Traveling with Type 1 Diabetes

I just got off a cruise to Cozumel, Mexico. We left on a Thursday, and returned on Monday. I believe this was the 12th cruise we have been on, but it is only the second cruise with a diagnosis of type 1 diabetes.

My first cruise with type 1, I was definitely more "stable" as a diabetic. Because I was diagnosed so late in life, LADA or latent adult diabetes of adulthood, there was still some random pancreatic function. My blood sugar was not so labile. I spent six years a "type 2" (misdiagnosed), so my slide into full fledged type 1 took a while. I attribute this to good diet, weight loss, and exercise.

Well, cruise number two was a lot different. I learned some valuable lessons.

I thought I was prepared, first of all - I had a new continuous glucose monitor on (CGM, made by Dexcom). I brought an extra one...just in case. They last 10 days, so my short cruise should have been covered by that.

Lesson #1 - bring extras for your extra.

On the beach in Cozumel, I was removing my cover up when my Dexcom sensor came right off with it. What!!!! This has only happened one other time in the two years I have been wearing a CGM, and it was when I tried to wear it on my leg. I learned that spot is not going to work for me! Since then, I always put the CGM on my abdomen, and I did not expect this to happen - especially considering that I hadn't been in the water at all.

Bummer. I pulled out my spare CGM when we got back to the ship, and in my flustered state, forgot to peel the tabs off. When I pushed the button to insert the CGM, it could not deploy into my belly, as the tabs covered the sensor. YIKES!

Now I had no CGM, and 36 more hours to cruise.

Let me explain why I love the CGM - there is a terrifying thing that diabetics talk about called "dead in the bed". Basically, it means your blood sugar goes so low while you are sleeping, that you die, because you have no way of knowing that it is low. The CGM alerts me when my blood sugar is 70, or when it is quickly falling. It also alerts my husband, and my daughter. That way, if I have a sudden drop and I am in a deep sleep and don't hear the alarm, they will call or text me and waken me so I can save myself by turning off my insulin pump, and taking measures to bring my sugar back up.

Now here I am on a cruise ship with no CGM. I am already out of my comfort zone of being at home. Of course, that night my blood sugar (which I was manually checking frequently, and have the scarred fingers to prove it) tanked. I always have glucose tabs and skittles with me - at home I have icing and juice. OJ works the fastest - when my blood sugar tanked, Chris ran for a glass of OJ from the nearest bar, while I sat in the room eating icing. Between the icing, OJ, insulin pump off, and a few skittles, my blood sugar came back up.

And up.

And up.

I spent most of that night awake, with blood sugars higher than I have ever had. I had brought my ketone strips in my diabetes emergency kit, and the 2+ ketones were not reassuring. I drank water and sprite zero and checked my blood sugars hourly. By morning, finally I had normal blood sugars, and no ketones.

It put the fear of God in me again, though.

The next day, I tried to keep my blood sugars a little higher than normal. I've experienced my blood sugars dropping suddenly, and it is terrifying. More so now that I didn't have a CGM to alert me.

Yes, you are probably thinking, don't I feel bad when my blood sugars dive? Sometimes. Unfortunately, I am already getting hypo-unaware, and my blood sugar can drop into the 40's without me feeling any worse for the wear.

So the night before we docked, I woke up at 0330 with a blood sugar of 124. With a CGM, I would have gone back to sleep. Instead, I ate my snack sized pack of Cadbury Mini Eggs, and that carried me through until morning.

Diabetes is a frustrating disease - the blood sugar is influenced by hormones, stress, illness, diet, hydration, medications, and a zillion things we don't know. Most of the time I am managing well - my last hemoglobin A1C was 6, which is not too shabby, boys and girls!

There are other days when the blood sugar is wacko, despite the controlled diet and life of exercise that I lead.

It's frustrating. I want 1+2 to equal 3, and that is not the way it goes with diabetes.

As I lay there in fear of going into DKA that first night (diabetic ketoacidosis, a dangerous state for a diabetic), I realized my traveling is now somewhat limited.

There will be no travels to exotic locales with no medical care available.

I will continue to take cruises...but I will be bringing a lot more supplies with me. And juice! I am bringing juice!

I will continue to fight for as normal a life as I can have.

Despite this dang diagnosis.....