Diabetic Backpacking

Krabi, Thailand

If you are an insulin-dependent diabetic (Type 1) and hold the view that it’s impossible to travel due to your condition, then I’m pleased to tell you that you’re wrong. I will initially give you three pieces of advice. First, you cannot let the fear hold you back. Second, you should look on your life post-diagnosis as a gift and one that you are obliged to use: if you had lived a few decades ago then you’d probably be dead. Third, if you plan properly and are prepared for a challenge, then you will be fine.

I have been lucky to experience backpacking with and without diabetes. My first trip involved traveling around Mexico, aged 18, roughing it as much as possible, using hammocks to sleep in to keep costs down, missing meals to save those extra few pesos and basically having the time of my young life. Following this I went to university, where at the end of my first year I was diagnosed with insulin-dependent diabetes.

There were many different things which I – like most people with the disease – have had to overcome. The inbuilt fear of needles and injections, the bad hypoglycemic (low blood sugar) episodes, the awkwardness of having to explain your condition to others, the self-conscious feeling of injecting insulin or testing your blood sugar in public while doing your best to hide what you are doing, and finally after the initial post-diagnosis ‘honeymoon period’, the depression and anxiety that kicks in when you realise that life has been forever changed.

These problems were hard to deal with but above all my biggest crisis, as a previously independent and confident person, was the loss in perceived independence which resulted in a massive loss of confidence. Suddenly I had to rely on a rigorous routine of medication and regular medical check-ups: my independence, in effect, was gone. I needed my confidence back, but the only way that this could be found would be through rediscovering my independence. It didn’t take me long to realise that I needed to do something drastic for this to happen. I had to get out of the country, away from the comforts of home, and travel alone with my demon.

I suppose this can be regarded as an all or nothing approach, but so far it has worked. I have been traveling in South-East Asia and living in Thailand for about 10 months, where I’m currently working as an English teacher. Now I don’t suggest that you should ditch everything on a whim and hop on a plane. That would be foolish as it would completely disregard the importance of planning. It took me some time to realise that if I wanted to travel again, I would have to plan around my condition and answer some pertinent questions.

Shall I bring my medical supplies from home or purchase them whilst I’m abroad? How can I keep my insulin cool and safe? How can I prepare for being seriously hypoglycemic and on my own? What do I do if I’m ill? How easy will it be to explain my condition to those who don’t speak English and those who do? Can I get adequate travel insurance?

I’ve heard it said many a time, (and believe it to be the case myself), that when backpacking, it is always best to travel light. Unfortunately, if you are planning to be abroad for a while and you wish to bring your medical supplies from home, then you will have to carry half a pharmacy on your back. On the positive side, you will be using your medication, so the weight in your backpack will gradually disappear. The only way to avoid this is to check that your medication is sold in the countries you’re visiting and then buy it there.

Both approaches have their merits but I believe that bringing your medication from home is the most convenient. Go to your friendly doctor and explain what you are about to do, that you will need a large prescription of insulin, needles, blood-sugar testing strips, and lancets. The doctor should have no problem in prescribing you a large amount. This will also save you money, which the budget-conscious backpacker should always be concerned about, as purchasing medicine at retail price is always expensive. Buying your medication whilst abroad can be seen as a good back-up in case the supplies brought from home are lost, damaged or stolen. Do some research and find out whether the medical products you are using are sold in the countries you are visiting and keep a list.

Insulin can survive without refrigeration for up to a month as long as it is not in contact with excessive heat or cold. If you intend to travel for over a month or feel that you cannot guarantee a stable temperature, then you will have keep the insulin cool. This was one of my main worries before leaving home, but it can be easily overcome. If you are staying in a guest house or hotel, ask if you can keep your insulin in their fridge. Don’t be shy about this but do check that the fridge is in a safe place with little likelihood of your insulin being tampered with. An excellent way of keeping your insulin cool is to purchase a cooling wallet. This fantastic innovation should be a must for any insulin-dependent diabetic traveler. It is activated by water, does not need to be refrigerated and is also completely reusable.

If you are diabetic you will already be aware that hypoglycemia or a ‘hypo’ can creep up on you at any time. When abroad – and especially if you are alone – you have to make doubly certain that you are prepared. Bring lots of glucose tablets from home (they are rarely stocked in developing countries) or have a sugary snack of some sort on your person at all times. Test your blood-sugar levels regularly (more than at home), especially when you wake up and before you go to bed. Prior to leaving home, refresh your memory on how heat, alcohol, exercise and local diet affect sugar levels. If you are used to a carbohydrate rich western diet, you may have to reduce your insulin levels when traveling to countries that generally use rice or noodles. When traveling through different time zones on a plane, remember to adjust your insulin dose. It is important that you seek advice from your diabetic nurse on this and other issues.

There are different rules for your diabetic regime when you are ill. It is likely that you’ll have some sort of sickness whilst you are away. Your sugar levels rise when you are ill so you’ll have to adjust your insulin intake accordingly. It is most important – even if you cannot eat a full meal – that you keep on taking insulin: your body needs the energy to help fight the illness. For more detailed information, consult your doctor or diabetic nurse

Learn a few precautionary lines of the local language and get a medical alert bracelet/neck chain. Learn how to explain that you’re diabetic, that you need sugar or need to see a doctor. I have always been a bit proud to tell others straight away that I’m diabetic, but when traveling you must swallow this pride. If you are traveling with others, make them fully aware of your condition and a need for strict eating times. You cannot miss those meals. If you plan, you should have enough money to purchase three carbohydrate meals a day and also a sugary snack.

A diabetic can certainly purchase travel insurance. It is extremely important. Most policies won’t cover the purchase of medicine, but they can guarantee that if you need a hospital, you can be treated at an international one, which will have staff who are trained in treating a diabetic patient. Be thorough in checking the policy before you buy.

I began the article offering three pieces of advice and I’ll conclude with two applicable adages. First, “what doesn’t kill you makes you stronger.” It is important to remember that undertaking this challenge will only serve to give you more confidence. I personally believe that these problems, with which I’ve dealt with, have made me stronger. The issues listed above are not definitive, and you are certain to encounter your own personal difficulties before and during your trip.

This leads me to the second applicable adage, “necessity is the mother of invention.” You will adapt to challenging situations because, to put it simply, you have to. It is amazing how resourceful humans can be, and being reminded occasionally through necessity that you do have hidden depths from which you can draw strength if the need arises, should be viewed as nothing less than inspiring.