A month ago, my family took its first real vacation since I was diagnosed with diabetes two years ago. I’m lucky that I survived the vacation.
It wasn’t that I was unprepared. I’d done some reading and followed the advice presented there. I had my medications, and they were sorted and in containers that allowed me to take just what I needed with me for the day, regardless of any change of plans. At least for the first few days, I made sure that I had snacks available for when meals were delayed, or if the blood sugar started to go low.
What I hadn’t counted on, and what I didn’t see in any of my reading ahead of time, was how the four foundations of blood sugar readings would all interact in a really bad way, and cause me to go into diabetic shock in the middle of Disney World. I was lucky, because the blood sugar readings were low enough that I could have passed out and gone into a diabetic coma.
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I had forgotten one of the first things that was presented in the diabetic living classes – the four legs of the stool that is a blood sugar level. All four contribute to whether the blood sugar levels are high or low in your system. Those four things are diet, exercise, medication, and stress.
My vacation activities had changed from my usual routine in all four of those areas, and I believe that is what led to my sudden problem as I exited a ride at the Disney Studios. As I stood up, the vision blurred, and I stumbled out of the ride into the corridor leading to the exit. My youngest son saw me and was immediately concerned. I told him that I had to take my blood sugar reading immediately, and to tell his father and brother what was happening. The reading registered at 64, the lowest that I’ve ever seen, and I hadn’t brought along a snack for the day, so I had to get to the nearest place to get something into me. Lucky for me, the ride was next to one of the restaurants, and with my younger son helping me to walk, I was able to make it there. Also, I was lucky in that the manager was making his rounds as we walked in, and my son was able to get his attention almost immediately. When the situation was explained, he immediately went and got an apple juice for me to drink. As soon as I had begun drinking the juice, I could feel that I had been very lucky, and that the blood sugar levels were improving.
Now, here’s where others who are diabetic can learn from my many mistakes. What had I done wrong? First, there was the very big problem of not having sugar pills or a snack or juice with me so that I could immediately begin to reverse the problems when I first detected it.
But, before it got that far, there were several things that had contributed to the suddenly falling blood sugar. What are those four basic things that contribute to blood sugar? They are: 1) Diet; 2) Exercise; 3) Medications; and 4) Stress levels. Going on vacation can impact all four of these areas. First, as any change to usual procedures, the stress, good or bad, can cause blood sugar levels to vary. I didn’t account for that at all. Second, because we were at Disney World, we were walking a whole lot more than I usually do, so my exercise levels were a lot higher than my usual routine. Finally, our usual pattern of eating was changed drastically, and I had no idea at what point we would decide that it was time to have another meal. I really needed to be more assertive and required more of a routine for our meals. With the change to the meals, I wasn’t taking my medications at the same time of day as usual as well. Therefore, all four supports for the proper blood sugar levels had been weakened, and it was no wonder that I found myself in a dire situation.
Since then, I’ve checked sites that are supposed to give hints for traveling as a diabetic, and I’ve confirmed that this information usually isn’t covered. If you are travelling as a diabetic, try to keep as close as you can to the regular routine, as that is so important to your body staying in control of the blood sugar.
Finally, never ever assume that you won’t have a problem during the day, so you won’t need to be without your backup sugar source. If a diabetic is on insulin, it is possible to adjust the insulin levels that are needed, but that isn’t as easy for those of us who are trying to regulate the sugar with oral medications alone. It is possible for someone on oral medications to have blood sugar levels that suddenly plummet. And take it from someone who’s been there, it isn’t fun to experience the changes to the body that the plummet causes.
Nurse Kelley Sez: Thanks to barbwires for more good advice for traveling diabetics:
An alert bracelet is a good idea, mainly because hypoglycemia can mimic acute intoxication (it doesn't feel nearly as good however): But you don't want a cop tasing you while you are having an insulin reaction because he/she thinks you are an uncooperative drunk. Assuming of course that they will actually look at the bracelet. All that said, I have resisted getting one; it seems too much like a scarlet letter to me.
If you take insulin, or if you are on oral meds that markedly drop blood sugars (like sulfonylureas can), you should also consider carrying a glucagon injection as well as rapid acting glucose tabs or sweet tarts. Your significant other should practise injecting an orange until he/she is comfortable with the idea of sticking this in your thigh or arm (subcutaneously) should you become unconscious and unable to take your emergency sugar by mouth. Glucagon causes the liver to release stored glycogen and is a counterregulatory hormone to insulin. It will raise the blood sugar fast and could save your life.
Another good thing to know about sulfonylureas is they can make you sun sick, so if you are taking them and start feeling weak and queasy out of doors in bright sun it may be sun affecting you and not low sugar. Or the two effects can tag team for a very unpleasant experience. Another potential problem is that diabetics don't regulate body temperature as well as non-diabetics, so heat stroke is easier to come by.
The other joys of travel with diabetes for those who are insulin dependent or take one of the other injectable medcations such as byetta is how to keep your medications cool through prolonged periods where you may not have accesss to a refrigerator. (Best I have found is to wrap the pen or vials in bubble wrap (to keep from contacting the ice directly, which denatures protein) and then to put in a plastic bag inside a narrow neck thrmos with ice. This will go for a fullday, even with extreme heat.)
Or you can run into weird laws, like I did in Florida--in at least a couple of counties you need a doctor's prescription to buy needles, even if you have a current prescription for insulin or another injectable medication. Doesn't help if you start running high sugars on a weekend evening; you can have the pleasure of a weekend evening ER visit if you can't contact a doctor.
The one good thing is the TSA is now very well aware of insulin pumps, syringes and other paraphenalia and you will not have a problem carrying these on your flight (do not check them!) You also can carry some oj or apple juice on if you explain that you are diabetic. If travelling overseas, make sure you have a current prescription handy if queried.
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