Calling All Diabetics...

*Before reading, just a quick reminder, that anything you see that's this color is a link that you can click.


Just a few days ago, I had a friend write me, asking for tips on how to travel and manage your medicine as a type one diabetic. After responding, Byron and I started talking about how we've had to learn so much through trial and error, in terms of managing my diabetes abroad.

With that in mind, I thought, maybe I should write a post about how I manage things, on the off chance that another type one diabetic would read the post and find it helpful.

**Disclaimer**
I am not a doctor, nor do I have any formal medical training. The following info is just a compilation of the different things I've tried and have found to work well as I live aboard and have to manage being a type one diabetic. 

So, hopefully some of you will find this helpful, even if you're not a type one diabetic... Maybe it will help you to have an idea of things you should plan for if you have any medical condition and will be traveling soon!




1) Packing List
For me, I make a pretty serious packing list for my medical supplies. Usually, I start making the list a few weeks before I leave on my trip, or in the case of missions, before I furlough or head back to my country of residence. There are a few things I try to consider when I'm making a packing list:

• What's available to me in the country I'm heading to? Usually, my packing list heading to the USA is very different from the packing list when I'm heading out of the USA.
• What if something spoils, gets damaged, gets lost, or gets spoiled? This helps me to decide the quantity of each things that I bring. For example, if I'm going to be gone for two weeks, I'll bring four weeks of medicine, just in case. But, if I'm going somewhere for 6 months or a year, I just pack an extra couple months of supplies, just to give myself some cushion in case something happens. 
• How much medicine do I actually use per month? Before heading somewhere, I start to track how quickly I use my medicine about two months before departure. 
• What's necessary? I used to think that the only necessary medical items were the prescribed ones. However, I quickly learned that I was wrong. Once, I was traveling and my insulin pump's battery needed to be changed. I had the battery with me, but I didn't have a way to open the battery slot. The insulin pump's battery slot can only be twisted open by a coin the size of a dime. Unfortunately, I didn't have a dime with me. Not only that, but the country I was in didn't have any coins small enough to work. Eventually, I got it opened with a key and learned a valuable lesson - I always have a dime AND a battery with me now. 

With that being said, here was my last packing list - for all you T1 diabetics out there, maybe it will spark something you forgot to pack, or give you peace about the list you've made:

Packing List - 1 Year Away from the US

• 15 Quick-set infusion set boxes (10 sets per box, 1 box lasts me 1 month)
• 15 Paradigm reservoir boxes (10 reservoirs per box, 1 box lasts me 1 month)
• 2 Quick-serters (used to insert the infusion set - I pack 2 in case I lose one of the quick-serters)
• Insulin Pump (on my person) and backup insulin pump (in case of pump failure)
• 20 AAA Energizer batteries (each batter last me 3 weeks)
• 1 dime, or small coin the size of a dime
• As many vials of blood testings strips as I can bring (My insurance will only let me get a 3 month supply at a time, so usually I only travel with a 3 month supply and then my mom continues refilling the prescription and sends it to me via mail every few months). 
• 2 blood glucose meters (1 in use, 1 for backup)
• 400 Lancets (I try to change them daily)
• 200 Syringes (in case of pump failure)
• Continuous Glucose Monitor (CGM) with charger, USB cord, and sensor chip (I don't have a spare)
• 26 (or as many as I have) Sensors (although not medically suggested, I do wear the sensors 2-3 weeks, depending on how active I've been, to make the sensors last longer)
• LOTS of alcohol swabs and IV preps (I'm not sure how many I have, but it's a huge ziplock bag full of them)
• 3 Glucagon kits (1 for me to keep with me, 1 for Byron to keep with him, and one spare)
• 24 bottles of glucose tablets (50 tablets per bottle. Each bottle lasts about 2 weeks)
• 20 vials of humalog (1 vial lasts me 3 weeks)
• 1 vial lantus and 1 vial NPH (for pump failure)
• 4 Frio Insulin Cooling Cases (2 in use, 2 spares)
• 1 thermal bag (to hold insulin)
• 2 ice packs (to keep insulin cool)
• Various sizes of zip-lock bags (they just make life easier, and it's also nice having things organized in clear, resealable bags)
• Doctor's Letter (Even if you have all of your supplies, if you can't get through airport security, it's pointless. Never forget your doctor's letter!!!)

2) Getting It Into Your Suitcase

This is always difficult, even if you don't have medical needs to consider. 

• For short-term trips, I take everything carry-on. 
• For longer, but still short trips (2-4 months), I can't take everything carry-on. So, I split it all up equally in my bag and Byron's bag, so that if something happens to half of my medicine, at least I'll still have the other half. I also make sure I have a one month supply of everything with me carry-on, just in case I lose my bag and Byron's bag. Then, I have enough supplies with me to figure it out and regroup. 
• For moving or being gone for 1 year+, it's a bit more difficult to work it all out. Because most of my supplies come in bulky boxes (meant to protect the contents of the boxes), it is impossible to get all of my supplies in only two bags. And with the high price of checking a second bag, it would be impossible to have two bags solely devoted medicine, and still at least 1-2 more bags devoted to clothing, etc. So, here's what Byron and I have come up with... It's not the best idea ever, but it's the best one we've had so far. We bought a hard shell suitcase (the largest one that a standard airline allows without extra fees) for my supplies. Then, we take all of my medical supplies out of their boxes, and put them all inside the hard shell suitcase. Again, I am not a doctor, and this might not be a great idea, so follow this advice at your own risk, However, this is the only way we can transport everything I have using just one bag. And then, we pray and ask everyone we know to pray for this bag to arrive safely, without any problems or tampering, at our final destination. 
• Because insulin is so fragile, as well as my spare insulin pump, CGM, and glucagon, these items always come with me carry on. 

3) Keeping Your Insulin Cold

This has been the most difficult aspect of travel for me. How do I keep my insulin cold if I'm traveling for 20 hours or more? And what if there is spotty electricity at my final destination (For example, when I was living in Uganda and the power would turn off for a few days at a time, leaving the fridge warm, as well as my insulin)? 

If you haven't tried frio coolers yet, let me just tell you, they will simplify your life like you wouldn't believe. Check out their website by clicking HERE. All you have to do is dip them in cold water, or room temperature water if that's all you have, and the gel inside is activated and will start to cool the frio pack. It's pretty cool and definitely a lifesaver. 

So, this is how I transport my insulin - I put all of my insulin inside of activated frio cooling cases, and then I put them inside of a thermal bag, zip it closed, and put it inside of the fridge the night before I go somewhere (the frio website does not recommend refrigerating frio cooling cases, however, I do refrigerate them to get them colder for long periods of travel, and I do so at my own risk). Then, the morning of my travels, I also add two ice packs to the thermal bag, and put it all inside of my backpack, which I always take carry-on. 

When I was in Uganda, the power would turn off and on frequently, and often, the power would turn back on for only an hour or two - not enough time to cool down the fridge. Keeping my insulin from spoiling was a constant battle in Uganda. So, this was the best system Byron and I came up with... I would re-dip the frio cooling cases every 3-5 days to keep them activated. Then, I would keep them zipped closed inside of my thermal bag, and I would keep my two ice packs in the freezer. When the power would turn off, I would make sure the fridge was opened only when necessary to keep the fridge as cold as possible. Then, once the fridge would start to warm up, I would take the ice packs out of the freezer and put them into the thermal bag around the frio cooling cases. Usually, all of these things combined could buy me 3 solid days without electricity. 

All that being said, when I returned to the US, I did throw away any spare insulin I had with me in Uganda (I think I only had 2 vials left), because I was pretty sure that it had spoiled, and was only working by the grace of God. So, that's another thing to consider - if you think your insulin spoiled while you were traveling, and you have easy access to more insulin, I would just replace the insulin as soon as possible. 

4) When All  Else Fails

Always have an emergency plan. This is something Byron and I do before we go anywhere, but it was especially important for us when we were in Uganda. Our emergency plan is usually a list of questions, if/thens, and worst case scenarios, and looks a little something like this:

• Is there pharmacy that carries insulin near where I will be staying? If so, how quickly can I get there and do I need to see a doctor to be prescribed that insulin?
• When we were in Uganda, we found a clinic about 10 minutes from where we were living that had a doctor who could prescribe insulin to me if I came in for a physical, and this clinic also had a pharmacy that carried insulin, and always had that insulin in stock. 
• What if I can't get insulin where I'm going?
• There were a few islands that we did medical outreaches to on Lake Victoria. These islands were renowned for disease and a lack of available medical professionals, pharmacies, etc. Whenever we would go to the islands, we traveled by boat. So, I had to prepare for (1) my insulin pump falling in the water (2) being stranded on the island. I would usually bring everything necessary for insulin pump failure with me, and I would bring a one week supply of everything I needed, even though I would only be on the islands for 5-8 hours. 
• What if I need a glucose IV to prevent passing out and seizing?
• This also happened to me in Uganda, and it was the first time this had ever happened to me in my entire life. Our car was broken down, so we couldn't drive to the clinic, which we knew carried the glucose IVs I needed. So, we called a taxi motorcycle and had him drive us to the clinic, and we told the driver it was an emergency and we needed to get there quickly. In the mean time, Byron was ready for me to pass out by having a glucagon kit on hand. Again, by the grace of God, it all worked out. I made it to the clinic, didn't pass out, and got the glucose IV just in time. 
• I don't have access to anything I need in this country. What do I do?
• Byron and I have agreed that if all else fails, we go to the airport. Usually, a local clinic or hospital can handle most things, and local pharmacies carried general medicine that can control my diabetes for a short amount of time. But if I couldn't get any insulin anywhere, or if my insulin pump failed, no matter what happens, I always make sure I have at least 3 days of everything I need with me (although more accurately, it's more like I always have enough emergency medicine with me to last through the first year of the zombie apocalypse), which would give us enough time to go to the airport and fly somewhere that has easily accessible modern medicine - IE: Germany, South Africa, Poland, and so on, depending on where we're living. 

5) Pray and Be Prayed For

I can make list after list and plan after plan, but the bottom line is, I don't control anything - God does. He called me to be a missionary, and He also allowed me to have T1 diabetes, so, with everything, I should trust Him first, ask Him for wisdom, and cast all of my cares and needs at His feet. 

With all of the medicine I need, and with all of the physical challenges that come my way because of diabetes, it makes sense that I should trust the One who created my body, and to pray about all of my needs. Byron and I have an amazing prayer team, and I know they have prayed me though many extremely dangerous situations, as far as my health goes. Every year, I go back to the US to have my A1C checked, and I wait to see if my endocrinologist will clear me to be a missionary for one more year. And every year, by the grace of God, my A1C is low enough to keep going as a missionary. 

With all that being said, I hope that this post, although a bit long and tedious, will be helpful to at least one person out there. Being a T1 diabetic isn't a death sentence, but even if it were, the Lord is greater than any disease or disability known to mankind, and no matter what we're afflicted with, if we want to live a life that's abundant, even if our lives are short, then we have to spend our lives sold out for Jesus. 

And so, in closing, here's to having had diabetes for 22 year, celebrating a 6.7 A1C, and being blessed with another year on the mission field!

Praise the Lord!

Emily