) Emergency Lancets (2) Frio Cooling Wallet (Large) Alcohol wipes (8) Glucose tablets (1 bottle of 50) Test strips (1 bottle open, 1 extra) BG Meter Extra battery for BG Meter Lancing device Since I keep all of this packed, I just need to soak the Frio Cooling Wallet in water for a few minutes and grab the refrigerated items, which are stored in a Ziploc bag: Insulin (2 bottles) Glucagon Pen If you use injections and don’t use a CGM, your list of supplies to pack will be much shorter. If you don’t travel frequently, but want to organize your supplies so they’re easily accessible, you can use this list to pack a small bag of necessities for general pump and CGM changes. It’s a great grab-and-go solution, even at home. Take it to work, take it to school. It’s your mobile transition pack: bigger than the daily meter/CGM/insulin pack that you inevitably carry, but just a portion of the supply stockpile that we all have at home. Airline Travel Tips Remember to pack all of your medical supplies in your carry-on luggage. If you’re traveling for an extended period of time and have an entire bag just of medical supplies, tell the check-in agent who will note in your record that you have an extra carry on due to medical necessity. I also tell security personnel that my medical bag will be coming through the scanner. I ask for a pat-down and never put my pump or CGM receiver through any metal detector or scanner. This is personal preference, and I’ve heard others pass through the scanners with no problems. I’d rather not take the chance of causing a pump or CGM malfunction when traveling. You may also choose to carry a note from your doctor stating type 1 diabetes and your need for access to certain supplies and medications at all times. I’ve had this letter before, but luckily never needed it. And don’t forget to change the time on your devices for your new destination. This can be tricky when flying over many time zones and following unusual meal times. It’s generally recommended to change to your destination time as soon as you get on the plane but use your own sleep and meal schedule as the determining factor. For most people, on most trips, a week or two of supplies will be sufficient. If you pack well, there’s no reason for your supplies to take a ton of room in your carry-on. It’s one less thing to worry about, so you can focus on your upcoming adventure. Bon voyage and happy travels!Health conditions Diabetes
Airlines and wheelchair
Airline travel can be a challenge to people for all different reasons. Our experience has been that the airlines try to make it as easy as possible for a person/family with a wheelchair or person with a disability. Our son finds airline travel exciting for the first hour or so and then he is very keen for it to be over making it a real challenge. He is a wonderful traveller once he gets to his destination but let’s just say I’ve been nearly moved to kiss the ground on arrival! I also scoff at those that say “travel is about the whole journey not just the destination!” For us the sooner the flight is over the better. I am sure that we are the exception rather than the rule. Now with in flight movies, messaging facilities between the seats, games etc the old days of one or two movies and everyone craning their necks to see the screen at the front of the cabin are over. Our experiences (we’ve been to the US twice as a family) have only been with Qantas, on the A380 and the 747 400. We chose Qantas for 2 reasons, it was important for us to sit together (QF seat configuration on the A380 is 3/4/3) and on the A380 they had a toilet on board that was for people with a disability. On all four flights we only had positive things to say about the staff, both on the ground (from check in) and in the air (Qantas in no way sponsor me so this is purely based on our experiences). I am happy to give them a good rap as they were great! What I found out on our second trip is that some airlines (in my research I found both Qantas and Virgin have them) have an upper body torso harness available to people with a disability. It is basically an upper body seat belt which may be of some benefit to people with poor upper body control. It might just give a little more support. It can be viewed on Virgin’s website and I am including the photos Qantas supplied to us before we travelled. This harness can only be used in certain seats on the aircraft due to it using an anchor point. The harness must be pre booked and I’d recommend doing it well in advance and at the time of booking. I have a friend who has used them on V Australia domestically so definitely worth checking if your airline has it available if you think it will benefit you. Airlines now require measurements of wheelchairs so make sure you have the height, width, and weight of your chair when you phone to make your booking it will save calling back again! Qantas had a very generous luggage allowance for people needing mobility equipment. Check with your airline prior to travel if this is essential to you. Qantas allowed 2 bags, 1 wheelchair and 1 other piece of mobility equipment. This was the allowance to the US but please note this varies according to your destination. Due to the liquid restrictions in the cabin of the aircraft you need to check with the airline regarding any foods or liquids if they are necessary for you to take on board. Our son has special drink containers he drinks from so I take that through the security check empty then fill it before getting on the aircraft. We have always used our own wheelchair to the door of the aircraft. Once again you need to mention this at the time of booking, again at check in and it should be possible if necessary. Our son can then walk assisted to his seat but they will provide an aisle chair to your seat if needed. At the door of the aircraft it is recommended that you do up the belt on your wheelchair to lessen the chance of damage and take any items from the wheelchair that are removable for example we always take the seat cushion and arm rests off our wheelchair and stow in the overhead lockers. The airlines encourage it as they prefer it is not their responsibility. Have an empty bag under the wheelchair or somewhere with you to put it all in to save juggling boarding passes, bags, armrests, seat cushions etc. You see people arrive with their one Versace bag looking very glam and there I am with boarding passes between my teeth, bags, juggling cushions, armrests etc while my husband walks our son up the aisle. Not quite the travel look I aspire to but having a bag to at least consolidate the wheelchair bits into makes it look a little more controlled! The airlines usually board a person with a disability and their family first to allow extra time to get organized. The downside is that at the end of a long flight you are last to leave the aircraft but usually the cabin crew are very helpful with bags. We prearrange to have our own wheelchair waiting for us on arrival at the aircraft door. We have only had this not work once and our son was most uncomfortable and unstable in the airport wheelchair that was nearly double the width of his usual chair and without a pelvic strap. Advise at check in and on boarding that you would like your wheelchair at the aircraft on arrival and we have also been encouraged to remind the cabin crew about a ½ hour before landing so they can contact the airport and ensure it all runs smoothly. These are all small things but at the end of a 15 hour flight it does make a difference. On arrival in the US we have always been fortunate enough to be taken to the shortest queue possible or let ahead of the crowd to get through customs quicker. This would always depend on the staff at the airport but our experience is that the staff are really considerate.Health conditions Diabetes
motherhood | pregnant travel tips
I’ll be 22 weeks pregnant tomorrow. Life growing inside of you isn’t, in my experience, without its ambivalence. Some days I fear she’ll disappear, that I’ll wake up to a stillness. Other days, I feel the burden on my body, feel invaded or fear the day (the day coming soon) when my life is no longer my own. But most days, I just enjoy the quiet before the storm, this symbiotic time I get to spend with her. I feel lucky to be a woman—lowered immune system, round ligament pain, swollen ankles, and all. Traveling with her—Matt & I are currently two & half weeks into a month long trip through Japan—as she grows, feeling her kicks grow more urgent and frequent as our journey wears on, makes me feel closer to her. The metaphorical journey in tandem with a physical journey makes the metaphor come alive: with each step, each train, each bus I move closer to being a mother. Momentum. I relish the fact that in her dark, watery world she’s experiencing the bumps and rumbles of the train, the flavors of each country I visit, her father’s voice as we talk over dinner. We’re already a family. That said, traveling pregnant is a different beast than all previous travel in my life—and I’m sure traveling with a baby will be even more so! But in the mean time I wanted to share my tips & advice that I’ve gathered along the way. There’s been a very real learning curve! If you’re like me and thought that being pregnant would be just like being you but larger, think again. Depending on how long you’ll be gone, how far along you are, how far you’ll be traveling, and what location you’ll be traveling to you’ll need to consider a few different things. These are just the basics and what I’ve noticed thus far in my experience. I get the feeling that after I finish up all my international travel at around 32 weeks I might have some updates to add to this. But after working & traveling in France, Morocco, Italy, and the UK during my 1st trimester for about 6 weeks total and traveling in Japan during my 2nd for 4 weeks, this is what I’ve gleaned thus far at 5 months along. I’ll be in France, Spain, and Sweden during the end of the second trimester for another 6 weeks, and we’ll see how that goes! Packing + Planning 1. Pack light. I’m obsessive about packing light, and I intend to write an entire post on it (namely on fitting a month—and if it will do you for a month, it will do you for 6!—in a carry-on), but suffice to say pack only your essentials, make sure all your clothing can mix and match, limit bulky pieces, and remember that you can buy a lot of “what if” items on the road. Never pack for what if. Except for the following… 2. Emergency medicine. If traveling somewhere very unfamiliar or with a big language barrier (hello, Japan!), bring an acetaminophen based pain killer like Tylenol or Pericetimol in case you need a pregnancy safe solution. I get migraines, and when traveling to a non-english speaking country the last thing I want is to be guessing & dancing around the language barrier in a foreign pharmacy trying to find something safe. Depending on where you’re planning to travel and for how long, your doctor might be willing to provide you with some emergency pregnancy safe antibiotics just in case. I’d also bring any other basic over the counter meds you & your doctor are comfortable with you taking pregnant—I’ve gotten bronchitis twice in in 4 months! 3. Doctor’s note. After 28 weeks some airlines require a note from your doctor saying you’re fit to fly. It’s generally acknowledged that in non-complicated pregnancies it’s safe to fly up to and including the 36th week. Follow doctors orders on this to be safe. A copy of your chart also wouldn’t hurt, though I don’t carry one because mine has been 100% uncomplicated, and I started healthy. 4. Pack clothes to grow into. If you’re going to be on the road for a long time, pack loose fitting clothes to “grow into”. Tunic tops, flowy dresses, and comfy pants with elastic waist bands that can sit below your growing belly are great options. My belly doubled in size our first two weeks in Japan! There comes a time when both your growth and the little’s will be exponential, and if you’re hitting the road for a month or two, things that fit in the beginning might not be so friendly by the end. Best to leave those bits at home and only pack the most versatile pieces. I’ve listed some of my favorite sources at the bottom of this post. 5. Fit your life in a carry-on that rolls on 4 wheels. Do it. Go for a lightweight, hard-case, 4-wheel rolling bag that fits into an overhead compartment. Both my husband & I are carrying Away bags which have the added benefit of being able to charge your phone, pocket wifi, tablet (any USB powdered device) etc. multiple times. It can charge my iphone fully 5 times. Forget backpack pride (I had to). A four-wheel rolling bag (and a friend or partner to carry it up & down heinous flights of train station stairs should you encounter them!) will make your life so much easier. Sit your purse/camera bag/what have you on top, and roll through streets, stations, and terminals bearing no weight. Your body will thank you. I travel a ton and have my whole life, and I doubt I’ll ever do it any other way again unless I’m actually going backpacking. Like in the woods. 6. Bring the vitamins. Pack your favorite prenatal vitamins. I travel with an organic catch all pre-natal and non-fish DHA as well as B12 and D3 (because I know I have low levels of those two). They take up room, but they’re worth it to know I’m getting the essential nutrition we need. 7. Comfy shoes only, please. Obvi. My comfy shoes of choice are Dansko clogs & boots, but I also like Birkenstocks for sandals. Sneakers are always a sure bet too. I like classic looking Nikes and vintage style Asics’ Onitsuka Tigers. Don’t bring more than 2 pairs of shoes and travel in the bulkiest pair to save space. I bring my clogs (my every day walking/travel shoe) and sandals or sneakers suitable for light hiking. If my trip is going to be on the more urbane side, I swap the hiking shoe for a pretty dinner shoe. A small pretty dinner shoe. I don’t do heels of any significant height and frankly 99% time my clogs do the trick day to night. 8. Travel with a partner or friend. If you don’t have to, avoid travel alone. You can, of course you can, and if I didn’t have a friend or partner to go with me, I would brave it on my own. But this is a time in life when you need all the help you can get, and it’s a time when no one minds lending it. Take the support, and let them help. I tried to insist on carrying my bag up some ridiculous stairs and just about killed my ankles doing so. I now let Matt (not without an inner cringe) manage both our bags up and down stairs. I look at it as his on the road gym time. : ) To ease my mind I make sure to look extra pregnant (hips out, maternal holding of belly, the whole 9 yards) when he’s doing this so passers by will know I’m not useless, just pregnant. Because that damn pride. 9. See the doctor! Try to see your doctor for a check up & ultrasound as close to when you leave as possible if you’re going to be gone a long time (two weeks or more). This will give you peace of mind. Check before booking to make sure you’re traveling to a pregnancy safe destination. Due to the Zika virus your doctor will likely recommend you not travel to affected countries because of its potentially dire effects on pregnancy. The CDC website has lots of information about Zika here. This goes for other diseases as well—malaria, dengue, etc. Talk to your doctor about vaccinations and prophylaxis safety if those are options you’re considering. I opted for the flu vaccine during flu season; I know not everyone is on board with vaccines but that was my choice. I usually research this when I’m researching what paperwork I’d need for any given country (namely is a passport enough or will I need a visa). Planes + Trains + Automobiles 1. Hydrate when flying. This one is a no brainer, and despite the fact that it will make you have to get up for the restroom more frequently than you could ever comprehend (seriously) it’s a must. I’m one of those weirdos that really dislikes drinking still, room temperature water. So I try to fill in my water gaps with coconut water (great for electrolytes), green tea, low sodium + sugar veggie juices, and sparkling water. I also travel (on short trips, not so much on long because of the added weight) with a copper water bottle from Spartan Shop. It deposits beneficial minerals into the water, purifies the water, and it’s pretty which makes me happier about drinking water. Whatever works. 2. Aisle seat + stretching on long flights. Book an aisle seat (you’re going to be up & down a lot) at bare minimum and one with extra leg room if you can. Got miles to burn or can afford business or first class? Even better! Get up frequently and move around and stretch. Your body is basically a transformer right now, and your bones & internal organs are doing all kinds of crazy gymnastics. That means long stretches of sitting can cause some serious aches. Not to mention pregnant women are at an increased risk of blood clots (DVT). So walk around every hour. If you’re drinking water like you should, you’re not going to have a choice and it might be more like 2-3 times an hour. Do some yoga by the bathrooms. Whatever, you’re pregnant. A little public forward fold never killed anyone. I’d say go for downward dog (really relieves round ligament pain) but I don’t think I could bring myself to touch the floor. 3. Accept special treatment on public transportation. Let people know you’re pregnant. Take the seat privilege on trains & buses and board early and seek upgrades on flights. Seriously, take it. I didn’t at first & lived to regret it. If you’re in a non-english speaking country you can just touch your belly in a maternal way and give them a pleading look if you need a seat. The message gets across. Willingness to give up seats to pregnant women is international. In Japan you can even get a badge in the train station to show you’re pregnant! I didn’t take them up on this, but hey, if it works. And if flying, take the opportunity to board early, get an upgrade, anything your airline is willing to do. This is not to take advantage of your condition and be lazy, but because being on your feet for very, very long stretches can (as I learned) cause some pretty intense pain especially from around 5 months on in my experience. Not so much during the first trimester. 4. Consider renting a car. I was one of those college kids floating from train station to hostel all over Europe on a dime with a copy of Lonely Planet in hand a decade ago, and I tend to be biased towards public transportation due to it being scenic, narrative, and frugal. But if you’re in a situation where car rental is an option, consider it. No more rushing from platform to platform, no more timetables, no more train or bus loos. No more bag wrangling. If you decide to go the car route, keep in mind that some countries require an international driver’s permit which you can get through AAA. Google it to find out what the requirements are at your destination. 5. Eff it. Get a cab. I can usually walk indefinitely, and metros & my own two feet are all I’ve ever needed to get around major cities. But if you get to the end of the day and can’t take it, just cut your losses and get a cab or Uber. It’s so worth it. Food + Drink 1. Eat clean food from reputable, sanitary sources & wash thoroughly all raw food you prepare. I’m not a doctor and this is not medical advice, but it’s my personal choice to not subscribe to the standard American pregnancy food restrictions. I know that is controversial to some people. This is not something I recommend doing without talking to your doctor and doing your own research, but I decided that for me the risk of getting in a car and eating chicken (or fruit and vegetables for that matter) far out weighs the risk of sushi or a fresh slice of prosciutto. I even eat raw oysters (from highly, highly reputable sources—there are about two restaurants and a handful of farms in the US I trust to this degree). I eat sushi (while limiting any high mercury fish and again from reputable sources). I ate raw, French cheese. I’ve eaten cured meats, freshly sliced. Never pre-packaged. The truth, according to my doctor, is that you really can’t know when or where listeria (a very dangerous to you & your baby bacteria) will come up because it’s in soil and water—any food can be contaminated. The last major outbreak was in ice cream, and one of the worst was in cantaloupes. The important thing is to only eat from clean, reputable sources that you trust and to wash your food. I’m more wary of salad than anything else. No dodgy sushi from a mall in the midwest. No grilled intestines in a dive bar (also learned the hard way). No rando queso fresco from a hole in the wall carneceria. But if you’re near a Japanese fishing village, you’re probably safe eating the raw fish. Really that’s true of Japan at large. Ultimately, do what makes you comfortable, err on the side of caution, consider what local moms & doctors have to say, and do some research to assess the risk yourself when it comes to food & drink. I, for one, made the decision to not be too precious about it while also not being foolish so that I could enjoy my travels & experience pregnancy without fear. Sushi in Japan is considered a perfectly acceptable part of a healthy pregnancy diet as are wine, raw cheese, and charcuterie in moderation in many European countries. That said, I did say no thanks to the (raw) chicken sashimi (I kid you not) I was offered the other day. Maybe clean, but I was skeeved out. One thing I don’t mess around with is water. Only bottled water if there’s any question, and in countries with less food sanitation, I avoid *all* raw things, especially salad. Food sanitation is the most important factor in deciding what to eat and what not to for me. If in doubt, cook the hell out of it. Heat kills listeria. Period. 2. Expect a bit of tummy trouble. That said, I’ve found that an upset stomach is going to find me no matter what I eat, wherever I go. It finds me at home; it finds me abroad. Having an entire human being growing in the space previously devoted to digestion causes some trouble. This might be particular to me & my pregnancy, but I find that I’m much, much more susceptible to being ill. This may differ from person to person, but I find that every week or two I get a very upset stomach that keeps me up. It isn’t dangerous and is gone by morning, but my theory is that any and all foreign bacteria that my body might have just dealt with before is now making me icked out due to a lowered immune system & hobbled digestion during pregnancy. 3. Favor frequent smalls meals. I’m hungry a lot. Yet due to the growing baby inside me, my stomach is smaller than ever. Any large meals also make me completely sick & miserable, so to avoid discomfort, eat frequent small amounts. For this reason I carry snacks, especially on long journeys. And don’t forget that (clean) water! On the Go 1. Do less. Cut what you think you can do in a day in half. Cut what you think you can do in a month by a quarter. This was and is still the hardest one for me. Walking all day around Tokyo I got to the point where I was in so much pain, I would have been afraid if I didn’t know it was round ligament pain. When you’re used to being able to go indefinitely and explore to your heart’s content, there’s a learning curve involved in deciding to see and do less. Everyone’s body is different, and you might have more pregnant stamina than I do, but I’m healthy and (relatively) young at 32, and it hasn’t been totally easy. Save yourself the discomfort, and accept ahead of time that your body is busy growing a person and therefore might not be able to do as much other stuff. That’s okay. Make lots of cafe stops, go to bed early, sleep late, and take down days. Seriously, if abroad for more than a week, take at least one “do nothing but hang around the room/neighborhood/bed” day. 2. There might be pain. I didn’t count on this, but being on the road and traveling place to place frequently means my body has hurt. Feet, ankles, back, round ligaments. Since I’ve been traveling my ankles have swollen up like easter eggs once; I’ve almost collapsed due to round ligament pain (twice); my feet became sore/blistered because of swelling inside my normally ridiculously practical & comfy shoes; I’ve fractured a rib from bronchitis induced coughing; pinched a nerve in my neck; and my back feels about one wrong move away from being thrown out on any given day. Truth. Ouch. I didn’t expect any of that. I’ve never been particularly fragile. So, I sit at every opportunity. I rest. If you’re like me, this will all be really hard to wrap your mind around or even admit, and you’ll feel like an invalid. But you need to take care of your body. The fact is that when pregnant your immune system is lowered to stop your body from rejecting the baby hence you’re more susceptible to infections like coughs, colds, and the flu. Couple that with the transformer stuff your bones and organs are pulling and you have a body far more fragile than you’d dealt with before. At least that’s been my experience. 3. Exercise! On the flip side, don’t be scared to do some walking & get plenty of exercise, but if the pain gets to be the bad sort, stop. Travel really is great prenatal exercise, and staying active while pregnant is associated with all sorts of benefits for mother, baby, and delivery. Just stop when your body says stop. No need to treat yourself like a sick person, just remember to be gentle. 4. Keep an eye out for restrooms, and use them every time you see one. When wandering big cities, keep an eye out for fast food chains: they have guilt-free bathrooms with no purchase. I’ve never been so happy to see a Japanese McDonalds in my life. Just try to resist the fries… 5. No scuba, no ski. Just in case you weren’t aware. Generally nothing that involves a likelihood of you taking a spill. Unless you’re like me and simply existing involves a likelihood of you taking a spill. In which case…fall on your side. Don’t ask me or my skinned elbows & knees how we know that one. 6. Keep up with your progress using a pregnancy tracking app. It’s nice when you’re not having check-ups super regularly to be able to follow along with the growth of your little and find out what’s happening to your body along the way. I use Ovia. It tells me what symptoms are normal for where I’m at in the process, and it tells me what size she is in terms of French patisserie, which I’m a fan of. It says at 21 weeks she’s the size of a large brioche à tête. 7. Sanitize, sanitize, sanitize. It’s no secret that I’m not a germaphobe. I’ll eat anything, touch anything, go anywhere. I just am not naturally inclined to worry about it. But remember that lowered immune system? I carry antibacterial gel in my bag, and try to keep my hands as clean as possible. If I were better at it, I might not be sick right now. Do as I say, not as I do. Lastly…Mindset 1. Expect the unexpected. If you’re a first time mom like me, you’re going to have no idea what to expect from your body. Don’t expect the worst, don’t expect the best. Just let go of expectations, take each day as it comes, and always keep your & the baby’s health priority number one. Even if you’ve had one or two or ten kids before, every pregnancy is different so I’d wager expectations aren’t much more useful in that scenario either. Just be committed to rolling with whatever happens with positivity and reason. 2. Don’t live in fear. The reality is babies are born every day in myriad different conditions; we’re tough critters. That isn’t to say things can’t or won’t go wrong and complications don’t arise—they do—but to say that there’s no point living in fear of them. I don’t pack for what ifs, and I don’t life for them either. I let passion and opportunity take me, and if it seems prudent that I should cancel, hold back, or change plans I simply do and enjoy that alternative. 3. Just go. Unless your doctor said not to. Then stay. Don’t overthink it. It’s not rocket science; it’s totally worth it (says the girl with a fractured rib!); most anything can be dealt with in developed countries; and language barriers are surmountable. If you want to travel pregnant and have no medical reason not to, just go. As someone who has had what I think could be considered rather bad luck this go around (this rib situation is seriously weak), I still say it’s 100% worth it.Health conditions Diabetes