Travel with Diabetes

As a diabetic, you need to be more prepared for traveling than others. There are more equipment and medications to pack and more steps to take before you are even ready to leave for your trip. This post mostly refers to type 2 diabetics, but some of these tips can transfer over for type 1 diabetics.


Before leaving on a road trip or vacation, remember to get a doctor’s note that includes a list of medication, monitoring and dispensing equipment, details on the need to carry supplies in your hand luggage as well as contact details for your diabetes care team.

Big tip: When you’re planning for a trip, make sure your destination has an in-room refrigerator for your insulin, if you take any.

Road Trip

BEFORE YOU LEAVE: Check your blood sugar, less than 100mg/dL -> have a snack (like a hard-boiled egg or orange), wait 15 mins then test again.

Stock the car with hard candies, crackers, and other fast-acting sugars within reach while driving. Add some substantial snacks (like cheese and crackers or trail mix).

If you’re on the road for an hour or more, check you blood sugar every 2-4 hours.

Once you get to your destination, place your insulin in the fridge.

Hypoglycemia – if you experience sweating, anxiety, and the shakes, pull over to the side of the road as quickly and safely as possible. Check your sugar and treat your low before you get back to driving.

Airport

  1. While planning for a long distance trip, make sure your destination has hospitals or pharmacies nearby. In case of emergency, if you’re in need of a hospital, extra supplies, or medication. Also take note of the time change so you can change the time on your equipment for better management.
  2. If you have an iPhone, make sure you setup/update your Medical ID. It should include the numbers for your doctors, medical condition, medication you’re on, and the contact information of any family members that know about your medical condition.
  3. Consider getting travel insurance. In case of medical emergency or cancellation, or lost, damaged, or stolen luggage. Especially if you’re storing your equipment in your checked luggage.
  4. Flying with diabetes supplies – As a precaution and in case of emergency, pack twice as many supplies than you think you need. In your carry on pack lancets, test strips, insulin, health insurance card, extra batteries for your monitor, contact information, oral medications, snacks and juice boxes, and glucose tablets.
  5. Get to the airport at least 3 hours before your flight. In case you run into any snags while checking in.
  6. TSA & Diabetes – Find out about the TSA’s guidelines for traveling with diabetes. You can get a TSA diabetes notification card or a letter from your endocrinologist.
  7. Tell the TSA officer about your diabetes supplies. You can’t remove your CGM or insulin pump.
  8. Keep your insulin cool while flying. Use a pouch or bag with an ice pack. There are some on Amazon that you can purchase for under $15.

Check your sugar before leaving for the airport, check again before boarding your flight, and once more when you’ve landed. If your flight is more than one hour, check every 2 to 4 hours as you think is needed. If you don’t have a designated disposal container, carry a ziplock bag or container with you for the used test strips and discard securely when able.

Arrival

When you arrive at your destination, here are a few tips to help keep your trip enjoyable.

  1. Avoid raw or undercooked seafood.
  2. Stay clear of food that’s been left out for long periods of time.
  3. Buy bottled water.
  4. Ask for your drinks without ice.

No one wants to spend their vacation on the toilet the whole time.

Remember no two people are the same. Some run high, some low. You know how your diabetes works so act accordingly to avoid medical emergencies.

If you have any more travel tips, please feel free to comment them below and share them with your fellow diabetics.


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Your Diabetes Care Team

When you get diagnosed with diabetes, it’s important to establish referrals and contacts with other medical professionals that can help you manage your diabetes. This team of professionals will help you during your journey and will require multiple appointments throughout the year. Here are the professionals you should have on your team.

  1. Primary Care Physician (PCP): your family doctor may be the physician who diagnosed your diabetes. Your PCP can coordinate your healthcare team and even recommend diabetes specialists for you.
  2. Endocrinologist: this doctor specializes in treating diseases of the endocrine system, such as diabetes and thyroid problems. The endocrine system is the collection of glands that produce hormones that help regulate metabolism, sleep, and more, including the creation of insulin in the pancreas.
  3. Certified Diabetes Educator (CDE): a specially trained healthcare professional, such as a nurse, dietician, or pharmacist, who can counsel and educate people with diabetes. A diabetes educator helps you set achievable behavioral goals and helps you address your concerns and challenges. To find one in your area click here.
  4. Ophthalmologist: a doctor that monitors your eye health to look for any damage uncontrolled blood sugar may have done to your vision. Check ups are usually for at least once a year, maybe more depending on your condition. Diabetes can affect the blood vessels in the eye.
  5. Podiatrist: this doctor checks your feet for nerve damage or wounds. They treat feet and lower leg problems. Uncontrolled blood sugar can damage the nerves in your body and the podiatrist checks your feet once or twice a year to make sure you can still feel in your feet and there are no hidden wounds between your toes. Daily checks done by yourself can also help you notice if anything has gone amiss.
  6. Dentist: a dentist knows about oral care and is trained to take care of your teeth and gums. Diabetics are at greater risk of gum disease because of the high amounts of sugar in our body. Our mouths become the best place for bacteria to thrive. Check us with your dentist are recommended for every 6 months.
  7. Registered Dietician: an expert in nutrition (what food your particular body needs to stay healthy). They help you use what you eat and drink as tools for managing your blood glucose.

It is important to choose diabetes care team members who can provide the best level of support you want and help when you need it. But let’s not forget that just as much as you need a team of professionals for support, you also need the support of your family and friends. You’re not going through this alone.

If you ever need anyone to talk to, feel free to reach out to me. I’m not a professional, but I will be a friendly ear you can talk to. My inbox is always open.


References

Web MD
Diabetes.org
Health Monitor, Guide to Diabetes, p. 14.


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Diabetes and Pregnancy

This topic is important to my husband and I. One day, we would really love to welcome a child into our lives, but I have to make sure I am healthy enough to get pregnant. Here’s what I have been able to uncover so far.


During pregnancy, women who have type 2 diabetes may need to up their dosage of insulin, take different medication, or may not need to change anything at all. Women who don’t already have diabetes can develop gestational diabetes which can be controlled by diet and exercise and may need insulin injections. Usually gestational diabetes goes away after giving birth, but if it doesn’t go away it could develop into type 2 diabetes. Most women who have gestational diabetes can develop type 2 diabetes later in life.

Being diabetic and pregnant means you have to visit the doctor a few more times than other women, and that’s okay.

If diabetes isn’t controlled during pregnancy it could increase your chances for birth defects, macrosomia, miscarriage, and stillbirth for the baby. For mommy, it increases your chances of developing preeclampsia which could put baby and mommy in danger and the need to induce labor earlier than the due date will increase.

Macrosomia is when the baby is born bigger than normal. The high blood sugar of the mother is absorbed through the placenta and causes the baby’s pancreas to create more insulin to process the blood sugar. The extra sugar in the baby’s body gets converted to fat.

Preconception

When you’re diabetic, pregnancy comes with a whole bunch of complications and worries, but it’s not impossible to give birth with diabetes. To prepare for your pregnancy, it’s best to prepare far in the future. Some women may need six months or more to get their diabetes under control enough to conceive.

What goes into this preparation? You need to undergo a series of tests to check where your diabetes is at currently and how much needs to be changed to be ready to conceive, then you retake those tests until you’re ready to go. You need to speak to the members of your diabetic health team to go over those results and make the necessary changes. These changes can include a healthier diet, regular exercise, losing weight, and taking vitamins and supplements, such as folic acid.

Some tests you should undergo:

  • urinalysis – checks if there are any problems with your kidneys
  • blood tests – check your cholesterol, triglycerides, and kidney and liver function
  • eye exam – check for glaucoma, cataracts, and retinopathy
  • electrocardiogram – check your heart function
  • foot exam – check for nerve damage

You need to get your blood sugar levels close to range before and during pregnancy. High sugar levels can harm your baby during the first 4 to 8 weeks of pregnancy, even before you know you’re pregnant. The baby’s organs start developing during the first few weeks and are very vulnerable to high sugar levels.

You need to check your A1C, too. If your A1C is 10% or higher, you have a 1 in 5 chance of giving birth to a baby with a malformation such as a heart, kidney, brain, or spinal cord defect. Try to get your A1C down below 7% to lower the chances of a malformation in your baby.

Make sure your weight is within a healthy range as well. Being overweight or obese can cause complications in your diabetes, pregnancy, and may lead to other diseases.

Once everything looks good and you’ve spoken to your various doctors and a dietician, hopefully you are ready and able to conceive.

During Pregnancy

During your pregnancy, the biggest thing to remember is DO NOT STOP YOUR MEDICATION. It is much worse for you to stop your medications and have your blood sugar increase than to have a fear of your medication. There is no evidence as of yet that your medication could cause a malformation to your baby. Remember, none of the medication you’re on have been 100% proven to cause any harms.

If you do have any concerns about your medication and your baby, talk to your doctor before stopping your medication. Your doctor can work with you to figure something out to keep your sugar levels low throughout your pregnancy. Besides, your body changes multiple times during your pregnancy and you’ll be going back to your doctor throughout to keep everything in check and make sure you make the right changes at the right time.

Insulin injections will be your number one drug during pregnancy because the insulin doesn’t cross the placenta therefore does not cause any affects on your baby. With diabetes, you might also be put on oral medications to help overcome insulin resistance.

Make sure to meet with your dietician to make sure the diet you were on during your preconception is still the right diet to be on now that you are pregnant, most times it will be, but just double check to make sure. During the early part of pregnancy, blood sugar levels can decrease from your normal levels and you might not need all the medication or the low glycemic-index foods. Check with them to be sure.

During your first trimester, you don’t have to load up on calories. Morning sickness will probably get to you anyway.

Exercising will help you lower your stress levels, blood sugar levels, and might make labor easier for you. It doesn’t have to be intense, just enough to get your heart pumping and a little sweat to start. Obviously, avoid training for a marathon, contact sports, any exercise that raises your temperature too much, and heavy lifting. When in doubt, contact your doctor.

It’s natural to gain weight during your pregnancy. The goal is not to gain more than 25 to 30 pounds if you’re already at a healthy weight, and nothing more than 20 pounds if you’re overweight or obese. Studies have found that babies born to obese mothers tend to develop heart disease, asthma, or type 2 diabetes.

By your third trimester, your need for more insulin will increase. Your medication, diet, and exercise might need to be tweaked at this point. Your doctor might order you more tests and scans at this point to keep any eye on baby’s development, especially the size. Babies born from diabetic mothers tend to be larger than normal and that could be a concern at this stage. If the baby is big in size, it could complicate a vaginal delivery and might require a C-section. Your doctor might not want you to go on beyond 39 weeks.

Hopefully, delivery goes well and you and baby come out okay.

After Delivery

Ideally, you are lucky enough to go to a hospital with a good neonatal intensive care unit on hand in case your baby has some special needs that need monitoring after delivery. In case the baby is born prematurely, with low blood sugar, or any other need, the NICU should be able to take care of it.

After delivery, your insulin needs should decline, but you may be in danger of hypoglycemia. Two weeks after delivery, you should see your doctor for a checkup. Please note that insulin also doesn’t affect breast milk, so if you want to stay on insulin (if you weren’t on it before pregnancy) after delivery, you totally can. Breastfeeding is the best option, if you are able to produce enough or have the time to do so, it does take a lot of energy to breastfeed. There are many benefits for you and the baby, like it helps lower your blood sugar and it can lower the risk of the baby developing type 2 diabetes.

Postpartum depression is a serious condition for mothers and even moreso in diabetic mothers. If your “baby blues” don’t improve after two weeks, consult your doctor about meeting with a mental health professional. You don’t want to stress yourself out with your new responsibilities as a mother while also taking care of yourself. Sometimes it can be too much, please remember you don’t have to go through this alone. No one will think any less of your capabilities to be mother if you need to ask for help.

I’m not a professional, but if you ever want to talk to anyone, please know that you can always reach out to me and I will be a friendly, non-judgmental ear you can talk to.

Having diabetes doesn’t mean you can’t have a family of your own, it just means it’ll be a lot more work to have your family. If you really want a family, you’ll be able to go through it. Just know you are not alone.


Spread the Word

If you liked this article, spread the word and share it with your family and friends. Do you know someone who has diabetes or who is pregnant or trying to become pregnant? Share this article with them to help give them an idea of what to expect when they are expecting!


References

Center for Disease Control and Prevention
National Institute of Diabetes and Digestive and Kidney Disease
WebMD
Diabetes Forecast, May/June 2019, p. 44-49.

Metformin in Management

Information

These are what my metformin pills look like at 1000mg.

Metformin is one of the safer, effective and inexpensive drugs used to treat Type 2 diabetes. It is an oral medication that helps to control blood glucose. It comes in multiple forms such as a pill, extended release tablet, and liquid. Usually you’re advised to take it with a meal.

Of course metformin doesn’t work on its own, you have to commit to a lifestyle change. A healthier diet and more exercise will help the user lose weight and lower blood sugar levels. These changes could possibly hold off diabetes in prediabetics for up to 15 years.

Metformin reduces appetite, affects how the body stores fat, and lowers resistance to insulin making your body use your own insulin more efficiently. It can also reduce the risk of dying from heart disease by 30-40%.

Side Effects

Usage of metformin can lead to a vitamin B12 deficiency that could lead to anemia, neuropathy, memory loss, and fatigue.

If you need a CT, MRI, or angiogram that requires the contrast dye you may need to temporarily stop taking your metformin. The contrast dye can cause minor, short term changes to kidney function.

Metformin should not be used if you have severe kidney disease, metabolic acidosis, or diabetic ketoacidosis. Also metformin shouldn’t be used with alcohol.

Pregnancy

During pregnancy, the body can’t create enough insulin to control the blood glucose levels which leads to gestational diabetes. Women with gestational diabetes require insulin injections to help control the blood glucose levels. In women with Type 2 diabetes, that gap grows exponentially with pregnancy. The body is in need of more insulin than can be provided with injections. Studies are being performed to see the long term effects of metformin during pregnancy to see if metformin can be used in tandem with injections during pregnancy to safely keep blood glucose levels in check and see if there are any affects on the baby.


When taking metformin, you’ll see greater results if you also change to have a healthier diet and more active lifestyle. You could potentially hold off full blown diabetes with this medication if you have prediabetes. Watch your health while taking this medication, look out for any side effects and let your doctor know about them as they happen.


Related Content

What is Blood Sugar and A1C?
How to Support Your Diabetic Loved Ones


References

Drugs.com
Diabetes Self-Management, May/June 2019, p. 30-31.


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Join 617 other followers

How Exercise and Diabetes are Connected

Exercise is very important for those who have diabetes. By being active, you can reduce long-term health risks, improve insulin sensitivity, and enhance mood and overall quality of life. Most of the time, working out causes blood glucose to drop, but some exercises can cause glucose levels to rise.

Using your muscles helps burn glucose and improves the way insulin works. Some workouts like weight lifting, sprints, and competitive sports can release stress hormones like adrenaline. Those hormones can stimulate the liver to release glucose.

The food you eat before or during workout can also contribute to your glucose levels. If you eat too many carbs before exercising could cause your glucose levels to stay high regardless of exercise.

Here are some exercise tips:

  1. Choose moderate-intensity aerobic workouts or circuit weight training with light weights and high reps.
  2. Practice relaxation techniques like meditation before and during exercise to minimize adrenaline effect.
  3. Consider doing your workout later in the day than in the morning. Some people experience high levels of glucose in the morning naturally.
  4. If you are taking rapid-acting insulin or short-acting diabetes medications, consult your doctor about adjusting it prior to working out if they produce a glucose rise.
  5. Avoid consuming excessive amounts of carbs before and during exercise. Try some yogurt with nuts or peanut butter.

Keeping a workout log and checking your glucose before, during, and after each workout you try can help you see which exercise works best for you and what pre-workout foods affect your glucose.

If I had known what I know now back in 2010, I wonder if I could have helped my dad and support him in his diabetes. I never knew about diet and exercise when you had diabetes. I thought it was just take your meds and avoid sugar. It’s not that simple and it’s so difficult to do it alone.

I will release another post about which exercises would work best for diabetics and bonus, they can be done with others. You don’t have to go it alone.


References

Diabetes Forecast July/August 2019, p. 12