Travelling for months with Type 1 Diabetes - Questions!!!

[London1988]

Hi everyone

I am Type-1 Diabetic (Insulin dependent) from the UK and I am planning to go travelling for 5.5 months between February and July next year. My flights are booked and I am spending about 2 months in SE Asia followed by 3.5 months in South America! I plan to visit Northern Thailand, Cambodia, Vietnam, Laos in SE Asia. I plan to visit Chile, Bolivia, Peru, Ecuador and Colombia in South America.

I have tried talking to various NHS doctors about this and I think their hands are tied in terms of what advice they can give. All they seem to know or want to say is that I should take enough insulin with me to cover the duration of the trip. Therefore I was hoping to see if anyone has any actual experience of this.

I use Levemir and Novorapid disposable pens which need to be kept refrigerated. When out of the fridge I have been advised they last for only up to 28 days, and only when stored at 25c or below.

I have worked out that per month the maximum I will use is 3 Levemir pens and 5 Novorapid pens. Between the two trips I have a couple of days in the UK where I will be re-stocking on insulin. So in total I will need 6 Levemir/10 Novorapid for my SE Asia trip and 11 Levemir/18 Novorapid for my South America trip. However, I understand that you should take about 2x what you need just in case, so I will need 12+20 pens and 22+36 pens for each trip. Getting this number of pens in the UK to take with me will not be a problem.

I will be mainly staying in hostels and I will kindly ask the hostel owners if they have any private fridges with space I can put it in (Will be happy to pay extra for this), or if not to store my insulin in communal fridges.

I will also be investing in Frio bags to store my insulin in when travelling between towns/cities. Also if I end up somewhere more remote where there are no fridges at all I will hope to use these bags to keep my insulin as cool as possible in such interim periods. Using the numbers above I have worked out I will need 6-7 of the largest Frio bags (holds 8 pens) and one smaller 2-pen bag to carry around with me day to day.

So some questions:

1) Does my strategy for keeping my insulin cool enough seem good to you? Is there any advice or tips you can give?

2) Have you any experience with hostels and insulin in either of the two regions I plan to visit? Are there generally fridges that you can put the insulin in? Any problems with theft?

3) In any eventuality there will be some risk of the insulin going bad or getting stolen. Does anyone have any experience of buying insulin in the areas I am visiting? Will I be able to pick it up in most places in case of emergency or in major cities only? Will I need some sort of letter from my doctor or prescription or can I just buy it? What kind of a cost is there?

4) From what I have read on travel insurance the best bet is to shop around. However as a ball-park figure, for a 5.5 month trip for a 25 year old male T1 with relatively good control, no complications and diagnosed 7 years ago - how much should I roughly expect to pay?

5) Any other tips, advice or things I should know?

Many thanks for any help or insight you can give on just any of these. I have done my best to search and get to this point but there really seems to be a lack of solid information on how to travel with Type-1 Diabetes for multiple months

 

[mentat]

Re: Travelling for months with Type 1 Diabetes - Questions!!

1) Does my strategy for keeping my insulin cool enough seem good to you? Is there any advice or tips you can give?

I've read that insulin lasts a long while at room temperature (about 20 degrees) and the "28 days" advice is just a precaution - particularly as the insulin can get much hotter if left in the sunlight or in a hot country. But you're going to be in a heap of sunny hot countries! Fridges are definitely the way to go, and failing that, air conditioned rooms. From my experience in Thailand, it shouldn't be hard to get ice (any street restaurant will have some) so you may want some watertight containers you can stick some ice in to help tide you over. Obviously you don't want to freeze the insulin but I don't think there's much chance of that with a bit of ice.

You can also buy ice blocks or cold drink and put them in the frio bags. Ice or cold water are one of the best ways to keep things cool on the go because water requires a lot of energy to heat up.

I am not sure you need to take 2x your insulin for such a long trip. When you are away for 2 weeks and you end up being sick for a week of that, and you also drop a pen down the gutter, you may need twice the insulin. But on a longer trip there's very little chance you'll go through twice your insulin (if anything you'll need less because you're getting more exercise), and if you suddenly start needing double dosages without warning, you probably still have a month's supply which gives you lots of time to get more insulin or whatever. Having less insulin with you will make it easier to manage. It's your choice, of course, and you should take into account what happens for you personally on sick days or when you change diet or exercise.

By the way I've been advised to always split my insulin between two carry-on bags when flying, because stuff in the hold can freeze.

2) Have you any experience with hostels and insulin in either of the two regions I plan to visit? Are there generally fridges that you can put the insulin in? Any problems with theft?

I have no personal experience with hostels. If you're using a communal fridge you may want to put it in a plain box or something. Someone may swipe it just on the off chance they can get something for it on the black market.

5) Any other tips, advice or things I should know?

Make sure you read the fine print on your travel insurance! Read about healthcare services in the countries you'll be visiting. If you're travelling alone print out some useful phrases in the languages of the places you'll be visiting, so you can point at them if need be. Get doctor's letters translated into each local language. Remember many SE Asian countries have very strict penalties for drug trafficking and while the local officers will probably have basic English they may have no idea what diabetes is. Be aware that bribery is commonplace in 3rd world countries.

Always make sure your sugar is comfortably high before going through airport security and make sure you have time to spare; hypo symptoms are the worst possible thing to have at a place like that.

Don't forget other supplies (needles, strips, spare meter, spare lancing device, spare batteries) and consider a medical bracelet or necklace.

That's all I can think of. Have a great trip!

 

[London1988]

Re: Travelling for months with Type 1 Diabetes - Questions!!

1) Does my strategy for keeping my insulin cool enough seem good to you? Is there any advice or tips you can give?

I've read that insulin lasts a long while at room temperature (about 20 degrees) and the "28 days" advice is just a precaution - particularly as the insulin can get much hotter if left in the sunlight or in a hot country. But you're going to be in a heap of sunny hot countries! Fridges are definitely the way to go, and failing that, air conditioned rooms. From my experience in Thailand, it shouldn't be hard to get ice (any street restaurant will have some) so you may want some watertight containers you can stick some ice in to help tide you over. Obviously you don't want to freeze the insulin but I don't think there's much chance of that with a bit of ice.

You can also buy ice blocks or cold drink and put them in the frio bags. Ice or cold water are one of the best ways to keep things cool on the go because water requires a lot of energy to heat up.

I am not sure you need to take 2x your insulin for such a long trip. When you are away for 2 weeks and you end up being sick for a week of that, and you also drop a pen down the gutter, you may need twice the insulin. But on a longer trip there's very little chance you'll go through twice your insulin (if anything you'll need less because you're getting more exercise), and if you suddenly start needing double dosages without warning, you probably still have a month's supply which gives you lots of time to get more insulin or whatever. Having less insulin with you will make it easier to manage. It's your choice, of course, and you should take into account what happens for you personally on sick days or when you change diet or exercise.

By the way I've been advised to always split my insulin between two carry-on bags when flying, because stuff in the hold can freeze.

2) Have you any experience with hostels and insulin in either of the two regions I plan to visit? Are there generally fridges that you can put the insulin in? Any problems with theft?

I have no personal experience with hostels. If you're using a communal fridge you may want to put it in a plain box or something. Someone may swipe it just on the off chance they can get something for it on the black market.

5) Any other tips, advice or things I should know?

Make sure you read the fine print on your travel insurance! Read about healthcare services in the countries you'll be visiting. If you're travelling alone print out some useful phrases in the languages of the places you'll be visiting, so you can point at them if need be. Get doctor's letters translated into each local language. Remember many SE Asian countries have very strict penalties for drug trafficking and while the local officers will probably have basic English they may have no idea what diabetes is. Be aware that bribery is commonplace in 3rd world countries.

Always make sure your sugar is comfortably high before going through airport security and make sure you have time to spare; hypo symptoms are the worst possible thing to have at a place like that.

Don't forget other supplies (needles, strips, spare meter, spare lancing device, spare batteries) and consider a medical bracelet or necklace.

That's all I can think of. Have a great trip!

Thank you for taking the time to provide such an in-depth answer. This has made me feel a lot more confident about my plans and provided me with a whole load of useful tips! :thumbup:

Good idea about the plain box, and I will make sure to always keep at least a months supply of insulin in Frio bags at all times regardless to give me time to source new insulin in case the worse happens and it gets stolen or something.

 

[mdaddison]

Re: Travelling for months with Type 1 Diabetes - Questions!!

I also asked for sources/stockists of my particular insulin a in each country (provided by a specialist diabetes nurse). Novo nordisk (the makers) should have it on their website.
When travelling over time zones don't forget to factor in both the change in time zone (putting clock forward or back) as well as the length of any journey. Eg Australia may be 11hrs ahead but it might take 21 hrs to get there.
The rest of your plan chimes with my approach to a 6 month journey in 2007 to Thailand, Canada, Australia, Hawaii and Fiji - the latter two would have proved more difficult to source insulin.

 

[naomi96___]

Hi, i hope you had a great time!
I am planning on travelling around thailand, laos, cambodia and vietnam for a few months so have similar questions to yours. Do you have any tips that you could share with me? I am on an insulin pump but i'm sure the same rules apply in terms of insulin etc.