Wednesday, 10 April 2019

Balancing Solo Travel with T1D - Caleb Britton

When I was in London in March, I sat down in King's Cross Station and pulled out my insulin pump to give myself some insulin, and I heard someone utter next to me "We're pump twins!". Sitting next to me was Caleb Britton: Caleb is a sophomore Kinesiology major at Gordon College in Wenham, MA, and is studying to be an Occupational Therapist. He loves music, writing, startup culture, and lucky for me, travel! We both happened to be in London at the same time, and Caleb bumped into me whilst travelling around Europe! I thought his expertise should be shared, I especially love his 10 handy travelling tips. Enjoy! - Alyssa x

I’d wanted to visit Europe since forever. Throughout high school and the beginning of college, I would keep bringing it up with my family – could we, by any chance, do a Europe trip this year? When the answer was still “probably not” last fall, I decided to take matters into my own hands – I was going to Europe all by myself.
              I ran through several versions of an itinerary, before finally settling on an eleven-day mad dash during my college’s Spring Break. In those eleven days, I would be visiting eight cities – London, Oxford, Paris, Barcelona, York, Edinburgh, Dublin, and Reykjavik, in that order – with visits stretching from three days in London to twenty hours in Paris to three hours in York. One frenzy of ticket and hostel booking later, I was on my way to Europe on an overnight Norwegian Airways flight.

Cliché wing shot!

I tried to pack as much as I could into those eleven days. Every morning I would wake up early in my hostel or AirBnB, grab a hearty breakfast at a local restaurant or cafĂ©, and walk or take public transportation into the city. Even though I gave unrealistically small amounts of time to cities like Paris (20 hours) or Barcelona (26 hours), I still managed to visit all sorts of iconic attractions and landmarks – such as Buckingham Palace, Magdalene College, Notre Dame, La Sagrada Familia, the British Railway Museum, Edinburgh’s Royal Mile, and Trinity College. I enjoyed a beautiful night view of Paris from the Eiffel tower where I ran into a man proposing to his girlfriend. I lost myself in Barcelona’s Gothic Quarter, where people crammed themselves into tiny tapas bars to enjoy a drink, some delicious bites, and good company. And when my eleven-day trip turned into twelve and I was (voluntarily) stuck in Iceland due to the now-defunct WOW Air overbooking my flight, I enjoyed the long, northern sunset as I walked down to the beach in Reykjavik.

I now realize this picture is equal parts British and American…

Magdalene College and local Oxford wildlife

Paris by night!

La Sagrada Familia is simply other-worldly.

Carlton Hill, Edinburgh – complete with my despicable attempt at a beard.

Abandoned church-ish thing in Howth, Ireland

Despite these wonderful perks, though, a solo trip like this is a daunting step into the wider world for anyone, and difficulties are bound to present themselves. Traveling solo can sometimes be accompanied by losing your wallet or passport, draining your phone battery, eating something strange that disagrees with you, or getting lost in a city where you know nobody. But once you throw Type 1 Diabetes into the mix, it adds a whole other element of difficulty. As readers of Alyssa’s blog probably know, Type 1 is a constant battle between high and low blood sugars, either of which can kill you or cause serious harm if left unchecked. In a single day at my Massachusetts college, my blood sugar can fluctuate between half of and two times the amount it’s supposed to be. That’s normal – it’s not perfect, but it’s still pretty easy to balance with experience and routine. When you travel at a breakneck pace through five countries in twelve days, though, that balance is a lot harder to maintain.
Here’s the deal: I love trying new foods, and I wanted to try as many as possible during my trip: the proper English fry-up breakfast, French crepes and baguettes, Catalonian tapas and pintxos, and Haggis in Alyssa’s home turf of Scotland (which, contrary to popular American belief, is actually pretty good). Unfortunately, if my blood sugar was high when it came time to eat, my options were pretty limited – unless, of course, I wanted to spike my blood sugar even higher than it already was, which is never a good idea. Furthermore, all of that food had carbs, and I had no idea how many.

The British love their protein…

…while the French seem to prefer carbs.

And if this wasn’t enough mental math, there’s one thing that sets European cities apart from American ones, other than perhaps New York: Everything is incredibly walkable. Walking means exercise, and for T1s like myself, exercise makes short-acting insulin more potent. If I exercise enough with enough insulin, my blood sugar goes low, and then even walking through a city can put me at risk for a worse low or even passing out. In short, I had to give myself enough insulin to safely eat my next exotic meal, but not so much that I wouldn’t be able to walk around.
As an example, my blood sugar was going low while walking around Oxford with my friend, who was studying abroad there. Because of that, when we got Cream Tea in the middle of the afternoon, I deliberately gave myself a smaller-than-normal bolus for the scones and clotted cream we ate. As it turned out, this bolus was much too small – even after another two hours of walking, my blood sugar was at 300 mg/dL (16.7 mmol/L) when it was time for us to have dinner in Lewis and Tolkien’s old haunt, the Eagle and Child. I still got a Cottage Pie anyway, because I needed food, but I was pretty sure this would spike my blood sugar even higher, so I gave a larger than normal bolus. Of course, by the time my train got back into London’s Marylebone Station that evening, my blood sugar was low again, and I ended up buying a banana and a cookie bar in the station before taking the Underground back to my hostel. Sadly, this sort of up-and-down game was typical throughout the whole trip.
Oxford was still totally worth it, though!

Then, of course, if something went horribly wrong, getting sent to the hospital in a foreign (to me) country could result in a bill equal to my entire travel budget. And if my bag full of insulin, pump supplies, backup pump supplies, strips, needles, swabs, glucagon, and glucose tablets got stolen, who knew what could have happened.
Thankfully, the worst didn’t happen. But I did have multiple low blood sugars pretty much every day, and half the time the only carbs I had to me were powdered orange glucose tables from CVS, an American chain convenience store. Other times, a well-timed smoothie or sweet treat from whatever shop or restaurant happened to be nearby me – my favorite pick-me-up was a chocolate chip baguette in Paris. My worse low by far was on the final night, in my hotel in Iceland, when I was at 50 mg/dl (2.8 mmol/L), my glucose tablets were running out, and the vending machine refused to accept the final ten kroner coin I needed to buy Pepsi (thankfully it ended up taking my debit card, which I probably should have tried first in retrospect, but I wasn’t exactly thinking clearly).
Don’t let any of that scare you, though, at least no more than is healthy. Going to Europe or any foreign-to-you country, even with Type 1 Diabetes, is absolutely worth it, so long as you understand the risks and have plans in place to minimize them. The challenges of travelling with a chronic illness are very real, but they are far outweighed by the places you see, the amazing foods you try, and the fascinating and diverse people you encounter. For me, this latter category included the Pumptastic Scot herself, whom I met in King’s Cross Station, right after discovering that, sadly, there is no barrier between platforms 9 and 10. Pity . . .I already bought my Hufflepuff scarf.

And thus my dreams were crushed.

If you, dear reader, are considering traveling abroad with T1D, especially solo, here are some friendly tips to help you on your journey.

1.      Always have backup. Bring twice as many supplies as you think you’ll need.
2.      Carry a wallet card explaining what to do if you have an extreme low blood sugar and can’t communicate.
3.      Upload a copy of your passport to the cloud, so that if it gets stolen you have access to it. This one goes for everyone, but access to an ID could be especially important for a diabetic in distress.
4.      Learn how to say things such as “I have diabetes” or “I have low blood sugar” in the language of the country you’re visiting. My next country is China, so this will be fun…
5.      If you’re staying in a hostel, inevitably you’re going to be digging through your stuff in the dark while other people are trying to sleep. As part of trying to only do this once, make sure you have a juice or soda ready to go next to your bed.
6.      Temp basals are your friend. If you use a pump and you have a target blood sugar, try dropping cutting your basal entirely for half an hour or more while you’re walking from place to place.
7.       Troubleshoot, troubleshoot, troubleshoot. If you’re having consistent lows, drop your meal boluses, then drop them again the next time around. Keep doing this until things even out.
8.      Always be asking yourself, “What if I had a low right now?” Pack lots and lots and lots of energy bars and glucose tablets, even if you think they’re disgusting. As much as possible, buy up sodas, snacks, and juices, so that you’ll have them on you if you do indeed have a low blood sugar. When you budget for your trip, take this into account – I spent over $50 (over £38) on low blood sugar snacks during my trip.
9.      If you’re on a plane, even a low-cost airline like Norwegian, EasyJet, or Ryanair that nickel-and-dimes you for everything, and you have a low blood sugar, don’t be afraid to ask for free snacks and drinks if you have a low. This worked for me on Norwegian, when I had an overnight low on a transatlantic flight from Boston to London, and the flight attendant gave me free juice and cookies.
10.  Speaking of flying, once you get on the plane, gather everything you need to have on you during the flight – including glucose tablets and your meter – and stuff them into the seatback pocket in front of you. This way you won’t have to get up or dig around in a bag to find things should you have a low blood sugar.

Happy travels!

-          Caleb

“The world is a book, and those who do not travel read only a page.” – St. Augustine