Managing T1D at Sea

Yo ho, yo ho, a pirate’s life for meeeeee…

I gleefully sang this song multiple times throughout my short Disney cruise getaway earlier this month. I love cruises. I love Disney. I love tropical islands. So I got to combine my love for all three by embarking on a cruise to the Bahamas with my boyfriend that was planned sort of last minute, but desperately needed nonetheless.

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When it comes to diabetes management on a cruise ship, I’m the captain (who does what she can to navigate safely through rough waters).

I’m so glad we went, even if it did involve a helluva ton of preparation time. Because as you’ve probably figured it out by now, traveling with diabetes requires extra work. But traveling with diabetes knowing that you’ll be stranded in the middle of the ocean for part of the time necessitates apocalypse-level planning.

There was a whole list of questions I needed to answer as I packed my bags for the trip. How many pods should I bring with me? How much insulin? How would I keep said insulin cool? What types of snacks should I have on hand? Should I bother bringing Glucagon? What about chargers for all of my devices?

The answer to most of those questions was…just bring more supplies than I think I’ll need. For instance, I brought triple the number of pods than I’d actually go through over the course of a four-night trip. I packed extra snacks – a few unopened boxes of granola bars and a whole bottle of glucose tablets. I don’t even know how many alcohol swabs or spare syringes I brought, that’s how many I crammed in my luggage. And I deemed that two bottles of Humalog, plus Glucagon, would be ample (after all, I’d rather have it all and not need it than need something random and not have it).

I ended up purchasing a cooling case on Amazon that would allegedly keep my insulin cool during the day trips we’d make to the islands. I say “allegedly” because it wound up not being that great (otherwise, I’d add a link here to purchase it). After a day on Disney’s private island, Castaway Cay, in which the cooling case never left the shade of our umbrella, I returned to our state room to discover the contents of the case were a bit warmer than I had expected. Disappointing, but the insulin still seemed safe to use.

In terms of meals and snacks on the boat, there was a plethora of foods to choose from. Oh, and virtual 24/7 access to a soft-serve ice cream machine. Aaaaand a lot of tempting tropical libations. I tried to stick to healthy options and incorporate vegetables or proteins at each meal, and of course I drank plenty of water, but it was vacation and I couldn’t resist a Mickey waffle at breakfast each morning or the occasional mojito-filled coconut. So it’s not totally surprising that on average, I ran a bit higher than I’d normally like for the whole cruise, but I don’t regret it because it’s really hard to judge how much insulin to take or food to consume when the days are jam-packed with physical activities and sun exposure. And I accomplished my goal of avoiding low blood sugars as much as I could, because I absolutely did not want to be stranded on the sand treating a low when I could’ve been swimming in the most gloriously warm turquoise waters with sea creatures.

Even though my diet wasn’t the healthiest, I was able to combat some of those choices with a lot of movement during the cruise. Between strolling the walking track that was on deck three of the ship, bicycling on Castaway Cay, snorkeling/swimming at the beach, and walking ALL OVER both land and ship to get wherever I wanted to go, I clocked some seriously miles on this vacation. Who would’ve thought that being on a boat would lead to so much exercise getting automatically incorporated into my day?

So sure, going on a cruise vacation does add an extra layer of stress to trip preparation. But trust me when I say it’s worth it. I was blissfully happy during the whole cruise and, even though I didn’t need more than half the supplies I brought with me, I enjoyed the peace of mind it resulted in because I’d taken the time to think things through. It just goes to show that diabetes can’t prevent the enjoyment of any type of travel.

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3 Things I Learned About T1D From my 10-Hour Road Trip

What do you do when a road trip that’s only supposed to last 7 hours turns into a 10 hour trek?

The answer isn’t cry, or whine, or freak the eff out. The answer is to roll with the punches…because you have no other choice.

At least that’s the way I saw it when my journey from Virginia to Massachusetts dragged out from 9 A.M. to 7 P.M. a couple of Fridays ago.

As someone who loathes driving, I was dreading this trip. But I knew it was important for me to conquer a fear of long-distance driving, as well as bring my car back to Massachusetts for a cutting-it-close car inspection. Plus, driving is much cheaper than flying, and you can’t beat the convenience of loading up your car with as much crap as you need to pack.

So I made myself do it, and besides teaching myself that I can handle a longer road trip, I also learned three interesting things about my diabetes from the many hours I spent in my car:hugging the cactus - a t1d blog.png

1. My diabetes doesn’t like for me to stay idle for so long.

This trip was an excellent reminder of how much my body and my diabetes rely on me to get up and move throughout the day. Throughout the workweek, I tend to get up from my desk chair at least once every hour, if only to stretch my legs. But that frequency of movement must make a difference, because I only visited a rest stop once during the full 10 hour trip. It felt awesome to move around for a few minutes, but I was eager to get back on the road and didn’t walk much while I was at the rest stop. Now, I’m wondering if I should factor that into my next long drive, but the idea of taking too many rest stops and prolonging my travel time is not exactly favorable to me…unless it means that my diabetes is guaranteed to be better behaved.

2. My diabetes is better behaved when I eat regular meals.

I eat a lot throughout the day. Breakfast, lunch, dinner, and at least two snacks are part of my daily meal plan. I typically eat all three meals and two snacks around the same times each day, to boot, so my diabetes depends on that consistency. It’s no wonder that I was dealing with rebelliously high blood sugars for most of my drive home, because I was fueling myself with absolute garbage: chicken nuggets (and only chicken nuggets for lunch), Fritos for a snack, and a granola bar for ANOTHER snack. In hindsight, it would’ve been much easier for me to pack a healthy lunch and maybe an additional, in-case-of-emergency snack, because I could’ve had a low-carb option available to me whenever I was ready for it. Plus, chicken nuggets and Fritos are things that I rarely consume, so of course my blood sugar wasn’t loving them.

3. My diabetes HATES stress.

And my goodness, was I stressed. I hate driving, period, so I doubly hate it when it’s a long distance. And my stress was exacerbated by the fact that I had to transport 60 cupcakes, on ice, back to Massachusetts with me for a bridal shower that I was planning for my cousin. That’s quite a bit to contend with, so it makes sense that my blood sugar shot up within minutes of me hitting the road. Even though I ran temp basals and bolused somewhat aggressively, it didn’t make much of a difference in my levels. And I suppose that I was hesitant to give myself too much insulin while I was behind the wheel, because going low seemed more dangerous and difficult to contend with than going high. Truthfully, though, there’s nothing fun about high or low blood sugar. It doesn’t matter if I’m driving, sleeping, exercising, whatever – anything other than “in-range” is just a pest to me.

So now that I’m aware of these three things, what am I going to do about it? For starters, I’m definitely going to get better about planning my meals for long car trips. I’m also going to try to take it easy a little bit…I put so much pressure on myself (I’m very good at working myself up into hysterics, really). So I might try some mindfulness exercises (e.g., meditating) before the next long drive…because anything I can do to take back control of my diabetes before going on my next one will be worth it.

4 Things That Make Traveling with Diabetes Easier

Throughout June and July, I’m going to be a travel fiend. I’ve got plans to travel by plane at least twice, and by car countless times. My trips will vary in length from just a couple hours to eight or nine hours. My head’s spinning just thinking about it, but I’ve got to get it together enough to think about how I can make traveling with diabetes a little bit easier. Given my past travel experience, I can think of four things that are absolute musts for me to take on any trip…

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Some of my favorite things to have with me when I travel.

4. Packing cubes
I always thought packing cubes were a total gimmick…until I actually started using them. I got a set of four for Christmas and they’ve really turned me into a much more efficient packer. They help me visualize the space that will be taken up in my suitcases, and what’s even better is that one of the cube’s is the perfect size for my diabetes supplies. I can fit 15-20 pods, a handful of CGM sensors, various device chargers, alcohol swabs, IV prep wipes, and more into the compact little cube. It’s so much better and more organized than the lame-o gallon-size Ziploc bag that used to store all my diabetes supplies for a trip.

3. My Myabetic backpack
I don’t know how I ever traveled with a purse as opposed to my Myabetic backpack. I can fit way more things into my backpack than I ever could put into my purse, and I love that there are specific compartments in the backpack for certain diabetes supplies. I know exactly where things I might need during a flight are stored, eliminating that panicky feeling I used to get when I would dig frantically through my purse in order to find my tube of glucose or my PDM.

2. Snacks and water
This is an obvious one. In my opinion, traveling with diabetes shouldn’t even be attempted without a refillable water bottle or at least two emergency-low-blood-sugar snacks. Even though it’s basically diabetes 101, I’m guilty of going places without water or snacks…and I’ve always regretted it. There’s not much worse than being in an unfamiliar place and unsure of where the closest food and water is located, especially when dealing with a blood sugar crisis.

1. My CGM
The most important tool in my travel kit is, without a doubt, my CGM. More specifically, my receiver is key, particularly when I’m traveling by air. I am religious about turning my phone off for the duration of a flight (just a weird paranoia thing, don’t judge me), so my receiver becomes my go-to whenever I want a status update on my blood sugar without taking out my meter and kit. It helps me handle any weird blood sugar spikes and drops that occasionally happen when I travel, and it provides me with a peace of mind that makes traveling with diabetes much more bearable.

 

Four Factors that Impacted my Diabetes in Las Vegas

Recently, I returned from a trip to Las Vegas with my best friends in the universe. It was awesome to take a vacation with them, especially in a place that’s virtually a playground for adults.

Before I went on the trip, I knew to expect some sort of disruption with my diabetes care and management routine. I did as much as I could to prepare myself for every potential scenario, from packing extra snacks and supplies, to asking the DOC how I should account for a sudden change in time.

While my preparation really did help, I still encountered the unexpected when it came to my diabetes on the trip. Four factors in particular come to mind…

  1. The heat – At first glance, this is a no-brainer. I’ve been to many hot climates on vacation, so it isn’t news to me that intense sun can make blood sugar go low quickly. We were literally in the middle of the desert, so I knew it would be important for me to watch my numbers closely, as well as keep myself hydrated. But I think the fear of going low all the time was a little too strong, which meant that I was running a bit higher than I’d normally like for most of the vacation. My paranoia about drinking plenty of water, though, was not a joke. I pride myself on being good about staying hydrated, but I struggled to keep up with the dry desert heat. I can’t help but wonder: If I’d been better about drinking water, would it have benefited me during some of the stickier high blood sugars? Speculation can only get me so far now; however, all signs are pointing to probably yes.
  2. The strip – The Las Vegas strip is less than five miles in length, but the whole stretch of it, marked by hotels, stores, casinos, and ginormous flashing lights, feels incredibly long. Nevertheless, my friends and I naively believed that we could skip taking taxis and walk all over the place. For the most part, we could, but it was definitely dicey when we walked nearly a mile and a half from the Cosmopolitan to the Rio one evening. It influenced my blood sugar in a positive way – the exercise brought my levels down to a nice and stable place – but that didn’t mean it wasn’t scary to walk practically on the highway at nighttime.
  3. The alcohol – I’m well aware of the fact that different kinds of alcohol can have different affects on blood sugar. To minimize blood sugar swings, I stuck with the less-sugary options as much as I could (i.e., opting to order a rum or whiskey with diet coke), only getting fancier drinks when I was consuming fewer carbs at mealtime. For the most part, this strategy worked well and proved to me that a little extra thought can go a long way when it comes to deciding how to treat yourself. But it also reminded me why I don’t have weekends like this often – it’s exhausting enough to take care of myself on a daily basis without alcohol being a factor. Throw it into the mix and I’m watching my blood sugar so carefully that my CGM’s battery is drained in half the time it normally takes to zap it.
  4. The pizza – The scientific answer to the reason why pizza is tough on blood sugar involves the glycemic index and some fairly complex calculations…boring! All you really need to know is that it takes a long time for pizza to have an affect on blood sugar due to its high fat-to-carb ratio. As a result, it tends to be a “treat” food for me that I only indulge in every once in a while. But when in Vegas…you have as much of it as possible. Pizza was one of the quickest and easiest food options for me and my girlfriends throughout our trip, so we ate it multiple times. I don’t regret a single cheesy, delicious bite…but I am slightly remorseful for not doing a better job bolusing for it. The first time we had pizza, I didn’t give myself enough insulin. The second time, I gave myself too much and went low, though that may have happened because I didn’t finish both slices like I thought it would. The bottom line? I didn’t realize that pizza would be a dietary staple on this vacation, and I’ll probably refrain from eating so much of it on future vacations.
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A slice a day does not quite keep blood sugar at bay. But it’s tasty as hell.

Despite the diabetes curveballs I encountered, I enjoyed my trip to the fabulous Las Vegas. I managed the challenges as best as I could without letting them interfere too much with what I wanted to do. Plus, it helped that my best friends were with me the entire time. I have to give them credit for making the most of my diabetes difficulties, too. For instance, I felt badly about sidelining them in the Bellagio on our last night there due to a low blood sugar that crept up on me after walking (the strip!) and over-bolusing (the pizza!), but they really rolled with the punches and made the most of it. In fact, I’m pretty sure they experienced their favorite people-watching moments while we sat and waited for my sugar to come up (I got a kick out of the weird people coming in and out of the lobby, too, but was slightly more focused on raising my number).

Thank you, Kortney and Roshani, for accompanying me on an incredible girls’ trip and for being my best friends in the world. Maybe Las Vegas 2020 needs to happen – now that we know to expect, perhaps my diabetes will be a more cooperative travel companion the next time around!

Favorite Things Friday: FRIO Insulin Cooling Case

One Friday per month, I’ll write about my favorite diabetes products. These items make the cut because they’re functional, fashionable, or fun – but usually, all three at once!

*Insert bad pun about how COOL this product is, like, literally AND figuratively!*

Alright, now that I’ve got that out of my system…let me tell you about my FRIO cooling case.

I heard about cooling cases from the DOC a few years back, and the timing couldn’t have been more perfect when I did. I was about to go on a weeklong vacation to Disney World. In Orlando, Florida. In August. A.K.A., one of the hottest and most humid times of year to be going there. And I was sweatin’ over what I was going to do about carrying my insulin around in the parks.

Before you even think it, no, my option wasn’t just to throw it in my backpack and call it a day. PWD know well that insulin needs to be kept a certain temperature – i.e., cool – in order for it to be viable. It CAN and WILL expire if it’s left out in extreme temperatures for too long. So clearly, I had to figure out how to keep my insulin cool in the Florida heat.

Fortunately, I’d read about the cooling cases on Twitter at some point and decided to order one a few weeks before the trip. When it arrived, I put it to the test right away to see how it fared.

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My magical FRIO cooling case

I followed the instructions that came with the pouch: Immerse the black inner casing in cold water for 10-15 minutes, allowing the beads stuffed within it to turn to gel. After the time elapsed, I removed the case from the water and pat it dry. Then I put two of my Humalog pens (because I was still on injections at this time) into the black case, put that inside the purple pouch, and forgot about the contraption for a few hours so I could see if it would stay cool for that span of time.

And it did! The case worked beautifully. It was just as cool as it was when I had first removed it from the water, meaning my insulin was kept properly refrigerated. The only downside was that my pens felt slightly damp when I removed them from the bag, but they weren’t damaged whatsoever. I knew right then and there that it was just the thing I needed for my vacation.

Fast-forward to present day and the FRIO case continues to serve its purpose as I need it. I couldn’t recommend it more to PWD who travel – even if it’s to a mild-temperatured place. It helps keep insulins cool no matter what, and to me, that makes the case more than worth it. Check out friocoolingcase.com to learn more about their products!

Traveling with T1D: Upon Arrival

Bags packed? Check. Made it to the airport? Check. Boarded the plane? Check. Touchdown? Check. I’ve made it through the actual travel part of my trip. Yay! But after all that, I’ve still got a routine to follow, even though I’ve reached my destination.

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This little cooler comes in handy when en route to a destination, but I always feel much better when I can get my insulin vials into an actual refrigerator.

It’s pretty straightforward, really. I simply need to determine where to keep my diabetes supplies for the duration of my stay. If I’m in a hotel room, I locate the mini fridge and stash my insulin vials  in there. I tend to keep everything else (pods, swabs, etc.) out of plain sight in order to avoid attracting attention from housekeeping. I mean, if I was going in and out of hotel rooms all day long and noticed that one contained a bag filled with needles, I’d probably get a little suspicious. So this means my other supplies live in my suitcase for the week, in an easily accessible pocket.

It’s easier if I’m going to be visiting with friends or family. I still find a fridge to home my insulin, but I worry less about “hiding” my supplies. I’m able to keep them in a spot that’s convenient for me, which helps make site changes throughout my trip a smoother process.

Speaking of site changes, I find them particularly annoying when I’m on vacation. It feels like I have to plan a day – or several days in a row – around the fact that I’ve got an upcoming site change. But planning is a part of T1D management, so I’ve come to accept that I need to be diligent with scheduling activities and meals around it.

Sometimes site changes are no big deal on a trip, other times they’re a whole event (like when my mom and I went to Disney and had to change our pods in the parks – going into a family bathroom to do it was not overly fun). And other, more seldom times, site changes are reminders of why it’s so important to pack extra supplies on a trip.

Case in point: My family and I went on a Caribbean cruise a few years ago. It was an amazing vacation, but also one that presented a few challenges regarding diabetes. I was spending a lot of time in the sun and on beaches, and that took a toll on my pods a couple of times. I had to rip off pods prematurely twice on this trip and replace them with my backups. Thank goodness I had thought to bring a pod for every single day of the vacation (seven days, seven pods) – because I wound up using five of them. So I never feel badly about obsessively packing tons of extra supplies that I might not necessarily use, because I never know when they’ll come in handy.

Travelbetes. It can be kinda complicated; hence, it requires its own word. But it’s worth it in the end, because my choice to travel independently with diabetes shows that it won’t stop me from seeing new places.

Traveling with T1D: During the Trip

A few days ago, I wrote about what it’s like to prepare for travel with diabetes. It may have surprised you to learn how many steps are involved! But the work doesn’t end when en route to the destination…

It doesn’t matter if I’m going to be stuck in a car for several hours, flying on a plane, or – my worst nightmare – waiting in the airport for a delayed flight: There are additional steps I like to take when traveling to help ensure my blood sugar is steady and I’m adequately prepared with my supplies.

These steps include:

  • Checking my blood sugar often. I don’t like to rely completely on my CGM; after all, it can be inaccurate from time to time. So I tend to perform more blood sugar checks than usual while I’m waiting at the airport or sitting shotgun in a car. But if I’m the one driving, I (obviously) wait to check at rest stops as time allows.
  • Seeking healthy snacks. It’s definitely easier for me to find healthy options when I’m on a road trip – I can simply pack meals and snacks ahead of time. The airport is a little trickier for me, though. Sometimes, I’m tempted by candy or chips – comfort foods – because I’m not a huge fan of flying and like to do anything to take my mind off it. Luckily, though, even if I don’t make the healthiest choice, everything I’m consuming does have a carbohydrate count that’s easily accessible. This helps me take the correct insulin dosage and removes some extra thought from the process.
  • Getting as much movement in as possible. If this means taking laps in an airport terminal, so be it. I know that my diabetes responds well to exercise throughout the day, but it’s next to impossible to get movement in when cooped up in a car or plane. So what if I look kind of weird at a rest stop doing jumping jacks next to my car? At least I know I’m doing my body some good.

One thing I’d like to note is that the airport comes with some added fun: the TSA!!! (Insert sarcasm here.) That means I also have to be prepared for going through security. Some PWD have reported terrible experiences with the TSA, which is why I’ve devised a protocol for myself when traveling so I can (hopefully) avoid a bad interaction.

This plan consists of:

  1. Having my ziplock bag of diabetes supplies at the ready in my carry-on in case I’m asked to remove it,
  2. Telling the TSA agent conducting the body scan that I have T1D, and pointing out the locations I’m wearing my pod and CGM sensor,
  3. Knowing that I’ll probably be asked to touch my sites (over my clothing), and
  4. Allotting for the extra time it takes to get my hands swabbed.

So far, so good with this little strategy of mine. I’ve found that it works best to stay cool, calm, and collected throughout the whole TSA process. It’s a miserable one at best, but I might as well not exacerbate it by getting in a panic about my diabetes supplies.

After all that, what do I possibly have left to do once I actually arrive at my destination? Be on the lookout for my third and final post in this little series of travel procedures – but certainly not my last on traveling with diabetes, in general!