Backpacking with Diabetes / by Frank Worsley

A lot of people have asked me about my experiences backpacking in Asia being a Type 1 Diabetic. I thought I would write this blog entry about it since others might find it useful too.

For background info, I traveled to Hong Kong, Vietnam, Cambodia and Thailand for seven and a half weeks in total. I've previously also traveled for six weeks in Europe, two weeks in Egypt, and many other one to two week business trips throughout Europe and North America. While some of my trips were quite long, they were not anything like the 6 months or multi-year trips that many of the other people you meet on the road are taking.

Planning Ahead - The first thing I do before going on a trip is to carefully plan how much insulin and how many test strips I will need. I prefer to always bring all my supplies with me. Even if going for a few months this really isn't a problem. At room temperature insulin will keep for around two months and most of the time on the road you will find fridges.

I always plan for many test strips since I find I test more often on the road. This is mostly because life isn't as "regulated" as it would be at home and I'm less confident in my insulin doses. For my Asia trip - even with generous planning - my test strips just lasted to the end and I went to the pharmacy the first day back in Canada to get more. Therefore I really don't think you can bring too many test strips.

For insulin I plan ahead using my normal daily dosages as a baseline. In general I always use less insulin when traveling, so this way I will end up with a comfortable surplus of insulin at the end of the trip. I suspect I use less insulin when traveling since I am much more active. Hot climates seem to result in me using even less insulin, possibly because of the influence of the sun, because I eat less when it is hot, or simply because I'm even more active in a sunny climate. Note that the reduced insulin usage is only for pleasure trips. For business related trips I find I use more insulin, probably because I eat too much restaurant food, sit in too many meetings, get less exercise and am more stressed. Yes, business travel really isn't that good for you.

I also always bring a good supply of sugar tablets (Dextrosol) and energy bars (Clif Bars). These work very well when low on sugar. I recommend Clif Bars over other brands since they keep very well in all climates. They don't freeze solid when it's cold and don't melt when it is hot. Also, they generally taste quite good. Dextrosol tables are always good to have, although they tend to get soggy in humid climates.

Caring for your Supplies on the Road - One of my main concerns going to hot places was keeping my insulin cool. However, I've never had a problem with this. Almost all hostels or guest houses I have stayed at had either a shared fridge or a fridge in the room. Especially in Asia it is very common for the guest houses to have a mini-fridge in the room. That means I can easily leave my insulin in the fridge during the day. Basically the only time your insulin isn't refrigerated is while you are traveling from one place to another. This means that even for longer trips it shouldn't be a problem bringing your insulin, since it will last a long time when refrigerated.

I have also never had a problem with theft of any kind while on the road. This may just be lucky, but in general I think leaving your medical supplies in a shared fridge is fine. I don't think anyone would have any interest in stealing that. Still, for safety I do always keep one vial of each insulin type and extra test strips in my backpack. When I need to refill my pen I use a vial from the backpack and then replace it with a new one from the refrigerated supply. This ensures that even if my main supplies get lost or stolen I still have enough to last for at least a week.

Getting more Supplies on the Road - This is an interesting problem I've never had to deal with. In general I would assume this is only a problem in the developing world. In developed countries you should be able to get whatever you need, although the expenses will probably be out of your pocket. Even in the developing world the pharmacies in the bigger cities seem to be well stocked, although they might not have the exact brand/type you are used to. For example, in Thailand I checked in a pharmacy in Samui and they had blood glucose meters and test strips, but only for one type of meter. Samui is a smaller town, so I bet in Bangkok I could have gotten what I wanted.

I try to save the sugar tables and energy bars I bring along for emergency situations and use local food instead. Coca Cola seems to be readily available in even remote places. Carrying around a can/bottle of coke to use in low sugar situations is a very easy solution. Buying fruit at the market is always possible, but it doesn't keep very well in a backpack. Finally each country usually has some sort of local snack that you can buy at the markets. For example in Asia one can always find various nut-based snack bars that are held together by caramelized sugar. These keep very well and work great for snacking or when low on sugar.

What else to bring - Bringing a dry bag is a good idea when spending time on or near the water. It's great for carrying the insulin pen, test kit and food, for example when kayaking or boating.

Buying one storage bag for all supplies is a good idea. I bought a nice first aid kit bag at MEC and use it for all my test strips, insulin, needles, sugar tablets, etc. Then I can just take the whole bag and put it in the fridge or put it in my luggage. It holds everything together and keeps it organized.

Also, make sure you bring a letter from your doctor explaining that you need your medical supplies in carry on luggage. Since 9/11 I've always carried one with me but have so far only needed it once: in Hong Kong before flying back to Vancouver.