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 café, 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
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