Monthly Archives: July 2013

Great Article to Support/Encourage Youth to go Abroad

http://markmanson.net/work-overseas

 

I love when I see articles that encourage dreams I have (one of which is working/living overseas!). Here’s an awesome article outlining a few very good reasons why it is actually very smart to try somewhere new! And, if a company is so willing to set you up in luxury if you’ll go somewhere abroad, pretty sure they’ll offer you some awesome medical support as well! Have your (proverbial) cake, eat it too, and pay very little for the insulin to cover it!

Summer Sugar Stresses

As a young adult who just graduated college, I am finding myself in a similar situation that many graduates find themselves: unsure of what I want to do with my life, but needing some cash to go do something for the time being- in my case, traveling to work for 9 months in rural Kenya. As the financial expenditure is my responsibility for this new adventure, this summer I am waitressing at 2 restaurants, and serving as a nanny for a family. Working 3 jobs has its benefits, as I am keeping busy and earning lots of money. But, a negative of working doubles and triples is that it has been hard controlling my blood sugars. Often during a waitressing shift, I am so busy I don’t have time to check my blood sugars. Nannying is easier, as I am able to slip away for a few seconds to do a quick prick of my finger. In the moments I have had a chance (and thought to) test, I have noticed that my blood sugars are running higher than I want them to be. As I am leaving for Kenya in less than 2 months, it is becoming increasingly important to get my sugars under control, and be as stable as possible upon my departure. So here’s my plan for the rest of my summer:

1.) Always take a blood sugar going to bed at night- 8 hours of good blood sugars a day can drastically help an A1C.

2.) Always start my morning with a blood sugar, to know how I’m starting my day.

3.) Although I might not be able to test during a shift, I can always test after the shift, before going to another job.

4.) Be more regimented about changing my pump site, every 4 days (my pump sites usually last between 4-7 days).

Things that have helped control my blood sugars that I will continue to do:

1.) Carry an extra pump site, so that if something goes wrong, I have access to a pump site change even if I don’t have time to go home.

2.) Carry insulin, and don’t leave it in the car to get hot.

3.) Carry a few extra needles, in case of pump malfunction.

4.) Hydrate with water during and between shifts.

5.) Consume balanced meals, with a focus on vegetables and proteins (I find that Greek yogurt in the morning with some fresh fruit to be an awesome way to not be hungry and to keep steady morning blood sugars).

内分泌学者, ענדאָוקראַנאַלאַדזשאַסט, endocrinolegydd… finding a doc in your future spot!

My ‘rents were nervous about me having access to western medicine while in Kenya, especially insulin. And while I knew that it wouldn’t be a problem, being able to show them that there were western trained endocrinologists in Nairobi backed up my assertion.

My endocrinologist in Baltimore recommended me to the Endocrinologist finder on the American Association of Clinical Endocrinologists, found here:

https://www.aace.com/resources/find-an-endocrinologist

Another option I found was through the Hormone Health Network:

http://www.hormone.org/contact-a-health-professional/find-an-endocrinologist

While planning trips abroad, it can be helpful to look up the location of endocrinologists in the countries you are traveling, to know which cities you can head to if a problem comes up!

Keeping Your (Insulin) Cool

The beauty of having T1 and living in 2013 is the possibility of finding information via the internet- beyond checking the spelling of certain words that my autocorrect does not understand, I have found a ton of good tips and advice on general travel,  backpacking, Type 1, backpacking with Type 1, traveling with Type 1, etc. And I want to share a few gems I have found!

 

Kenya is HOT. It is on the equator. But insulin needs to stay cool… problem? NOPE! Thanks to a blog called The Active Diabetic, I found out about a company called FRIO, that specializes in designing cases to cool insulin…. And the best part? You don’t need to freeze them ahead of time. Check out the website to learn a bit more, but the gist is that these green-reusable packs (I LOVE when something both works AND is environmentally conscious) are able to keep insulin cool for a minimum of 3 days when activated for 5-15 minutes in cold water. And you can reuse them again, and again, and again. FRIO offers a lot of different sizes, from single to multiple packs for insulin vials or pens, and different colors (perfect for those who like to color code or have multiple diabetics in the fam who tend to disagree about what supplies is whose…). I will most likely order several red cases, in different sizes for Kenya- red being easily seen and based on the western system, the color of medical signs.

FRIO also offers medical packs for a variety of other situations, from Earthquake/Emergency Kits, to First Aid, to Assistive Living Products, to Sport products- definitely check them out if you are in need of any supplies!

 

FRIO: http://www.readycareco.com/splashpage_frio.htm

 

And check out the reviews, they are at the bottom of the page listed above, on the right hand side, on a dark navy panel (called Here’s what others say about FRIO).

 

Also, check out the blog The Active Diabetic for ideas on backpacking and hiking with T1! She’s great!

 

http://theactivediabetic.wordpress.com/2012/04/24/backpacking-with-type-1-diabetes/

 

 

Doctoring Life… Finding the Right Endo Fit

In knowing and talking to many friends and acquaintances with T1 (thanks to T1 camp and a small hometown), and to several endocrinologists, I have found that one’s experience with insulin and meds can be drastically dependent upon one’s endocrinologist- translation, if you like and get along with your endo, you’ll generally seek and take their advice when having struggles with blood sugars, injection sites, strategy to lower A1C, etc. I was lucky to get along with the only endocrinologist within a 6-hour radius who treated my brother (who also has T1) and I through our youth.

Transitioning to a bigger city on the east coast for college, I needed a new doctor, who I initially (and naively) assumed would simply serve as a ‘script provider (i.e. would write a prescription every year to get me insulin). As school was busy, I often didn’t maintain 3-month checkups, and if I ever got into a jam with the prescriptions running out or expiring, I would make a fast appointment with a physicians assistant, who generally could see me within a week (versus a month or two wait to see the MD). And while this worked, it probably wasn’t the best strategy – through other medical issues, I have found that building a relationship with your endocrinologist is important. But, sometimes this can be difficult. I saw two endocrinologists while in Baltimore: one I got along with very well, for he viewed treatment for diabetes in a similar manner as I did: that you treat in a way that is livable, although often not perfect. The other doctor was much more stringent and rigid in how I should be controlling my disease, the frequency with which I should be testing, and how I should be treating highs and lows. I was in decent control (my A1C at that time was around a 7.2) had a hard time imagining drastically changing my daily life to fit her proposed treatment schedule just to lower that number by .3- we fundamentally did not get along, which became obvious and awkward during my visit. Through this experience, I found that sometimes the better medical advice comes from the less intuitive resource, so I went back to the lesser known hospital that housed the endocrinologist who not only understood the way I treated my diabetes, but also who gave me advice and tips that enabled me to live better with my disease (my next A1C with him was a 6.7)! And based on his view of enabling his patients to live as fully as possible while also controlling their T1, he not only supported my decision to pursue 9 months in Kenya, but he encouraged me to go forward with confidence! This support became very important when I discussed my plans with my family, as their first question was about if it was possible for me to move for 9 months to a non-western, low-income country—and I was able to answer truthfully that it was, and that my doctor supported the decision! So my advice for you is to find an endocrinologist who you click with, and who you will approach when you need advice and guidance, both for the science behind the medicine, and for how to implement the science while living the life you want to live!!

 

Tip: If moving, ask around about new possible doctors. Start with your current doc, maybe they will be willing to advise you from afar, but also have a colleague in your new city who can help you out! If you are starting college, try asking the school’s medical office. Reach out to your local ADA office! Google docs and see if there are any reviews. If you become part of a T1 group, or know/meet any other T1s in your new town or city, ask for their opinion! The more information you have, the better you can choose. And, if you have a meeting with a doctor, and absolutely cannot get along with them/don’t respect their opinion, then try another! You shouldn’t pay for advice you know you won’t follow. So find an MD who’s advice you can take, and who will give you tips that you will be able to implement in your daily life to live as fully and be as healthy as possible!

Calcualted travel!

I recently went backpacking for a few weeks in Europe, which was my first experience abroad without my family! It was a great adventure, seeing new cities, trying new food, drinking delicious wine and beer!

One of the bigger challenges was trying to figure out how much supplies I should bring, as space and weight are big factors when backpacking. In order to not have any problems, I decided to pack 1.5x the amount of supplies I would need if I were using it as prescribed. I am a “pumper” (I used the Minimed Paradigm) – for those of you who have the smaller cartridge (I believe it is 180 units), it is easier to change the cartridge less often, so if you have an update coming soon, think about getting the bigger 300 unit size! For pump sites, 24 days = 8 pump sites (24 days/ 3 days per site). So, I took 12 pump site insertion packages (remember, I took 1.5 times the amount I would need if following my prescription). I go through around 70 unites of insulin a day, so normally, each pump reservoir lasts around 4-5 days (300 unites / 70 unites per day). However, as the amount of exercise and the types of food I would eat were going to be different, I calculated the amount of reservoirs if I was using 100 unites a day, meaning that each reservoir would last me 3 days. 24 days of travel = 8 reservoirs, for a total of 12 reservoirs. I also brought 3 bags of needles (10 needles/bag, total of 30 needles) in case any pump malfunctions occurred. For insulin, I brought 1 bottle of Lantus (for backup if my pump failed or was stolen etc.), and 4 bottles of Novolog; I calculated that I would need around 2.5 bottles (so 3 bottles) if I was using 100 unites a day (1000 units / 100 units a day), and an extra in case I dropped a bottle. I also brought some alcohol swabs (backpacking and travel in general is usually dirty), an emergency glucagon kit, and glucose gel. The amount of supplies made me feel very comfortable as I went off, BUT IT WAS MORE THAN ENOUGH! I went through 5 pump sites, 4 reservoirs, 2 bottles of Novolog, and 10 needles – this is because I packed for the “recommended” dosing – not the dosing I generally use at home.This is because I have found that my pump sites generally are functional for 5-6 days (sometimes longer, but I don’t like to risk going beyond 6 days). I typically also refill my reservoirs 1-2 times before throwing them out (meaning that a reservoir can be used up to 3 times before I change to an unopened one).  For the next trip, I will most likely pack a little more conservatively, and factor in the duration for actual use versus prescribed use, while also considering external factors such as heat and food, which will effect the amount of insulin and the length of time I can use a site!

Tip: When packing, always pack a few extra!! Yes, space is limited, but you never know when you’re going to rip out a site, drop an open needle on the ground, or even shatter a bottle of insulin! However, be realistic about how much supplies you will most likely use- do you use your pump sites for 4-5 days? Maybe you are okay refilling a reservoir 3 or 4 times. Being realistic will not only help the space issue, but you won’t be subjecting extra supplies that could be safely stored at home to the dirt/crushing that happens in a pack or suitcase!