Type 1 Diabetes didn’t stop Amy backpacking in India

If I’m honest I thought I’d be doing lots more posts about how Type 1 Diabetes affected our trip, which ends in 3 days. Although we backpacked in India in 2011, 8 months after Amy’s diagnosis, this trip involved more trains, lower class hotels/homestays and we’ve visited more middle-of-nowhere places far away from big cities and their big hospitals. It was also the first one where she is using an insulin pump.

Here’s a picture of Amy at 7am after 15 hours on a train, as we reached our penultimate stop of Badami, well off the beaten path.

If you think about all the potential problems too long, you’d never travel very far at all: the potential loss of much needed medical kit; electronic medical devices failing; consquences of small issues turning into larger ones; worries about not having a major hospital within a few minutes drive; running out of insulin; running out of acceptable glucose treatments; getting food poisoning and potential DKA hospitalisation. And that’s on top off all the normal day-to-day management issues faced.

Well, honestly, we did think about all of the above, we did worry about them (a lot), where possible we planned for each potential issue, but once we’d planned or thought about it we decided to no longer worry about it.

Diabetes-wise: she’s had a few hypers, often waking around 11 mmol (probably down to purposefully underestimating carbs); very few hypos (we’ve still got the European Dextro Mountain in our rucksacks); ketones of 0.6 or lower only twice; one failed set highlighted by pump occlusion warnings and caused by a bent cannula; one set which came off, probably due to heat/humidity. Fantastic going considering that everything is laced with sugar and/or ghee and it’s hard to buy a diet drink where we’ve been, so many full-‘fat’ sodas have been consumed. Throughout the trip Jane and I have had very little involvement as Amy’s managed her diabetes by herself, doing exceedingly well with the carbohydrate guessing game. Amy’s not been wearing CGM for this trip and we’ve not been using Nightscout, it’s all been down to finger-stick checks.

It’s been a wonderful trip.

Nothing has stopped 16 year old Amy from having a brilliant time, doing many life ‘firsts’ – she’s kept a list which runs at over 50 things so far – and gaining such wonderful insights into different cultures, people, food and ways of life.

And one of her highlights of the trip, well, it’s got to be this:

NOTE: For the animal welfare concerned people: this was in an elephant santuary and rescue centre, where elephants are cared for very well. In fact, they’d all be dead if the sanctuary had not rescued them as not many are willing to take on the £50 a day feeding/caring cost of elephant who is not allowed to work. All walks are conducted in the forest, the elephants are fed and bathed well, and the mahouts treat them very well indeed.

Type 1 Diabetes & backpacking round-up, 8 days in

We’ve always been in that interesting place of not wanting Amy to feel that having Type 1 Diabetes stops her from doing amazing things, to being a little anxious of doing amazing things, like this trip. For me especially if I feel prepared I feel confident going into any venture and this four week trip is no exception. But how would we fare? Well in short Type 1 has not caused any issues, maybe a few delays in the airports but that’s it. Yes, we’ve over-prepared but I don’t see that as a bad thing.

Here’s a round up of a few of the things from the planning and the first week or so backpacking in India.

Amounts of medication and supplies

As a general rule of thumb whilst travelling in the UK we’d take just a little more than we’d thought Amy would normally use, maybe two extra insulin pump infusion sets & reservoirs for a week away. Longer trips to Europe we’d take double.
For India we’ve taken close to triple of everything we didn’t think we’d be able get a replacement for over here – insulin pump stuff – plus double of most other stuff – BG strips, insulin etc..
The perhaps excessive kit is mainly because we had a worrying experience last time – read second paragraph – and almost lost it all.
Being away for four weeks meant that by tripling the supplies we’ve taken 30 insulin sets and 30 reservoirs.
We’ve taken one pen and 2 basal insulins (levemir) just in case we have to revert back to MDI.
We’ve taken one glucagon kit.
We’ve also taken two backup pumps, purely because they’re small and I had them available. Amy’s pump is out of warranty so if it broke there would be no replacement coming our way.

Insulin cooling

Because of the amount of supplies we’ve taken four Frio wallets, of various sizes. Thanks to the loan from Kelly for these.
Frios are working brilliantly for cooling insulin and much required as we had no fridge in the first two places we stayed, or the train, and only here in our current location do we have a fridge.
We’ve also got a few Frio wrist/ankle bands, which also work well when you’re feeling hot.

Luggage and medication and supplies

The general recommendation from most travellers is to carry everything in hand luggage, something just not feasible with so much stuff.
We made sure all Frios/insulin were in hand luggage and enough set changes for the whole trip, the rest went in our rucksacks.
All kit was divided between the 3 hand luggage daysacks and same applied to kit in our rucksacks. For info, we also did this with our clothes in the rucksacks after hearing the tale of our niece Emily who’s rucksack went missing on the flight here and she had great difficulty finding replacement clothing.
Rucksacks give you the added problem that they are soft and there’s no hard protective edges to be able to use for safety. Easy to get around that though.

Airports – Heathrow and Mumbai Domestic

Armed with letters from the hospital and about xRay machines we felt confident.
Spare pumps and any supplies were (where possible) in clear plastic bags.
At security we made them aware of Type 1 and the kit we had, it was no news to the security people, they’d dealt with this many times before.
The kit in hand luggage went through the xRay machine, which highlighted every Frio wallet, and meant we had to have it all checked, something which only took 15 minutes, most of which was waiting for our turn.
We did have an issue with the xRays though.
We were worried about whether Mumbai Domestic airport would be a problem but without a full body scanner it was even easier than Heathrow.

Take offs and landings

Suggestions from many travellers with Type 1 say to unclip before every take off and landing, and to check for air bubbles before reclipping. Others of course say they never do this and never have any problems.
Amy did follow the advice and had no issues, however after one descent there was an air bubble, but it could have been there anyway.

Trains and cars, the benefit of the pump

With 2011’s trip shortly after Amy’s Type 1 diagnosis she was still using MDI and injecting 4 times day. I remember finding it tricky when we wanted to eat during a train ride as there was no way she’d inject whilst moving, so she got used to getting ready with the injection for when we pulled into a station and stopped.
This time, with the pump, things are so much easier. She can bolus whenever and whereever and snacking on the train, or plane, or car, or taxi, or tuk-tuk is really easy.

Heat and humidity

It’s been between 25C and 35C everywhere so far and humidity is pretty darn high. So far this hasn’t caused any issues.

Hypers and hypos

Officially, using below 3.9 as the limit, Amy hasn’t had a hypo yet. She’s only been 3.9 twice.
Conversely she’s not been very high either, maintaining levels between 6 and 11 generally.
Which does mean we’ve still got rather large stack of Dextro in our bags!



If there’s anything I’ve missed out which you’d like to know about please leave a comment.