By: Pat Piper
If there’s a common word people with diabetes use when their blood sugar drops or goes high, it’s “routine”–as in, “Whenever I get away from my routine, that’s when I get into trouble.” For most of us, traveling isn’t part of our routine, so here are some suggestions to find that sought-after balance between “getting away” and “staying OK.”
There are 17,000 miles of trails in America’s 401 national parks, monuments, and battlefields. In 2010, National Park Service statistics recorded 793 instances of “hiker fatigue,” meaning a hiker went to a park’s visitor center for assistance after walking, or park rangers were summoned to assist a weary walker.
“The Grand Canyon and Yosemite are where we have made the most rescues,” says NPS spokesperson Kathy Kupper, “and that’s not surprising because these places are huge. In many parks we will station a ranger about a mile past the beginning of a trail just to make sure there’s no indication a person is having a problem. We’ve even seen people start a long hike wearing flip flops, which isn’t a good idea.”
If you intend to hike in a large park or remote area, keep these things in mind:
1. Carry glucose tablets or gel packs of glucose for a rapid treatment of low blood sugar. In fact, hand a container to someone you’re walking with as well. Tell your fellow hikers about the symptoms of a low blood sugar so they understand what to do if you start to have a hypoglycemic episode.
2. There’s nothing wrong with stopping and taking a rest. Many national and state parks have benches along a hiking trail for this very reason.
3. Know your limits. If hiking is a new adventure for you, don’t start off with a weekend 60-mile trek.
The Cruise Lines International Association says there are 410 ships operating around the world, many of them embarking from 30 ports in the United States. Cruise lines, including Carnival and Princess, follow the American College of Emergency Physicians guidelines, which specify the quality of medical personnel and the appropriate level of medical equipment, supplies, and facilities onboard.
“We have more than 400 medications onboard our ships,” says Carnival Cruise Lines Medical Director Dr. John Bradberry, “and we routinely provide medical assistance to diabetics. If a passenger needs medical supplies because they’ve run out while onboard, we can usually supply them until we reach port. Once there, our port agents work with local pharmacies so they can make recommendations and provide directions to get there once ashore.”
(Some lines have cruises designed for people with diabetes. Royal Caribbean offer a voyage during the New Year’s Eve holiday.)
Cruise Ship Checklist:
• Talk to your endocrinologist/physician about your plans for a cruise. Ask for a list of medicines you require and have that list with you onboard the ship.
• Determine the length of the cruise and your medical needs (insulin, test strips, syringes, tablets, and pens) and add extra amounts of each in the event you are delayed at sea. Some suggest taking twice the amount of insulin/test strips you’ll need.
• Eating is part of taking a cruise, so the temptation is always there to have an extra side dish of garlic potatoes or a crème brûlée. But most cruise ships will provide a special menu for people with diabetes. A few, like Carnival, will do so without advance notice. Celebrity Cruises has a “Guest Special Needs” form on its website that can be used for meals as well as ensuring that insulin can be kept cool.
• Wear a medical identification necklace or bracelet.
• When you go ashore, have glucose tablets with you and carry the meds you need in a small pack.
• Check that your health insurance will cover you if the cruise goes outside the United States.
• It is suggested you check your blood sugar more frequently at sea than you do at home. This is because of time zone changes and probably increased activity ashore as well as at sea (cruise ships can be longer than a football field).
Diabetes Health spoke with a pair of organizations that operate camps for people with diabetes. Blair Ryan works with InsulinDependence, and says the most important part of a camping trip–and any other traveling experience–is talking to people who aren’t diabetic.
“You have to realize that the people around you want to feel comfortable and it’s not always about you. If the people around you are comfortable, you are guaranteed to have a better experience. Taking a moment before you start a trip to educate people about your condition will make for an improved overall experience for everybody. Don’t be afraid to make fun of yourself and have a good time. Your efforts to educate your friends and family will help them the next time they encounter diabetes in their lives, benefiting the community as a whole.”
The Diabetes Education and Camping Association works with more than 115 organizations in the United States, many with camping programs. “A person with diabetes can do anything,” says Executive Director Terry Ackley. “Create a plan that takes into account physical activity, where you’ll be and then get physically prepared. Match your activity level with your preparation.”
If you use an insulin pump, carry a backup supply of basal insulin and syringes in the event your trip lasts longer than the pump’s battery life. Carry 1.5 times the supplies normally used (test strips, insulin pens/vials/syringes). If you use insulin vials, pack extras because they can break if dropped on a hard surface. Alcohol wipes are more important when camping because of potential contamination sources, so pack a lot.
A number of camps devoted to people with diabetes suggest testing more frequently than usual as a result of the many activities they offer. Some diabetic camps factor in 12 test strips/day.
You’ll need fast-acting glucose when camping. Standard glucose tablets work (though InsulinDependent suggests all-natural tablets called GlucoLift). There’s usually a gas station at the entrance to most trailheads, so grab a few Snickers or Skittles. Packaged dried fruit works well but can melt in the heat. (Dried mangoes can increase blood sugar quickly and are easy to carry, but expensive). If you’re swimming, putting a bar of AirHeads under a swim sleeve is handy–it’s waterproof and contains the standard amount of carbohydrates for low blood sugar correction.
Know the location of nearby emergency locations, have their telephone numbers and, if possible, know the location of a nearby land line phone in case the area you’re in doesn’t have cell phone coverage.
If you aren’t using a camper, vials of insulin can be kept cool in your cooler. A neat trick is using frozen water bottles instead of ice. They keep the cooler cool and can be used for drinking as they defrost. Terry Ackley recommends FRIO Insulin cooling cases and wallets (soak in cold water for 15 minutes and they keep insulin cool for 48 hours) that can be carried while walking.