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Posts from the ‘Traveling’ Category

PSA: Wash Your Hands.

Over the last few days, I’ve logged plenty of airplane travel hours, which are hours I don’t enjoy for a dozen different reasons, one of which being how rotted out my hands become after just a few hours on a plane.  I know the air is low on humidity, which doesn’t help maintain hydration, which turns my hands into these wizened old lady hands that crack and bleed even if I’m gently pushing the lever to put my tray table into its upright and locked position.

Most of the time, I forget to bring hand lotion with me and by the time I arrive at my destination, I need to wear gloves to cover my mangled hands, but this time, I remembered.  (Forgot insulin, but remembered hand lotion.  Not exactly a even trade, but still.)  So I spent the majority of the flight with plenty of lotion slathered on my winter-ruined hands.

“386 mg/dL.”

What the what?  Sitting at my seat on the plane, I was baffled.  My CGM had me at 98, not 386 – what the hell was going on?  No sweaters on my teeth, no desire to pee every fifteen seconds, no need for water constantly pouring down my throat.

(I know you already know the source of my idiocy.)

I washed my hands, and checked again.

“103 mg/dL”

For almost three decades, I’ve been told to wash and dry my hands before checking my blood sugar.  Clearly, hand lotion is filled with honey.

 

Insulin Pump Refill: In a Pinch.

Usually, I am a thorough diabetes packer. Extra test strips? Yep. Back-up insulin pen? Yes, again. Glucose tabs? I have a WHOLE JAR and will share them with the plane.

But today, I effed up my routine.

I’m currently en route to Seattle for work and there are 59 units left in my insulin pump.  To last me until Saturday night.  This may not be quite enough.

In my carry-on bag (no checked luggage because I tie my clothes into intricate, teeny pretzel-esque knots before shoving them into my suitcase), I have all of the aforementioned diabetes supplies but I forgot my vial of insulin.

HOW?  I’m usually so fastidious!  Ish!

Normally, I open a bottle of insulin and work my way through it over the course of however many weeks. While I’m using it, it sits in a makeup bag in my bathroom, along with some infusion sets and insulin cartridges.  (One stop shopping – just reach my hand in and I come out with everything I need to do a site change.  Convenient, especially if Birdzone is waiting [im]patiently for me.)  Once the bottle is kicked, I throw it away and crack open a new one.  (Not literally, though it has happened.)

Whoops on that last part because I forgot to grab a new bottle and add it to the bag when I last filled up my pump. And in the wee early morning hours today as I left for the airport, I totally forgot to get a new bottle.

So now I’m flying across the country with a half-filled insulin pump and only an insulin pen in my bag.  Stupid forgetting things brain.

insulin pump refill

Thankfully, there are some MacGyver‘ing options available to me.  I do have a bottle of Levemir and a few syringes that I could use, alongside the pen of Humalog, and I could go off-pumping until I get back home.  But I can also refill the insulin reservoir by pushing the refill needle into the top of the insulin pen, dialing back a bunch of units, and pushing the insulin into the cartridge.  My preference is to remain pumping, so I’ll be knocking out air bubbles aplenty when I do this to refill before flying home.

It’s a messy, make-shift refill, but when you’re far from home and it’s the only option, it’ll do.

Flight Anxiety and Diabetes.

Every time I travel, I go through the same routine to prepare for the trip:

The night before, my suitcase is packed.  My medical bag, a bright orange packing cube that I bought probably while hypoglycemic at Target, houses all of my medical supplies: bottle of insulin, insulin pen, infusion sets for pump site changes, pump cartridges, Toughpad for CGM sensor swaps, extra test strips, lancets, blood pressure med, AA battery for my pump, and a quarter to change said battery.  Morning of travel, I don’t want to worry about anything other than making sure I have pants on.

Day of travel, I arrive at the airport two hours before my plane is scheduled to take off (unless I’m leaving from the Providence airport, in which case, I can limit my prep time to an hour … we’re a very teeny state). Working my way through airport security is usually very easy, with all of my supplies going through the x-ray machine except for my pump and my CGM, which remain on my body and are examined via pat down and swabbing.  (Your diabetes/device/airport comfort may vary, but this is how I do it.)

Once I’m through security, I get the biggest iced coffee I can find and try to find a chair at the gate that is reasonably close to an outlet, so I can charge my phone/laptop for the flight.

But the best laid plans can still have hard-to-anticipate outcomes.  Even though my approach for preparing for and going through airport-related travel remains the same every, single time, my body’s response to these events varies wildly. Airplane travel, for me, has always been a source of stress.  Even though I’m “used to it” and my emotions feel calmer throughout, the panicky feeling is unpredictable and hard to prepare for.  Sometimes, the anxiety will kick an in-range blood sugar up into the 250′s and hang there, even before I get to the gate.  Other times, the nerves kick in at take-off and my blood sugars start to rise about 20 minutes into the flight.  (Melissa wrote this great article at A Sweet Life about blood sugar fluctuations and airplane travel – worth a read!)  I wish I could blame my pump for this issue, but this trend happens whether I’m pumping, on injections, drinking decaf (or wine), taking anti-anxiety medication for the flight … the only constant is the airplane.

Yesterday, traveling across the country from Sacramento to Providence by way of three different airplanes for a TCOYD conference, I spent twelve hours watching my Dexcom graph hold steady once I was in the air, but my numbers spiked due to anxiety before every take-off.  It amazes me every time – even without any insulin on board or any food in my system, anxiety, its accompanying cortisol boost, have a dramatic (and sucky) effect on my blood sugars.  My blood sugars, for as long as I can remember, have been influenced directly by my emotions.  Super emotional moments – even the excessively happy ones – prompt blood sugar spikes.  So, for me, my airplane anxiety equals out to spikey blood sugars.

It’s interesting, in that “wish-it-wasn’t-my-body” sort of way, watching my CGM graph “take off” with the plane.

Airplane Mode.

When it comes to traveling by airplane, I follow all of the rules (if you don’t turn off your cell phone when it’s time to take off, I’m the one shooting you panicked looks, which is how my face remains for the duration of the flight).  Until we’re up in the air, I leave my Dexcom receiver fully shut down and when I was using the Ping meter, I kept the RF (radio frequency, aka the automagic shuttling of blood sugars from my meter to my pump) shut off.

imagine my delight when I finally figured out that pressing the button on the side of my Verio Sync twice in rapid succession would put my meter into airplane mode!  (IMAGINE IT!!!)

(But did I test in my seat on the airplane?  I’ll never tell.  ;) )

This is how we do it.

Wednesday morning, leaving Logan Airport in Boston, en route to Montreal:

TSA agent:  “Excuse me.  What is that?”

Me:  “An insulin pump.”

Their mouth:  “Okay.”

Wipe it down, test my hands, pass the screening, no issues, carry on with my carry-on.

My mouth:  “Thanks!”

Their mouth:  “Safe travels!”

Thursday morning, leaving Montreal and headed back to Boston:

Security agent:  “Bonjour.  What is that?”

Me:  “An insulin pump.”

Their mouth:  “Okay.”

Wipe it down, test my hands, pass the screening, no issues, carry on with my carry-on.

My mouth:  “Thank you!”

Their mouth:  “Bon voyage!”

Flying with diabetes: This is how we do it.

 

Missed Manners.

So this popped up as a Q&A in a recent Miss Manners column:

“DEAR MISS MANNERS: I am a businessman who frequently flies both domestically and internationally. I also happen to be an insulin-dependent diabetic.  I currently do my glucose testing in my seat. It does involve using a lancet device to get a drop of blood to test, but is fairly unobtrusive. Of course, all lancets, alcohol preps and test strips are stored in my test kit for proper disposal later.
Am I being rude to perform this test next to a stranger? Injections I perform privately in the plane’s lavatory. In the airport, I use the counter by the wash basin, since most water closets have no room for insulin vials and other supplies.
Many people seem to stare and resent the fact of performing such a function in this space. I have also had children ask, “What is that man doing? Isn’t that a bad thing?” (They’re obviously thinking of their drug education classes.) Am I too self-conscious?

GENTLE READER: Absent an emergency, medical applications (like bodily functions and grooming) are properly done out of sight — meaning in private or in a restroom — unless they can be done so surreptitiously as to be unrecognizable as such. Miss Manners does not object to a pill taken at dinner, so long as it is not accompanied by a dissertation on your cholesterol.
The technology associated with diabetes is fast approaching this standard, although Miss Manners draws the line at drawing blood. Restrooms exist to provide a proper location for such necessary activities when away from home, and those who use them have no business monitoring the respectable, if sometimes unaesthetic, activities of others.
You may chose to tell children that it is a medical procedure, or ignore them and let their parents do that. Miss Manners would hope that any parents present would also resolve to teach their children to be more discreet with their curiosity.”

Hmmm.  My response:

DEAR MISS(ED) MANNERS:

I am a person with type 1 diabetes, and I’ve been testing my blood sugar regularly for the last 10,000+ days.

Testing my blood sugar is not a bodily function; It’s a practice required for proper diabetes management. It’s not grooming; it’s a medical necessity.  I travel a considerable amount and when I am in transit, I do what is required to take care of my diabetes from the comfort and safety of my seat. I take great care to be discreet in testing my blood sugars, and I properly contain and dispose of my supplies throughout my travels.

I wish I had the option to afford myself the rule of “drawing the line at drawing blood.”  Hell, if I could test my blood sugar without pricking my finger, it would be a great day, indeed.  Restrooms exist to provide a place for travelers to urinate or defecate, and I would prefer not to perform my subtle medical procedure where people are known to perform those actions.  You have no business monitoring the respectable, responsible activities of people with diabetes who are trying to stay alive.

The technology associated with diabetes is fast-evolving and has grown by leaps and bounds since my diagnosis 27 years ago.  But if I took your cue and relegated myself to bathrooms to tend to my diabetes needs, I’d be in the bathroom(s) all the time.  (And everyone on the plane would hate me for taking up the bathroom every hour or so.)  Instead, I discreetly test and medicate as needed, so as to avoid a more serious diabetes issue, such as a severe hypoglycemic reaction wherein I could seize and potentially bite my tongue (causing blood to spill) or accidentally relieve myself (causing urine to spill).  Which is more offensive to you – the controlled, unobtrusive checking of my blood sugar or the unpredictable, emergency effects that may transpire as a result of not checking?

You may choose to tell your readers that it is in bad taste to perform this medical procedure in a public place, but I disagree.  I would hope that you would resolve to teach children and adults alike that taking care of your health is something to be proud of, not ashamed of.  Offer whatever advice you’d like, but at the end of the day and during the course of every day, I will do what I need to do to live with this disease.

 

Long Term Lows.

Last night, just before bed, I did what I do every night before turning off the bedside lamp:  checked the IOB (insulin on board) on my pump and looked at the Dexcom graph.  IOB was okay (0.21u from a small snack bolus two and a half hours earlier), but the Dexcom was showing 146 mg/dL and heading in a southwesterly sort of way.

It was midnight-thirty, and I had to wake up at 5 am to catch a flight to California, so I knew I wasn’t going to be asleep long anyway.  Since my blood sugar was in the 140′s and not the 40′s, I decided to run a -90% basal rate for an hour and hoped that would stave off the low.

(This shit never happens on a night when I am able to sleep in and I don’t have any responsibilities the next day.  It ALWAYS happens when I’m scheduled to catch an early flight and have a full agenda for several days straight.)

Fifteen minutes later (close to 1 am), I saw double-down arrows and my meter confirmed me at 70 mg/dL.  A jar of glucose tabs on the bedside table showed I had four left in there, so I chomped them all down in an abundance of caution, pretty sure I’d end up in the 150′s when I woke up at 5 am.

Twenty minutes later (close to 1.30 am), I was 52 mg/dL.  And I stayed in the 50 mg/dL range for three hours.  THREE stupid hours.  For three hours, the Dexcom wailed, I checked my blood sugar, and steadily consumed carbs made out of dreams and air, apparently, because they didn’t touch the low.  This low wasn’t symptom-free, either; it was one that made my shirt damp between the shoulder blades, and had me flipping the pillow over repeatedly in search of something cold.  And once it was starting to taper off and the Dexcom arrows were pointing back up, the adrenaline from waiting out the low for hours had my muscles tense, like a cat who had been stalking the same dangling ribbons for hours.

Only instead of rolling over and taking a cat nap, I was wide, wide, wide awake.

“Are you awake?” I asked Chris at 4 am, who had been awake for part of the night, when the low dipped into a tough range.

“No.  Unless you need juice, and then yes.”

Just past 4 am, I fell asleep, and the alarm set to get me to the airport on time went off an hour later.  Pity party time?  No, but it will explain why most of this post is rambly and might smell like glucose tab dust.  So far, today has been a hazy, confusing shuffle of airplanes, connecting flights, and awkward naps on the shoulders of strangers (but we know each other better now, don’t we, Tom?).  And the low hangover is impressive, making me actually want to put on sunglasses and have a glass of that Naked Mighty Mango drink (which seems to cure every hangover I’ve ever had – shit is magical).

But I’m glad that today’s destination is somewhere warm (Los Angeles) and I’ll be seeing some of my favorite people from the diabetes community at the Medtronic diabetes forum taking place this weekend.  (Hashtag to follow is #MedtronicDAF, and by way of disclosure, Medtronic is covering my travel, lodging, and expenses, although my opinions and poorly-timed jokes remain, as always, mine.)  Other people posted that they were attending and asked for discussion points from the DOC, so I’m doing the same. If there’s anything you’d like me to be sure to bring up to the Medtronic team, please let me know.

… only I’ll be wearing my Animas Ping and my Dexcom G4 and a host of dark circles under my eyes and hopefully clutching a Mighty Mango drink.  We’ll see how that goes.

 

 

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