James, who has type 1 diabetes, shares his experience of travelling with the condition and planning ahead.
"If manually performing the job of a pancreas is not already enough, the concept of doing it while backpacking around the world was daunting to say the least. But with a bit of forward planning, it was perfectly manageable, and was, as I had hoped, the best five months of my life.
I was diagnosed with type 1 diabetes in 2003, at the age of 17, and have managed it fairly well since then. But as all sufferers and their families and friends know, it is hard work and adds a considerable and complex burden to one’s already busy life.
So when I first described my travel plans to my specialist nurse, she was palpably shocked; perhaps that I wanted to do the trip in the first place, let alone with my condition added into the equation.
The plan I detailed involved starting in Delhi, India, in March 2010 and flying back from Rio de Janeiro, Brazil, the following August, via Singapore, Thailand, Laos, Vietnam, Cambodia, Australia, Argentina and Uruguay.
My top travel tips
The main things to consider and plan for are: storing and transporting your insulin and other supplies; the availability, practicability and cost of obtaining more insulin and supplies; and staying healthy.
My top tips would be the following: Firstly follow all the usual travel advice given to diabetics. Secondly, invest in one or more 'Frio' bags. Thirdly, plan in advance where you will collect supplies and ensure that you understand the process you will face. If you are heading out on a more open-ended trip, do the same research into anywhere you might go to ensure you know where you can get your insulin.
The most important message is not to be too daunted, and above all do not let a medical condition like this stop you doing something you really want to do. The key is in the research and planning, and of course being sensible and responsible whilst on the road."
Travel tips my diabetes nurse gave me
My specialist nurse was able to offer me all the usual travel guidance for diabetics. This includes matters such as insurance; managing sugar levels when ill; carrying a doctor’s letter; carrying more of everything than you need; and keeping your insulin with you when travelling and in a safe place when at your destination.
She advised me to purchase 'Frio' bags which cleverly keep insulin cool and only require immersion in water every few days to ″recharge″ them (particularly useful in temperatures of 40°C and above, and equally they can stop insulin from freezing in very cold conditions).
She suggested I get an identification necklace or bracelet to wear at all times, which I did. She helped me consider how to manage my sugar levels when crossing time zones; generally I took more insulin when gaining hours, and less when losing them, but it does take some planning and careful management.
She also trained me in the art of drawing insulin into a syringe from a bottle, just in case I ended up in a place where medical supplies were more primitive.
But as it is not that common for diabetics to attempt a trip of this nature, I had to look to other sources for additional backpacker-specific advice. My specialist nurse advised me first to contact my insulin manufacturer, Novo Nordisk, who were very helpful and quick to respond.
I laid out a list of the countries I was visiting, and they responded with a detailed description of the insulin availability in each country. It was interesting to know, for example, that in Singapore and Argentina I could only get a pre-filled pen version, and in Cambodia and Laos I could not get anything at all!
It occurred to me that Australia would be the approximate halfway point of my trip so I contacted Diabetes New South Wales (DNSW), who were extremely helpful. I learned that thanks to the reciprocal healthcare arrangement between our governments I could get my insulin for the price an Australian citizen would pay (hugely subsidised, but not free as in the UK). Therefore I would stock-up there, and I packed enough insulin to last me until Sydney.
I had decided to take enough test strips and needles with me to last the whole trip as these do not have special storage requirements and the system to obtain them in Australia was slightly more complex. It involved getting a Medicare card and registering with the National Diabetes Services Scheme (NDSS).
I was moving quickly up the coast and had little time to spare; DNSW did kindly offer to help me speed up the process from several weeks to a day or two, but it would still have involved a lot of form signing and office visits. In any event, my test meter and strips were not available in Australia, so always check the local availability of any items you want to pick up on the way round.
Once in Sydney I visited a public hospital to get a prescription, as I had been advised that no registration would be required in a hospital as opposed to a GP’s surgery; you do of course need your passport. I took five boxes of five cartridges to last me comfortably for the rest of the trip, and it cost me $33 (approx £20).
There were other things to plan and consider too. I had to clarify with various airlines that I would be permitted to carry my insulin in the cabin (Qantas purported to forbid this however I had no trouble on the trip).
Furthermore, I had to do everything possible to ensure good health while away; I went well vaccinated and carrying a versatile travellers’ antibiotic and other useful medication.
I actually managed my sugar levels well all considered, though better in Asia than Australia due to the diet. I suffered no significant hypos and I returned from the trip in very good shape."
