Please note that I’m a mum, not a doctor, so please don’t take anything on this blog as medical advice. If you have any tips for me, please put them in comments: they would be very welcome!
Don’t it always seem to go, That you don’t know what you’ve got, ‘Till it’s gone (Joni Mitchell, Big Yellow Taxi)
It’s time to make the leap. Having put off international travel since my son’s diagnosis a year ago, we’re finally steeling ourselves for a trans-Atlantic adventure. My husband works for an American firm and spends a lot of time state-side, and with this latest trip to NYC falling in the summer holidays, we’re going too.
I’ve been prevaricating about this. Travel with type one diabetes presents unique challenges, but we can’t let our world shrink so I am biting the bullet. A lot of the things my son uses are not available over the counter: insulin, CGM sensors, pump infusion sets, needles. So we need to pack like we’re facing the apocalypse. Double this (Joe Travel List) may cover it. Insulin needs to be kept at a stable temperature, which means that it needs to travel in our hand luggage in special cool bags, and we also need to carry liquid glucose, glucagon and various sharp things (lancets, needles, infusion introducer needles). We have a letter from our Diabetes Specialist Nurse (DSN) which should hopefully smooth our progress through security with these items.
Pump manufacturers insist pumps must not pass through full body scanners (as opposed to the more common metal detectors), nor through an x-ray machine. The same applies to CGM sensors (even the spares carried in the hand luggage). Theoretically we are entitled to request a pat-down and screening with a handheld wand, although pump and CGM users regularly encounter problems. Even after assiduous lobbying from parent Rachel Humphries following a terrifying experience at Dubai airport, the UK Airport Operators Association still asserts that “government medical advice is that screening by security scanners pose no known health and safety risks and are safe for passengers with such medical devices” while conceding that manufacturer advice differs and that passengers are entitled to request alternative arrangements. As we are travelling to the USA we will carry this card for the TSA.
F*k what they say
F*k it if they talk
It really don’t matter.
We’re going to New York (Stephen Fretwell)
Once through security, we need to make the normal arrangements for queuing, long walks to gate and delays.
Take off and landing can affect the pressure in the pump, causing hypo- or hyperglycaemia due to erratic insulin delivery.
“Diabetic” meals on board unfortunately don’t mean carb counted (we measure every single gram of carbohydrate my son consumes and enter it into his pump to try to get the most accurate dosing possible), so we will be eschewing this in favour of weighing out the “normal” meal. As we’ll be eating in restaurants for most of the week, we’ll have our fold-out scales and Carbs&Cals book with us.
Like any great love, it keeps you guessing
Like any real love, it’s ever-changing
Like any true love, it drives you crazy
(Welcome to New York, Ryan Adams/Taylor Swift)
On arrival, advice from our DSN is to simply change the time on the pump to the new time zone. Experience of travel with my children makes me a bit wary of this: I know their bodies don’t adapt instantaneously to the new clock. My son has twice as much basal insulin at some times of day as others, and the ratio of insulin to carbohydrate is radically different for different meals (e.g. 1:9 at breakfast, 1:23 at lunch). As too much or too little insulin can have life-threatening consequences, I’ve been giving this quite a lot of thought. Diabetes Care‘s recommendation is in line with my thinking :
“If your journey involves a time difference of more than four hours, then set the pump to administer the lowest basal rate as the constant basal rate upon arrival at your destination. Maintain this constant basal rate for approx. two to three days. Once your body has adjusted to the new time, you can return your pump to your original basal rate profile.”
I want to wake up in a city that doesn’t sleep (Sinatra)
This doesn’t solve the problem of the carb ratios, but I’m aiming to play it conservatively and to encourage my children to see New York not as the city of burgers, pizza, hot dogs or even big apples and to embrace the city’s modern love of paleo. Children with type one diabetes need carbohydrates to function and grow, but less carbs means less margin for error. I expect we’ll be able to make up for it in “free carbs” which we use to fuel exercise, as we stomp through the streets or chase Pokemon in Central Park.
Finally, should the worst happen, we’ll need travel insurance that specifically covers T1D.
If I can make it there
I’ll make it anywhere
It’s up to you
New York, New York (Sinatra)