New Country, New Doctor (part 1)

I've totally neglected this blog.  And at this point I'm sure no one is reading it.  I'm not sure if I should just delete it or... try to keep it up better.  I think the stories I tell (about Diabetes) are important and valuable for some to read and I really love it when someone has a question about something specific and I realize that I've written a nice long post on the topic.  The only problem I have with consistently blogging about diabetes is that I HAVE ANOTHER LIFE.  I mean, Diabetes is my life, but it's NOT my life and I don't want to spend ALL of my time talking about it, or writing about it.  So.  Yeah.  That's why I don't blog here much.


HOWEVER, there have been a few things recently that I should really put out there.

So most of you know that I recently moved to the other side of the world and now live in Asia; one degree above the equator, in the tropics, on a tiny little island, city, country called Singapore (no, not Japan or China or the Philippines).  Anyway, there are a lot of things about diabetes which were affected by my diabetes, or maybe it's the other way around.

First of all, I had to find a new doctor.  I asked some really great resources for help on referring me to a doctor here in Singapore.  Several people suggested this one doctor in particular so I figured he would be a good one.

I basically waited until the last minute to book an appointment.  I'm not sure why I was dragging my feet.  Maybe because I had plenty of other things to adjust to what with living in a new country or whatever, maybe it's because I REALLY like my old doctor and didn't want to face the fact that I am going to be seeing someone new for the next two or three years.  Dr. Day, if you retire before I get back, so help me!

Getting ready to go see my doctor.  I was so nervous! 

He was.  or... is, or whatever.

The first appointment I had with him went REALLY well.  I was very pleased with the experience and found him to be VERY thorough in getting to know me, my diabetes, and my health history.  He took my HbA1c and looked at my blood glucose data. He decided that he'd like more data and asked me to do a week on a blind CGM so that he could use the information to adjust my basal and bolus rates.  He also ordered a FULL panel of blood work.

I wasn't really pleased with my a1c but given the disruptions to my life the previous three months, I decided to give myself a break about it and aim for better next time.

Stay tuned for part two.

Making Friends

Met a new friend.  Decided to go on a hike with this friend.  The hike was intended to be a long one.  About 3 or 4 hours.  So, naturally, being diabetic, I had to think about ways to prepare for low blood sugars along the way.  My sugars were doing really well, staying within the normal ranges so I decided to lower my basals by 50% like I would during any exercise and carry three packages of mentos with me.  That's more than enough to cover any lows I may have had on the trail, as well as share some with the boys, and their new buddy.

It's really awkward, you know, meeting someone new and having to jump right in with, "so, I'm diabetic and..." But... I feel like, when doing this kind of activity, it's probably better to bring it up right away rather than, you know, try to explain while having a low or something.  

New friend has a kid.  This kid is basically a big fat brat.  He's asking for my stash of candy pretty much right away.  I tell friend that it is hard to have candy in front of kids when, you know, they're gonna want you to share, but that I always explain to my classes (substitute teacher) that they'd much rather NOT have the disease than share my candy, or juice, or orange or whatever it may be that I'm treating with.  And, I don't go out of my way to openly eat it in FRONT of the kids, but sometimes you have to, especially in my profession.  

So she says to me, "yeah, and I guess if they eat too much candy they can get diabetes too" UGH!  Really?  So I politely say, "no, not really, actually you're more prone to get it by genetic predisposition than by eating too much sugar"  "Oh, I guess I don't know that much about diabetes anyway".  

Right, I hadn't noticed.

Had tea with another friend and when I explained to her that I wear an insulin pump because I have diabetes her reaction was, "Oh, you have it THAT BAD?"  "yeah", I said.  

I mean, I don't expect everyone to know everything about diabetes, not by a long shot.  But since moving, I've noticed this kind of becoming an issue for me.  

I'm usually one to meet friends pretty easily.  I'm outgoing, friendly, talkative, and usually that ends in me rapidly making good friends with a lot of people. I'm usually really open about diabetes.  Don't mind telling poeple about it, don't mind people asking about it.  Until recently.  

I've had kind of a hard time adjusting to my new life here, in Asia, thousands and thousands of miles away from home.  For some reason, well, I know what the main ones are, but anyway, it's just been... difficult.  Add to that the fact that making new friends means they don't already know about diabetes like my friends back home already know about it... it's just added to the stress of it all.  

I mean, how do you just go up to a person and explain that you have this chronic condition?  It's so damned awkward.  I'd take the silly questions my OLD friends had over explaining it new for the first time any day.  

Traveling with Diabetes

Below are my experiences in traveling with Diabetes. Recently, I moved to Singapore from the United States. I was in four air ports around the world. I have taken many flights previous to this journey whilst having diabetes. I've also been on road trips and have blogged about my pumping vacation last summer for a trip to the beach here: http://sugarfreesweety.blogspot.sg/2012/07/pump-vacation.html

Disclosure: I am not a doctor nor a TSA agent. These experiences are my own and as always, your diabetes may vary.

I've got SLC International Airport down to a science when it comes to wearing an insulin pump. But, I had never taken a year's worth of insulin across the world with me. So, I was a little bit worried about how that would all play out but it turned out fine.

I looked it up on the TSA website as well as asked them on twitter (and they responded!) about how to travel with diabetes supplies.  There I found out that I could indeed take a year's worth of insulin as well as the ice packs necessary to keep it cool on the 21 hour journey.  The website just said that I had to declare my insulin before putting it through.  Easy enough, I thought!

As I approached the security check, I told them that I had insulin and ice inside my bag.  The TSA agent asked that I separate them.  I pulled out both my insulin and my ice and put them in the totes provided and sent them through security.  I hid my pump under my shorts and easily walked through security. No issues and on to boarding.

The reason I choose to hide my pump is purely from experience.  The insulin pump has NEVER set off the alarm.  But, I've been leery of taking it through before, thinking it would set off the alarm.  A couple of times, while traveling through SLC int. I showed them my pump, told them what it was, and then proceeded through the metal detector.  Because I had shown them my pump, and NOT because it set off the alarm, I got the pat down.  As security measures increased, and full-body scanners, and full body pat downs came around, this process also involved an extensive full-body pat down.  Personally, I do not think a simple insulin pump warrants such treatment.  It is a medical device, OBVIOUSLY  a medical device.  It is also VERY COMMONLY worn and used by millions of diabetics in the United States. Therefore, I see no reason why a pat-down is necessary.  Especially when it doesn't set off the alarms.  The entire process would make me more and more frustrated and I just HATED the entire process. The ONLY positive side was that my husband had to deal with the kids, their shoes, coats, bags, the stroller, and whatever else our family of four was traveling with... for just a few minutes, while I was held up in security.  He usually had it under control by the time I finished and all I had to do was put on my shoes and follow them to the gate.

So.  One time when traveling to see the in-laws, I decided to hide my pump by wearing it clipped to my underwear (I ALWAYS wear my insulin pump with the belt clip) underneath my jeans.  No issues.  Whatsoever!  so... that's what I've done from now on!

But.. I digress. In San Francisco, we didn't have a lot of time.  So little, in fact, that unbeknownst to us, our bags didn't make it.  Security at the International gate at SFO was basically a nightmare.  It was HOT and extremely crowded.  The line was moving very slowly.  If we hadn't had business class priority, we probably would have missed our flight... maybe.  I followed the same procedure I had done in SLC but this time I made the mistake of ASKING the TSA agent whether or not I should separate my ice from my insulin inside of my carry on.  He agent told me that I did NOT need to do so.  And... of course, my bag was held up.  The boys' bags were also held up for some reason which they decided NOT to tell us about.  Damn those crayons!  ha ha ha.  Anyway, The woman on the x-ray side started chewing me out about not separating my ice from my insulin and I got right up in her face.  I was NOT losing my cool, but very firmly, and calmly, I said to her, "THAT is why I specifically asked about it.  I asked him, (pointing), right there, if I should separate my ice and insulin inside my bag before I sent it through the belt because they told me to do so in Salt Lake City and he told me that I did not."  "And that is why I ASKED SPECIFICALLY".
"Well," she responded "you should always do that."
"Well, that's why I asked" I told her again.
Eventually, our bags were all cleared through security and we were on to the gate at Singapore Airlines.

Our layover in Korea wasn't really long.  I think we had about an hour.  It was like 4:00 am our time and we all did very well with being awake at that time.  I have to give it up to the Koreans, their Incheon airport was fantastic.  Security could not have been easier.  It was 6:00 pm local time and there was no line whatsoever.  A nice man helped us all put our belongings into bins and carefully guided us though security.  No issues with the insulin, ice, or any other bags!  Quick, easy and so friendly.

By the time we made it to Singapore, we'd been en route for 21 hours.  My blood sugars did very well the whole time.  I did check them quite frequently, as recommended.  My insulin was still cold by the time we made it to our hotel and everything arrived safely... except for our bags.  ALWAYS carry on your diabetes supplies, even if you are taking a year's worth!

Moving across the globe with Diabetes

Many of you who follow me on twitter and Facebook know that I recently moved from Salt Lake City, Utah to Singapore!  Quite the change.  And when it comes to diabetes and pumping insulin, a 14 hour time change is something to consider.

Disclosure: I am not a doctor and as always, your diabetes may vary.  

About 2 weeks before we moved, I met with my Endocrinologist.  He updated all of my prescriptions and gave me a good plan for adjusting my insulin.

The plan:

- reduce my basal by 80% the day of my flight (or upon boarding)
- check blood sugar frequently
            side note: It would have been really nice to have a working CGM but my loaner transmitter died so I was flying blind
- change pump clock to local time upon landing at destination

Some people suggested changing the pump to local time upon boarding.  I would not recommend that because of the distance I was traveling.  It takes typically 3-7 days to acclimate to the time change and changing pump settings in advance when your body isn't used to the change could be dangerous.

The results:

I took my doctors advice and the plan has worked pretty well.  About three days after I was in my new home here in Singapore I was fully adjusted to the time change and at that point I probably should have changed my pump back to the normal basal.  I did not.  And as a result had some unstable sugars which resulted in a yeast infection--- fantastic!  But, if I'm being honest, this is a side effect a lot of women with diabetes will suffer frequently.  In fact, it was how I was diagnosed 12 years ago.  So, while I understand it's gross and totally TMI, it's the facts of being a woman with diabetes.  Polly wolly crappy too!

Next time: traveling through security with diabetes.