Travelling as a type 1 diabetic can throw a few extra variables into the mix. My last trip to the US really took me by surprise and will reset my plans for future visits.
Time zone shifts are tricky anyway, but with more frequent finger prick tests it is possible to manage more or less on an hour-by-hour basis. A previous trip during a trial of the Freestyle Libre was a revelation, but I’m not on the qualifying list yet so its back to the stabbing process.
The difference I found in America was the inaccuracy of my lifetime of carb counting. I made my standard estimates for a slice of bread, a bowl of fruit and yogurt, a burger with fries, a bottle of Sam Adams, and found my BG readings constantly high.
I typically take 40 to 50 units of Humalog a day and that covers 160 to 200 grams of carbs at an average BG of around 7 mmol/l. On my week in America I averaged 80 units a day. By my standard carb counting this was covering around 150 grams of carbs and yet my average BG was more than 13mmol/l. Something was out and it can only be the sugar content of what I was eating.
Throughout the week I was careful – no donuts, avoid the coffee creamer, moderate portions etc. It’s really tough to load the insulin doses when a lifetime of caution to minimise hypos has drummed in the opposite behaviours.
I found that once the BG readings got high, it was very tough to get them back down. The two-hour effect time of Humalog led me to a strange world of scheduled testing and re-dosing, even through the night.
The only answer, I think, is experience. I may be doing more business in the States, so will need to travel there more often. Over time I will calibrate the body systems and the management processes and hope to find a better balance on future visits.
Which brings me back to the Libre – business travel doesn’t make finger pricking easy or convenient, and so the more constant monitoring offered by the Libre would be welcome. If only to hit rising sugars earlier and prevent rather than recover from high readings.