Type 1 diabetes is a metabolic disease in which the body’s own immune system attacks cells in the thyroid gland for mostly unexplained reasons, thereby destroying the production of insulin. Insulin is a hormone that is needed to break down carbohydrates in the body and is therefore essential for life. As the thyroid gland produces little or no insulin, it must be supplied to the body from outside in the form of injections or pumps.
The difficulty with traveling lies in the storage and procurement of insulin in other countries and continents. Insulin must be cooled between 2 and 8 °C. As we want to travel to warm to very hot countries and regions, we need to plan our trip well. There must always be a fridge and a freezer compartment before long flights, bus or ferry trips, otherwise the necessary cold chain cannot be maintained. If the insulin becomes too cold or too warm, it can lose its effect or, in the worst case, even become completely unusable.
In addition, not all parts of the world have easy access to insulin. Often no distinction is made between the different types of diabetes, so there are few or limited choices of insulin. However, each insulin has different modes of action and therefore you cannot/should not simply switch brands, especially if you don’t know them. I had my diabetologist give me a list beforehand of which insulins I could use as an alternative and what different effects they have.
In a person without diabetes, blood glucose levels are on average in the range of 70-100 mg/dl. The consequences of blood sugar levels that are too high or too low can cause serious long-term damage, which is why it is important to always keep an eye on your levels and react to any deviations. There are various ways to measure your blood sugar and various gadgets that you can use. More on this below.
Please bear in mind that we are not doctors and have no medical training whatsoever. Our reports and texts are based on our experience of over 6 years and are individually tailored to Rebecca.
Diabetes medication
Various devices, medications and accessories are used for her own diabetes management. In the following sections, individual devices and their functions are explained. The following content relates explicitly to Rebecca’s diabetes management. As there is no one-size-fits-all guide, each management is individualized to the person and varies by different factors such as environment, mental and physical condition, and more. We have calculated for our trip with enough coverage of everything for about 7-8 months.
Insulins
Type 1 diabetics have to inject insulin themselves, taking over the role of the actually healthy thyroid gland. Insulin is usually injected before every meal and to correct sugar levels that are too high. If sugar levels are low, sugar usually has to be added through food or drink.
There are generally two different types of insulin for type 1 diabetics. There is a so-called slow-acting basal insulin, which is usually injected once a day to slowly and steadily supply existing blood sugar to the cells.
Bolus insulin is a fast-acting insulin, which is usually injected before every meal and thus enables the absorption and processing of carbohydrates into energy for the body’s cells.
The insulin is either pre-filled in so-called disposable pens, which are thrown away when empty, or filled in cartridges that can be placed in reusable pens. Rarely, there are still ampoules where you have to draw up the syringes yourself.
Needles
There are attachments for pens, which are small needles that you screw onto the pen and throw away after one use for hygiene reasons. The length of the needles varies from 4 mm to 10 mm, as the insulin is injected under the skin into the fatty tissue and this varies from person to person. Rebecca’s needle size is 4 mm.
Blood glucose measurements
Nowadays, there are various ways to keep an eye on your blood sugar. We’ll focus on the two most common ones here: taking a finger prick yourself or continuously using a sensor. It is best to keep an overview of your own values 24/7 so that you can intervene if necessary.
One Touch Ultra meter
The typical measuring method is to prick your finger with a small needle and put the blood into a test strip and a device gives the current blood glucose value.
The disadvantage of this method is that it is painful if you have to prick your finger more often and you only have a single current value. This means that you have to take several measurements throughout the day to keep an eye on your values. You do this approx. 5-7 times a day and should only use the little, ring and middle fingers alternately.
Lancets
Lancets are small needles and are used to prick your finger in order to obtain small amounts of blood from your finger. These are also disposed of after a single use.
Test strips
The test strips are individual for each blood glucose meter and collect the drop of blood from the finger and calculate the current blood glucose value.
Sensors
There are so-called CGM (continuous glucose measurement) sensors that can be worn on the body (upper arm/abdomen) for 10-14 days and send the values permanently to the smartphone. This gives you the best current coverage and an overview of your values at all times. Alarm functions warn you if the values are outside the target range (70-170) and you can act accordingly.
xDrip
This is an additional app that is not officially recognized medically, but can bring great added value to everyday life with diabetes. Using technical functions, a graph can show how the blood glucose value will develop in the near future, allowing the patient to intervene and react in advance before alarms are even triggered. In addition, individual alarms can be set at different times, for example, the sensor can be calibrated and the values can be sent to a smartwatch, for example. Installation is not so easy for people with an affinity for technology and not so easy at first. However, I wouldn’t want to do without this function in my everyday life.
Carbohydrates for emergencies
To protect yourself from hypoglycaemia, it is important to always think about carbohydrate-rich snacks or drinks. Most people think of chocolate, which is unfortunately not ideal, because chocolate is very sweet, but the fat it contains means that the required sugar reaches the body too slowly and is therefore not suitable.
Sweet drinks such as juices or cola are better. The typical piece of glucose helps extremely quickly and is easy to transport.
Extras for diabetes management & traveling
We have two different gadgets to maintain the cold chain in everyday life or when traveling.
Frio
One is Frio, which has small crystals sewn into pockets that absorb water on contact and keep the temperature cool.
Disoncare
The Disoncare is similar to a thermos flask with a special coolant that has to freeze in the freezer compartment for several hours beforehand and can then maintain a temperature of between 2 and 7 °C for several hours.
Documents for flight
My diabetologist issued me with a certificate in English to allow me to take insulin and the associated equipment with me on the plane. This certificate lists everything I need for my diabetes management and that I am allowed to take this with me as hand luggage. So far, I haven’t had to show this document on any flights within Europe or on international flights. I also have a small cooler bag with me for our trip around the world, which contains 4 thermos flasks and 8 ice packs, and here too I have never been asked to unpack and show everything. The cooler bag doesn’t count as normal hand luggage either, but as special baggage, as it only contains medication and dextrose. If you are unsure whether you are allowed to take an extra bag for your medication, ask the airline’s customer service or visit their website. You can usually find all the information there.