Any advice on travelling to India with insulin?

Bertyboy said:

Can I take my FlexPens on the plane with me?

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Yes. You certainly can't put them in the hold as frozen insulin dies. So should be taken as hand luggage.

I've never been to India, but provided you are carb counting and you familiarise yourself with carb content of likely meals/sundries then just continue carb counting and adjusting your insulin dose accordingly.

There's a useful Jdrf guide to travelling with type 1 - https://jdrf.org.uk/information-support/living-with-type-1-diabetes/everyday-life/travelling/

@Bertyboy - India is fine. I've been many times for both work and leisure. One thing I would caution, is Delhi Belly. It happens to most westerners after a number of days in the country, so I'd make sure you are prepared to nip down to the local pharmacy when you are there and get the over the counter antibiotics that they offer.

Otherwise, @catapillar's comments are valid. Just be aware of rough carb counts on everything, remember to take plenty of glucose tablets and adjust your insulin. And it's also okay to run a bit high if you aren't confident about balancing everything during the short period you are there.

I’ve not been to India but have travelled a bit. I advise that you ensure you have good travel insurance, one where the insurance company will contact medical services and will advise where to get supplies. Also make sure you wear and carry identification that says you’re T1 - in your home country as well as abroad. It’s unlikely you’ll need either but if you do then they’ll be there!
How stable are your blood sugars? Many people have a honeymoon period as they settle down. I suggest you also carry glucotabs should you need to treat a hypo, and get a couple of frio or the like to keep your insulin cool in a warmer climate. It’d also be worth taking a supply of plain carb such as ryvita, rich tea, etc and invest in carbs and Cals which has a few Indian foods on the app/in the book and their carb values. You may already have scales to weigh foods with.
It seems very early after diagnosis to travel that far - have you asked the doc/consultant/DSN’s advice too?

You really need to speak with HR, let them know about your diagnosis - under the Equality Act you now have a disability and should, where reasonable, be given special consideration. If the company knows that you have been diagnosed as T1 then the travel insurance they arrange for you should cover it, but do make sure it does.
Do you feel confident to go to India? Are you going there alone or will you have company? Someone to watch your back?
I know I’m probably sounding too alarmist, but it’s early days.
Put it this way, five years after diagnosis I had no qualms driving the 100 miles to our sister University in sub-Saharan Africa on my own or riding on my own through the bush, but two weeks after diagnosis I was a real learner-driver.
Glad you’ll be speaking with Your DSN.

I really must add too, that if you get Delhi Belly, or any other illness, homegrown or foreign, it could seriously affect your blood sugars.
If you were my son or daughter then I’d feel very concerned that you were travelling away from support systems so soon after diagnosis.

I went to Bangalore for work and it was all fine (it was a great city). My advice is:

Make sure you only drink bottled water (including when brushing your teeth) you will feel awkward and a bit of an *rse constantly asking for it, (especially if you are in a nice hotel where they promise the water is filtered), but the bugs in the water will be different to what you are used to and it just isn't worth the risk of getting sick. Everyone there will be used to foreigners asking for it so don't worry about seeming rude. For the same reason take a pack of wet wipes and hand sanitiser so you can clean your hands on the go.

Take lots of glucose tablets! Also a box of cereal bars. Worse case you can bin them before coming home.

With the heat, travelling stress of work and time difference be prepared for your insulin requirements to change so you will need to test more. If it is a short trip just accept that things won't be as perfect as you'd like.

Put all your diabetic kit in your hand luggage and invest in a Frio wallet or similar for the insulin.

Take spares of everything.

Wear ID and if you are travelling with colleague let them know what to watch out for.

Have a great time!

Also check with your work what to do if you get sick. My work insurance had a number to call if I got sick and then they would deal with arranging for doctors or medication rather than expecting me to try and deal with it or find the right people!

One more thing - if you go then when you get back, let us know how went. Make us envious too if you have a good experience.

Don’t just listen to me. See what others on the forum think, and what your DSN and your GP think

There’s a T1 section on the forum so if you moved this there you might get a broader range of responses

@Bertyboy , as you're only a couple of weeks in, you've maybe not had any serious hypos yet.

Assuming you're on fixed doses, and not yet familiar with the finer points of carb counting and insulin adjustment, and maybe also have the honeymoon period kicking in, there's a lot of uncertainties and variables already in the equation, so please be absolutely aware that if you go out of your normal routine, to a hot country, involving long flights, maybe uncertain daily routines, rushing around from place to place, those additional factors will likely substantially increase by a large margin the chances of a serious hypo.

I'm not saying you shouldn't go, it's not my place to, and you're a grown adult who can make his own judgment call about it in discussion with dsn etc, but if you've not had a bad hypo yet, believe me, you don't want to have your first one in a hotel room in a foreign country!

At the bare minimum make absolutely sure you carry adequate glucose supplies with you at all times. And by that, I mean on your person. A common newly dx'd mistake is to have glucose but leave it in the hotel room or wherever - if you're dropping hard and fast, getting a few a hundred yards to your room to get the stuff is not easy. I'd be inclined to carry three tubes of glucotabs or dextrotabs or equivalent at all times, preferably a glucojuice as well, although not sure if you'd get that as a liquid through airport security, so maybe pick up small cans of coke or apple juice once you're in country. Mentos sweets are widely available in pretty much every country and are a good bet if you run out of glucose tabs (mainly because they don't melt!).

And also be aware of the timing of insulin. If you take your fixed dose just before a meal, and then something at work drags you away or something is rescheduled, that insulin is not going to wait till you get around to eating - it'll start working and continue working, dropping you lower and lower. Some newly dx'd have had pretty savage hypos by overlooking that fact, and it's easy to lose sight of if you're dashing around on business in such a hectic country as India.

If you're walking around on site visits or whatever, or even just walking around doing a bit of tourism during breaks, remember that even that counts as exercise, which can reduce your levels quite substantially on its own so insulin dose may need to be adjusted.

Heat can also substantially affect response to insulin - many find less is needed because the hotter weather opens up capillaries so insulin gets circulated around the body quicker. Don't know what the weather over there is like at the moment, but assuming it's hotter and more humid than here, there's a chance that the heat will increase the chance of hypos and the humidity might cause confusion - profuse sweating is a common indicator of a hypo and so you might not know if you sweating is the humidity or a hypo.

So, like I say, it's your call, but if you do go, these are factors which you'll need to be aware of and make adjustments for.

Bertyboy said:

Lawks...it sounds like I need to do a bit of research. I thought I was doing well - I've just about got my BG down to 5.x fasting levels by adjusting up the basal insulin and they're not so erratic. I was assuming if I was careful, I could avoid hypos. I would really like to speak to my GP (I'd quite like to *meet* my GP, truth be told), but the lead time on appointments there is sooo long
This may seem like an odd suggestion, but is it worth trying to "force" a hypo before the trip to make me understand what I need to be aware of?

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Nah, forcing a hypo is way too risky. Years ago, they used to induce a hypo in newly dx'd before they let them out of hospital to but it's not the sort of thing to experiment with at home.

Many newly dx'd can be remarkably stable during their honeymoon period but it's almost inevitable that you'll hypo at some stage, purely because the dividing line between a nice 5 and a nasty below 4 is quite a narrow one, and the body basically acts in unpredictable ways no matter how careful we are.

I'm not trying to scare or alarm you by saying any of this, it's more just that docs and dsns, who have never actually experienced a hypo themselves, generally understate the impact of the first few, so it can come as a real shock when the first one hits.

They'll normally just say, oh, you might feel tired, confused, shaky, sweaty, but that really doesn't get across the genuine "what the f*ck is going on here?" state of confusion caused by a bad hypo. They can be genuinely scary - your brain runs on glucose, so if bg drops too low, it processes thought in a different way: you perceive things differently. Your arms and legs might shake to the point you have difficulty standing - that is mainly caused by a large adrenalin rush released to make the liver release stored glucose.

None of this means you won't be able to work or travel abroad - I've done it frequently. But that was after a bit of experience and learning how to handle situations. Whether it's a good idea to do it only a few weeks in, hmm, it's a personal judgment call.

Ask them how to go to sleep safe with your current doses: I find that if I’m 7-9 when I go to sleep then I avoid night-time hypos, and they can be the worst.

I recently went to Bangalore for a week. I'm type 2 - on metformin - so I did not have an issue with insulin.
People there are very understanding about different dietary needs., but be prepared to keep on about it ..

On the fourth day I was still given a fruit juice carton with about 6 spoons of sugar in it in a "Diabetic Lunch".

There will be a lot of security checks to tack your glucose meter through - even on the metro.

Bear in mind that there are long flights involved - 9 hr 30 minutes there and 11 hours back on the most direct route BA119/BA118.

You will also need to account for 5h 30 minutes time shift.

You may want a packed lunch rather than trust the airline food.

( Be prepared to spend a lot of time in traffic jams ;-) )