Travelling with type 1 diabetes

Since I've been travelling, I've always found it lots of fun but I realise that with diabetes I need to take extra precautions and pack more :) Just some additional things that I feel need to be considered:

• script from my doctor for medication - I got pulled over in Phuket as my insulin was showing as liquid in my carry-on bag. Surprisingly they were the only people who checked. Even in Malaysia where they make an announcement about 'drugs' - they didn't check my bags. I guess wearing the scarf helped in this case :)
• at least 1 extra set of everything - I usually split it in 1/2 so 1/2 goes in my husband's bag and 1/2 goes in mine (just in case 1 bag goes missing). I make sure I put both bags together because just now they arrest him lol
• I remember to put insulin in with biocool bag (those blue gel like things you get at the pharmacy)
• my pump always sets off the metal detector which leads to me showing my pump (very funny when I have to lift my dress up) and being searched - I guess wearing a scarf adds to it lol
• extra batteries for my pump - it only seems to like Energiser and who knows where I'll find those in places like Morocco?
• Wearing your sensor on during flights were highlighted in the manual and it said that you should turn it off - I kept mine on & I'm happy to say that none of the flights crashed :)
• On long, long flights my blood sugar was dropping before they served food - so I usually take snacks along with me or I have to order the halaal, diabetic meal especially so that they  bring it first.
• Keeping hydrated especially for my sensor is important but I haven't found that they give enough water or rather I have to keep asking. Sometimes they should just give me a big bottle and save themselves the trips to my seat every time lol
• I keep pen sets with me as well - just in case my pump decides to give me issues. This happened on my flight to Malaysia when my blood sugar was raising for no reason. I changed my catheter site before the flight but despite that it kept raising some more. So I had inject, without pen sets it would have been more tricky.
• So I pack with good control in mind - this includes things to keep my blood sugars up (all the chocolate I like eating) and things to keep my blood sugars from going up (treats like nuts)
• I usually pack things like Provita biscuits - I know it sounds silly but it's not easy to find these in all places!
• My pump makes it easier to travel especially when I fly in different time zones. In some cases I don't even adjust to local time and it really didn't make a difference. Everyone is different though - so don't trust that this will work for you!
• When swimming make sure that you put your pump somewhere safe! Lots of pumps go missing at the beach. For that reason I have my pump insured for almost as much as my car!

Above all, I usually travel with someone. My sensor makes it so much easier since I get low and high predictor messages and my pump has a suspend function to prevent comas. In some cases though, this all fails and you just need someone, who knows you, to assist.

Other than that - it's all just lots of FUN (I just have to remember my pump in wet conditions lol).

Menstruation and type 1 diabetes

I blogged previously about the challenges that women with type 1 diabetes face, now here is another - MENSTRUATION. Menstruation occurs at puberty and describes the physical and emotional changes that a girl or boy go through making them adults and capable of reproducing (having children).

Source: http://www.wakeuppune.org/site/index.php/sex-education/puberty

In some women who have type 1 diabetes, the hormonal changes that come with menstruation can cause changes in blood glucose levels. Monitoring levels and adjusting insulin accordingly is key to managing this monthly shift (Krisha McCoy, MS). 

In a study of Menstrual Cycle Differences Between Women With Type 1 Diabetes and Women Without Diabetes (http://care.diabetesjournals.org/content/26/4/1016.full) the following differences were reported:

Table 2—

Self-reported menstrual cycle characteristics of women with and without type 1 diabetes by age range

	Type 1 diabetes	Without diabetes			P
				Sisters		Control subjects
<20 years of age (n)	143	186	158
Bleeding ≥6 days	56.5	41.6	47.7	0.04
Cycles >31 days	24.8	14.3	17.8	0.07
Heavy bleeding	25.2	18.1	22.4	0.31
Any irregularity	78.7	64.3	66.7	0.02
20–29 years of age (n)	143	186	158
Bleeding ≥6 days	52.8	38.7	40.5	0.04
Cycles >31 days	22.1	8.0	12.3	0.002
Heavy bleeding	27.0	14.7	21.0	0.03
Any irregularity	76.8	55.4	55.5	<0.001
30–39 years of age (n)	141	180	152
Bleeding ≥6 days	44.8	41.1	36.2	0.36
Cycles >31 days	11.9	8.4	8.3	0.53
Heavy bleeding	25.0	18.6	25.2	0.29
Any irregularity	67.5	57.9	53.8	0.08
40–49 years of age (n)	100	114	91
Bleeding ≥6 days	40.8	36.0	29.0	0.34
Cycles >31 days	8.6	11.1	10.4	0.87
Heavy bleeding	21.6	27.5	29.2	0.55
Any irregularity	67.6	67.4	62.1	0.74

• Data are %.
  
  
  
  
  
  According to the results of the study 'women with type 1 diabetes had more menstrual problems (long cycles, long menstruation, and heavy menstruation) before age 30 years than sisters and control subjects. These differences were all statistically significant, except for heavy menstruation at age <20 years. No differences were observed after age 30 years. Women with type 1 diabetes experienced later menarche, earlier natural menopause, fewer pregnancies, and more stillbirths than women without diabetes. Multiple regression analyses revealed that type 1 diabetes caused an approximate twofold increased risk of any menstrual problem before age 30 years. These were primarily related to long cycles and long menstruation in women aged <20 and 20–29 years, as well as with heavy menstruation from 20 to 29 years. Oral contraceptives were protective for any menstrual problem and heavy menstruation from 30 to 39 years of age. With history of pregnancy from 20 to 40 years of age, any menstrual problem and long menstruation were more likely' (Elsa S. Strotmeyer, PHD, Ann R. Steenkiste, MS, Thomas P. Foley, Jr, MD, Sarah L. Berga, MD and Janice S. Dorman, PHD).
  
  
  According to Jay Cohen, MD (medical director of the Endocrine Clinic in Memphis and clinical assistant professor in the department of family medicine at the University of Tennessee),  "Two or three days before menstruation, as estrogen and progesterone levels are changing, a number of women — but not all — will notice that their insulin needs increase substantially because their blood glucose levels are rising,” In addition he adds that, "In women whose diabetes is out of control, high blood sugars can put a woman at increased risk of vaginal and yeast infections, and can also affect regular menses," says Cohen. "Once again, it is important to have good blood sugar control on a regular basis.” 
  
  So ultimately it all still boils down to the same thing: TEST, TEST and TEST and then use the test results to make the necessary changes to your insulin requirements. Also speak to your endo or gynae if you have any concerns.

To insulin pump or not to insulin pump? That is the question...

If you or someone you love has diabetes and you have considered changing to an insulin pump, there are some questions you need to ask yourself to assess whether this is the right tool for you or them. The pump is not a magic silver bullet for obtaining great control, it is merely an enabler. It has great benefits but it also takes work on effort on the side of the pump wearer.


Also, given the cost of the pump and consumables making the right decision is important as spending a lot of money on anything that is not going to be used or meet your expectation would be a crying :'( shame.

 


My husband bought me a book called, 'Pumping insulin' by John Walsh and Ruth Roberts. They include questions to ask to decide whether changing to the pump is right decision for you. Areas covered include the following:

1. Motivation - e.g. how well have you accepted your diabetes?
2. Expectations - e.g. what do you expect your pump to do for you?
3. Need - e.g. are frequent highs or lows a problem for you?
4. Preparation - e.g. what other approaches have you tried?
5. Questions for parents to consider -e .g. is your child willing to wear a pump?

They've also included an assessment questionnaire that I've included below.

Gauge your control
1	How motivated are you to control your blood sugars?
	not very	0	1	2	3	4	5	very
2	Number of blood sugar tests your do each day:
		0	1	2	3	4	5	(or more)
3	Number of injections per day:
		0	1	2	3	4	5	(or more)
4	Do you record your test results
		yes	(5 points)	no	(0 points)
5	Do you use your test results to adjust your insulin?
		yes	(5 points)	no	(0 points)
6	Do you match your short-acting insulin to the carbs in each snack or meal
	by carb counting or other means?
		yes	(5 points)	no	(0 points)
7	Do you use extra insulin to correct high blood sugars?
		yes	(5 points)	no	(0 points)
8	Do you adjust your long-acting insulin doses?
		yes	(5 points)	no	(0 points)
9	Do you get an hba1c test to evaluate your control at least every 6 months?
		yes	(5 points)	no	(0 points)
10	Do you call your doctor when problems occur?
		yes	(5 points)	no	(0 points)
								TOTAL =
Self assessment
	Points	0 - 9	10 - 19	20 - 29	30 - 39	40 - 49
	Meaning	A bit casual	Honesty pays	You've got the idea	Minor changes will help	When do you start?
							

I found the book really informative and enlightening, even after I was already wearing a pump. Check for it online. It was worth getting.
http://www.amazon.com/Pumping-Insulin-Everything-Success-Smart/dp/1884804861

The guide I obtained with the Medtronic pump was also really useful. So be sure to read it.

Have a fabulous day :)
Fazlyn

Reference: Walsh, J and Roberts, R (2006) Pumping insulin, San Diego : Torry Pine Press

Dealing with the changes that type 1 diabetes brings

I remember being diagnosed, like it was just yesterday. From that point forward, it just felt like my whole world had changed and that I needed to change too. Having diabetes was a BIG change. I had to change and my family had to change. My mom went from drinking 4 teaspoons of sugar in her tea to drinking only 1. I’ve done a presentation on change management in my B.Com Honours and have covered it in my Masters thesis, so I thought I’d share some of my research with you. I know it’s fundamentally theoretical and that all humans deal with change differently but it’s worthwhile knowing and adapting it to suit your situation. I’ve included some of my ideas below.

Most individuals prefer things to be comfortable and familiar; and they like to feel capable and confident in their work and surroundings. Change affects people's ability to feel comfortable, capable, and confident – due to the fact that they must learn new things, behave in new ways, and accept new responsibilities. Diabetes brings along a lot of that.

Individuals facing change often go through a cycle of emotions similar to those experienced when faced with the death of a loved one. Understanding of the "grieving" process used by individuals to deal with change may make it possible to reduce some of the potentially damaging consequences, such as sabotage. "The change cycle" is a four-step cycle of emotions that individuals are likely to experience when faced with change (Crain, 2007). Any change, even positive change, results in a loss of something – tangible or intangible.

Parents can alleviate the effects of reactive depression by recognising how change impacts an individual, and by understanding that all individuals, children in this case, will go through the change cycle at various rates, and that their reactions will be dynamic – rather than at a steady progression (Crain, 2007).

Managing the cycle of change (Source: Craine, 2007)

Craine (2007) suggests the following advice to aid individuals in each cycle of change but I’ve adapted them to suit children with diabetes:

Advice for managing the cycles of change (Source: Crain, 2007)

Phase	Assist yourself	Assist others
The Comfort zone	• Notice the situations in which you experience ease and comfort. • Notice the situations that will change as a result of diabetes. • Create a plan for the situations you want to change.	• Encourage creativity and ask your children how they will innovatively deal with some of the challenges of diabetes • Acknowledge, celebrate, and reward success e.g. good Hba1c results. • Plan for future changes e.g. perhaps you want to change to a more comprehensive medical aid.
The ‘No’ zone	• Identify the reality of the current circumstances. • Acknowledge the losses you are experiencing. • Identify your feelings about the situation. • Reframe "danger" into "opportunity."	• Give information about diabetes to teachers, extended family members and friends. • Provide a picture of the expected outcome i.e. living a healthy life by making some adjustments such as eating a healthier diet, exercising, testing and going for Hba1c tests. • Be there for others in small, supportive ways. Your children will need your support now more than ever. • Listen to worries and fears, they probably fear a lot more than you’re aware of.
The Chasm	• Discover what you want for the future and how you will deal with the differences in your lifestyle e.g. now you have lots more to pack when you go on holiday • Get necessary information and support from your doctor, dietician and nurse etc. • Don't let the all the negative stories about amputations etc. get you down. All those complications are perfectly avoidable if you exercise good control.	• Create new ways to communicate and share information and feelings e.g. have supper at the table in the evening and discuss the day’s events. • If they aren’t doing what they are supposed to do, e.g. snacking or testing find out why by asking questions such as ‘why do you think testing is important?’, ‘what do you think happens when you don’t snack?’ etc.
The ‘Go’ zone	• Take action on issues within your area of control e.g. teach your child to inject and test themselves, let them choose what they want to eat and discuss the effects of their choices. • Let go of what you cannot control – going hypo or hyper is sometimes unavoidable. Provided that it doesn’t happen all the time, don’t sweat it. • Visualize yourself (positively) in the new paradigm.	• Clarity purpose and desired outcomes {again). • Involve your children in the planning and implementation of the changes. • Celebrate small successes e.g. if they are good all week use weekends for treats • Provide on-going feedback and information.

I know that we are all different and there aren’t too many people who jump with joy at the idea of change, let alone when this change is type 1 diabetes.

There is unfortunately little you to prevent someone you love from being diagnosed with type 1 diabetes BUT there is lots you can do to manage the changes and your response to the condition.

No-one is perfect and having type 1 diabetes is as big a change for the parents as it is for the child with type 1 diabetes. It may not always go smoothly but you will get through it. There are far worse things in life than having a perfectly manageable condition. So accept and do the best you can with what you have (I know that it’s easier said than done) . Learn from the mistakes and scream silently into the pillow when your child is sleeping. Pray, smile and laugh often – it’s medicine for the soul when insulin is medicine for the body J

References:

Crain, K. (2007). Managing the cycle of change, Information Management Journal, Sept/Oct 2007 pp. 44-50.

Have a fabulous day :)
Fazlyn