Hello all! I am traveling out of the country for the first time since being diagnosed with type 1 diabetes 3 months ago. I am going to Jordan for 1 week - leaving in approximately 3 weeks. I want to bring extra insulin pens with me but know that it needs to stay refrigerated or cool until opened. Does anyone know of any type of cool pack that I could purchase? Also, any other tips and advice for traveling to a third world country with diabetes would be very much appreciated.. I'm very nervous!
I wouldn't get too worked up for such a short trip. Insulin stays fresh for at least 1 month at room temperature from what I recall. Just don't leave the insulin in the car in the blazing sun every day while you're out hiking for instance. If it is only one week I usually don't bother with any special treatment for the insulin, I just keep the backup doses in the luggage and the one I currently use in my backpack. If I stay in a place with a fridge I place the backup doses in there if possible and usually only if I stay a longer period of time, otherwise I am afraid I might leave those behind when I move to the next location :) If you are worried about leaving the luggage in the car in the blazing sun for extended periods of time while sightseeing you could possibly consider getting a cold pack but I'll let others chime in since I never used any of those.
One thing to remember is to lower the doses of insulin if you're becoming more active than while @home, otherwise you'll get more frequent hypos :) A CGMS can help monitor your BS but you have to remember to lower the doses yourself...
I second the Frio vote; I love mine, because all you have to do is "recharge" it with water. I also second the comment that a one week trip shouldn't be too much trouble. If it is somewhere you will be returning to, you might want to check their pharmacies while you're there; many third world countries sell modern insulin over the counter (one pen, rather than a box). I lived in Guatemala for 2 years and that's how I got my insulin (cost of about $13-15 for a pen).
I went to Ecuador for 10 days last January and I didn't do anything special for my insulin, I have vials to fill my pump, and I just packed them in my carry-on and left them in my bag, wrapped in cloth the entire week. Insulin can last for awhile outside refrigeration, but I did hear that if you have it outside of refrigeration for a bit, you shouldn't put it back into the cold afterwards.
Just be sure to bring your "back up bag" extra pen(s), strips, monitor, battery etc. In case something happens to the one you are currently using. Also if you are traveling with companions you may want to stash an extra in one of their pieces of luggage. I do not worry about refrigeration for my pens when on a 1 week trip.
I agree with the use of a Frio Pack. One thing to know with the Frio pack is that it works by evaporation. So do not put it in a airtight pouch of your suitcase or backpack.
I disagree with the idea of using a refrigerator at a hotel. One reason is that such refrigerators are notoriously unreliable and could end up freezing your insulin. And as one of the posters mentioned, you could accidentally forget it.
For a one-week trip, a Frio pack will give all the cooling you need. It’s not as cold as a refrigerators, but it’s cool enough. One other reason I like the Frio is that when it’s “charged” by soaking it in cold water, it gets puffy and provides some protection against breakage of your vials and/or pens.
Remember to take tons of extra supplies. You never know when a missed flight or some political or natural disaster might strand you somewhere. Don’t worry about that possibility because it could be a great adventure. But do be prepared for the worst.
Make sure that you get a letter from your doctor for flying with supplies. When I travel, I have vials of insulin, my pump (attached to me), extra syringes and other supplies (strips, lancets, batteries). I always set off the alarm at the airport and get checked, and occasionally swabbed. I keep the letter from my Endo in my passport holder, so it is easily accessible. When I crossed borders in Europe, it was helpful to have that on hand to explain things in my bag, and makes security and customs much easier.
Also be aware that the time change from flying to Jordan may cause some issues at first, but they usually resolve themselves quickly. Your body will be tired from traveling and eating at weird times, so don't freak about a few weird blood sugars that first day. I carry glucose tablets and granola bars with me as well. It may be hard to find something easily to eat in a hypo situation, especially in a foreign country, so make sure you keep some on hand.
Other than that, have a lot of fun! I have friends who went to Jordan a few months ago, and they loved it. :)
Could you tell me a little more about living in Guatemala? I was considering teaching at a school in Haiti for a year, but the director of the program I was applying with was concerned about a T1 living in a third world country for a year. I'd like to keep that option open for my future though. :)
Guatemala, actually, is where I was living when I figured out that I had been misdiagnosed and was, in fact, Type 1. It really didn't offer any insurmountable obstacles to me. As I said I could buy insulin otc. I did find an endo in Guatemala City who confirmed my Type 1 diagnosis, but only saw her the once. There is both a small population of ex-pats and a small population of wealthy Guatemalans, so in the city there was good medical care. Everything there was divided into public and private hospitals and the private were up to standards. I don't know that the same would be true in Haiti. But I did have to travel out of the country every 6 months for my visa so could get my needs met in the U.S. on a trip if necessary. Insulin, test strips, etc all available though I did have to switch meter brands.
Downsides: My insurance didn't cover "out of system pharmacies" at the same rate so though meds were much cheaper, my reimbursements were much lower. I never saw any glucose tablets (though I didn't hunt in the city which was an hour away). The pharmacies were always running out of things so I needed to plan enough ahead of time to account for waiting a couple days for a shipment. You didn't have as many choices. For example, Apidra was the only rapid insulin and Lantus the only long acting.
Living in another country, especially a third world country comes with it's own brand of bueracracy which is often more flexible than in the U.S., but less logical, if that makes sense. It can be frustrating, but for the experience, it's worth it. I think everyone should live in another country for awhile. It's an amazing experience!
If you are considering it and this is feasable I would consider a visit first. Then you can check out the pharmacies, doctors, hospitals, etc. Also check in the Thorntree website (a part of Lonely Planet). You can connect to other Americans and Europeans who may be living there and get the "inside scoop". Finally, check with your insurance re reimbursements, etc. One somewhat sneaky option is to get a year's prescriptions before you leave the U.S. Then see if there is a mail/courier service that sends to an address in the U.S. and then courier's it down. I did that for awhile. The courier service isn't cheap but allows you to get mail away scripts covered by your insurance.
Hi Dianne: I have traveled all over the world with Type 1 diabetes, including third world countries. I never use a cold pack, I just take extra supplies (insulin does not actually have to be refrigerated). I have never had a problem. I agree with Jamie Dee, having a note from your doctor is a good idea. Have a great time and let us know how it goes!
There is no problem with putting it back in the fridge after its been out for a while (even days or weeks), in fact the longer you keep it cool the more effective it will stay (heat and time both increase degradation of insulin independent of each other).
I was told by a CDE when I was diagnosed that changing the temps too much can cause a quicker breakdown of the compounds. She said you should try to maintain a regular temperature for vials.
