Tuesday, 16 May 2017

Traveling light

Before T1 I was always quite good at traveling light, a week on holiday would be just hand luggage and no, that didn't involve reusing socks and underwear.
Then T1 came along and that ability seemingly went out the window. Even a brief trip to the local pub now has a checklist worthy of launching a fighter jet off an aircraft carrier.
Sticking with that analogy, many years ago while sing a flying scholarship I was taught the 7 P's.
Proper Prior Planning Prevents Piss Poor Performance
In the spirit of that lesson let's have a look at the problem we have to solve.

Maths, maths and more maths.

Let's first start with what I need while I am at home on a normal week (Since that is how long this trip will be). So I don't get myself more confused and go completely crazy let's break it all down into the different things I need in an order of easy to hard.

Test strips and lancets

Lancets... 1, easy! Well okay if I'm going to do it lets do it properly and use numbers I wouldn't mind showing my DSN and consultant. 
Lancets (Changing Everytime) 7 x 5 for Week Days; 9 x 2 for weekends = 53
Test Strips (Easy. same as lantects of course) (7 x 5) + (2 x 9) = 53

Basal Insulin

Even easier, I should have started with this one.
(22 + 16 + 6) x 7 = 308U
All good so far, nothing too hectic..... you may want to take a break and have a little run up to this next bit.

Bolus Insuiln

On any average weekday my Carb intake is around 40g at lunch, 40-60g at dinner and I don't bother with breakfast. So lets work on the upper numbers since running out on holiday would suck!
Given that my ratios vary this requires a little more working:
Lunch : (40g/10)  x 1 = 4UI (+3 For Test Shot) = 7UI
Dinner: (60g/10) x 2 = 12UI (+3 for Test Shot) = 15UI
Now maybe I have some breakfast so again lets go worst case and call it 50g each day. Lunch tends to be variable and I sometimes skip it and dinner can be higher one day and light another. But we are talking worst case.
Breakfast : (50g/10) x 1.5 = 7.5UI (+3 For Test Shot) = 10.5UI
Lunch: (60g/10) x 1 = 6UI (+3 For Test Shot) = 9UI
Dinner : (80g/10) x 2 = 16UI (+3 For Test Shot) = 19UI
Adding all of that up for a full week then looks something like this:
Breakfast (10.5 x 2) = 21UI
Lunch (7 x 5) + (9 x 2) = 53UI
Dinner (15 x 5) + (19 x 2) = 113UI
So at home that gives me a weekly total of (worst case) 187UI
Well what does all of this look like, given that every single shot will include a pen tip so we will also need 30 pen tips.
All up for 1 week we are looking at:
308UI of Levemir, a pen and a bit
113UI NovoRapid so just over a third of a pen
30 Needles
53 Lancets
53 Test Strips (a pot and a bit)
And all of that looks a little like this:


Well okay maybe I did it a little simplistic and didn't cover things like correction doses and the all important supplies for hypos, but I think it is a fairly close approximation. Looking at my logs my average daily bolus for the last few weeks has been 20-34UI per day so allowing for that I should probably say I need to add another 10UI each day to cover for corrections, but this illustrates the importance that you keep a log of EVERYTHING and more importantly you actually go back and look at the data you have gathered.
So holidays become a lot more tricky but I tend to simplify things for myself and assume it is the ultimate weekend and I am going to pig out, so lets start there since it is easy:
Basal is same so no worries (actually may be lower if I am doing active out doorsy things.. but remember, worst case)
Bolus: 38.5 (call it 40) x 7 Days for my hols: 280UI
Yikes almost a whole pen.

What if?

Lets be honest chances are you will find all sorts of yummy things to eat and drink and so we probably need to consider that.
Next up, the thing we REALLY don't want to think about but absolutely should.
What if I get sick?
No one wants to be in hospital with DKA when you are at home, away in a foreign country where you don't really know the systems and it will likely cost you? Hell no!
So consider that too.
I work on the assumption that I will only be able to hold out for maybe 3 days before tiredness will get me so lets just go with DAFNE guidelines:
20% TDD every 2 hours plus usual QA and BI so that would mean I need:
77 x 0.2 = 15.4UI, lets call it 15 and don't forget the 3UI for test shot
So my total sick day insulin stock would be  (18 x 12) x 3 = 648UI (OUCH!)
In reality I would likely only do 2 days so call it 432UI, but that is still a lot.

Adding it all up

For the hols I will usually add 30% on just to be safe and then follow the recommendations of my DSN and DAFNE and take double what I would need, so lets add all that up then:
Basal : 308U x 2 = 616UI which is 2 and a bit pens. Lets call it 2 new and the remainder of my active
Estimated 280UI x 2 = 560UI which is 2 refills
Sick Day: 432UI = 1 and half refills
Totals: 992UI, or 3 and a third refills.
Blimey... all that for a week?

Back to the real world

So the numbers are quite sobering
But in practice it doesn't actually work out to be all that bad.
For starters I generally have 2 bolus pens on the go at any one time. One that lives at home and one that comes with me. Depending on how much I have in those I will likely have almost a full pen or a pen and a bit between those when I take off.
So what will I be taking then?
2 x Bolus Pens (1 full, one half full)
3 Bolus Pen Refills
1 Already in use Basal Pen
2 Fresh Basal pens
Frio pouch
2 Test Meters with part used pots of strips
2 Fresh pots of test strips
A good handful of lancets (High tech measuring device)
1 Box of pen tips
1 Ketone test meter (my health authority is awkward about me having the BG strips for that meter)
All my others pills
Needle Clipper (Longer trips I just throw a sharps bin in my checked luggage)
Hypo treatment
Hospital letter
And in the real world that lot looks something like this:
Hmm, starting to get serious now. How on earth does that lot become travelling light?
A nifty little wash bag and s misspent youth playing tetris is how!

And there we have it:
I should explain the wash bag goes in my rucksack everything else I carry on me. That way worst case I know I have basal and bolus insulin with needles (about 9 crammed in the blue pouch and my tester pouch) to last a couple of days.

Not that I will likely ever allow them to separate me from my little blag bag that holds my personal pharmacy :)

Yes I am a bit short on hypo treatment but I will get some jelly babies at the airport after security.

All up my week away looks like this:

So like I said way back at the beginning it is all about the planning. While I gave some example numbers here I actually based my packing on my logs for the last couple of months and added a bit to allow for the food I am likely to be eating.

This kind of planning and packing has served me well so far and I have managed a fair few places like this, Spain, Spanish Islands, Greece (and islands) South Africa (several times), Seattle USA (several times) Florida, New Orleans, Australia, New Zealand and a whole bunch of places around the UK.

Obviously always make sure you have suitable insurance and if possible do some research on availability of your supplies where you are going, a little effort now means a more relaxed holiday later and out T1 is just a slightly annoying travelling companion.

Enjoy your hols folks!

Happy travels!


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