We were living in Jakarta, thousands of miles from our home country, when we took our daughter to the doctor with flu-like symptoms. We did not expect the diagnosis. A urine test revealed “sweetness in the urine”, or diabetes mellitus (known simply as diabetes).
Our daughter, then only seven, was rushed to intensive care with ketoacidosis (acid in the blood), and was hooked up to all kinds of machines. We were told, “She does not produce insulin anymore. She has an autoimmune disease and her own body that has triggered a beta cell crash. With Type 1 diabetes, she will be insulin-dependent all her life. This means having two to three injections plus seven blood tests a day.” Within just three hours, our daughter was medevaced on business class to Singapore, accompanied by her treating doctor and me.
As parents, my husband and I had to learn fast. Our daughter would only be released from hospital when we could both show the diabetic team that we were able to inject her, understand food-insulin ratios and how to interpret food labels to calculate the insulin dosage needed, as well as how to handle sick days.
In just three weeks, we were due to take off on a Bugis Schooner around Eastern Indonesia. We had to decide quickly whether we could still go, knowing we would be taking our daughter to remote islands without access to medical care.
I phoned the charter company and spoke to the manager. He assured me the schooner had a satellite phone and could summon a helicopter in an emergency. As long as we were confident and had everything we needed, they were happy to accept a child with a chronic illness. A fantastic response.
This was not the case when we tried to enrol our daughter on a school holiday camp in Malaysia. When she was rejected because the organization did not have “an on-site nurse,” she was crushed. Luckily, that was the only time she was excluded from anything.
I learned quickly that planning is essential when travelling with a diabetic child, so here are a few tips based on my personal list of “must-do” items.
Medical Advice and Supplies
Discuss travel plans and possible challenges with your doctor or diabetes team. These might include travelling in a hot climate, travelling through time zones and adjusting insulin on flying days.
Obtain an extra insulin prescription with the correct medical name of the insulin needed and the dosage, plus contact information for your child’s doctor in emergencies.
If you are crossing international borders, obtain a letter from your doctor explaining the need for syringes, lancing devices and pumps.
If your child is using an insulin pump, ensure you understand basal rates, carbohydrate ratio and adjustment factors. Ask your diabetes team if it is possible to get a “loan pump” as a spare. Also carry emergency contact numbers for the pump supplier in case you need to access technical advice.
Get advice from your doctor about what to do with your child’s pump if he/she is swimming or in the sun for long periods. Take written instructions on what to do on sick days or in emergencies such as pump failure, as you may feel overwhelmed at the time. Refresh your memory on emergency requirements such as how to use a glucagon hypo-kit.
Pack a separate travel bag with supplies: extra insulin and needles to cover the journey, two glucose meters (and extra batteries), capped lancets, a glucagon emergency kit, ketone testing supplies, plenty of carbohydrate snacks and glucose (instant sugar).
Remember to always bring spare insulin (and spare pen devices), at least two to three times the normal amount your child would normally require during the same time frame.
Changing your child’s routine may interfere with diabetes control, so check blood sugar levels more frequently. You will use twice as many glucose testing strips.
Always split the supplies into two bags and, if possible, give one set to a travel companion in the event you become separated from your luggage.
Extra excitement, for example a hotter climate, can increase your child’s risk of a hypo. Always carry glucose so you can treat any hypo symptoms on the spot.
Flying and Overseas Travel
When crossing borders or taking planes and some other forms of transport, you need to show your doctor’s letter, so keep it handy.
Also, keep all diabetes medicines and other supplies in original pharmacy packages with any prescription labels.
All insulin must be carried on board planes and not packed in your main luggage.
Order diabetic meals at the time of booking flights. If not available, bring your own meal on the plane. Be aware of restrictions if you carry liquids on board.
If you are flying outside of your home country, contact the foreign embassies of countries you are visiting to ask about any other requirements for bringing in diabetes supplies.
Going through scanners and X-ray equipment will not affect diabetes devices or medicine. If your child has an insulin pump, you should show the pump to the screener before your child walks through the X-ray. Again, have your doctor’s letter handy at all times.
Write down the words for such phrases as “my child has diabetes” or “please can I have some sugar or orange juice,” in languages of the countries you’ll be visiting. Photocopy all important documentation and give a copy to your travel companion to keep separately.
Meals and Food Supplies
Check in advance about any meal arrangements. When we travelled by boat we made contact in advance with the cook to ensure meal times would be adhered to, including making sure our daughter’s meals came out first.
Also check in advance about food availability, in particular the basic forms of carbohydrates eaten in the countries that you are visiting.
Carry enough snacks for in-between meals, diabetic lows and unanticipated delays.
Remember that heat and excitement can cause low blood glucose levels. Carry plenty of handy, individual carbohydrate packet snacks, glucose and water.
Teach your child to always carry a little backpack and be responsible for these items.
Amusement Parks and Attractions
If you are visiting places such as amusement parks, call them in advance. Find out what their policies are for visitors with diabetes. Some have rules about not bringing in backpacks or your own food and drink.
Many amusement parks cater for diabetics with a “special assistance pass.” This allows you to bypass long lines, which is important if following a strict meal schedule.
Water Intake and Foot Care
Ensure sufficient fluid intake. Dehydration may cause insulin to be absorbed more slowly, leading to high blood sugars.
If possible, have your child wear covered shoes to avoid accidental injury, for example via broken glass or shells in sand. Diabetics are at increased risk of infection, especially if blood sugar levels are high. It is advisable to visit a doctor if there are signs of infection present.
Being parents of a child with diabetes brought new responsibilities into our lives, but it never stopped us from travelling the world. Our journeys with our young daughter also included a ten-day road safari through Sumatra, a journey into Tana Toraja, South Sulawesi and crossing Java by road and train. With careful planning and taking extra care, we learned you can travel anywhere with your diabetic child. So, go forward with confidence, talk to your doctor before you go and the rest becomes second nature in the end.
Photos by David Metcalf. For more information please visit www.davidmetcalfphotography.com.