Chris Scully writes at her own blog Canadian D-Gal. I have been following her posts for some time. After reading I frequently come away with a feeling of “whoa this is girl power and diabetes power’”. You see, Chris, despite being a type 1 diabetic, is very in active outdoor sports. She caught my attention big time when I learned she had backpacked for 4 months in South East Asia and lived abroad in Taiwan for two years while teaching English. It’s not an impossible feat. Yet, I feel extremely intimidated just thinking about going off into the wilderness as a type 1 diabetic. Or living in another country, for that matter. Even for a day. So her experience means a lot to me. It says, “you can do it”. We diabetics can use that reminder every day. We can’t let it hold us back from what we really want to do.
I’ve asked her a few questions about her experience and here are her answers:
GG: Chris, I’m curious, what are all the outdoor activities you do? How do you manage your diabetes on those activities?
Long distance running and cycling, spin class, stair climbing, mountain biking, rock climbing, rollerblading, snowboarding, snow shoeing, hiking, back-country camping including backpacking and canoe tripping. I’m sure I’m missing a few things. I manage it all quite differently since the activities differ greatly. A lot of these things I do alone and that makes some activities harder than others. Since the pump, the Temp Basal Rate option has become my best friend. I owe all my successes to having that feature. It requires careful pre/post-planning and constant monitoring throughout. Protecting my meter also being my number one priority. Keeping it dry or cool/warm. Keeping it close and protected while always having spare batteries, lancets and strips just in case. Without being able to check my blood well then I’d be going at it blind. Which I’ve done on many occasions and where I learned most of my lessons from. Always having different kinds of fast-acting sugars depending on the situation. Most importantly being able to address the situation no matter what might arise. Contingency plans whether it’s carrying too much glucose or notifying family of a possible phone call is key. Knowing that things can and probably will go wrong is not something to ignore but something to keep in mind at ALL times. If I didn’t go out there with the utmost confidence that I will do my best to handle whatever situation arises I would never go out.
GG: How long have you engaged in outdoor sports?
Since I was a young teenager. I started rock climbing and back-country camping at 14.
GG: Ok, so you spent two years in Taiwan teaching English. How did your life take you there? And how did you do with your diabetes management while there?
My boyfriend at the time and I thought it would be a neat experience to teach English in Taiwan. As far as diabetes management it was hell at first. I went with all the supplies I had which was only a few months worth. Once I got settled I had to find out how the “system” worked. My mum was back home frantically trying to find a way to ship it to me but it was too much trouble requiring import/export licenses. I qualified for a Taiwanese health card. I had to go to the hospital (only on Tuesday nights) and wait in up to a 3 hour cue to get my prescription. They would fill it right there in the hospital and it cost me almost nothing. There was a language barrier, so once they got used to me coming once a month there weren’t many questions. They would only ever give me 1 month at a time. I had to buy my test strips at the store for full price. I never got blood work done the entire time I was there because of the language barrier and I was a pretty irresponsible diabetic back then.
GG: Did you discuss this trip with your health care provider before taking it? If so, did you receive any help or guidance?
I came home for a visit from Taiwan after the 2 years teaching before I went back to travel. I met with my CDE at the time. I had no travel plans set in stone but I told her all the countries we may or may not visit. She then contacted Lily and got a list of which countries had what type of insulin.
Some countries had only the old school “N” stuff where you must wait 30 minutes before eating. Some countries didn’t have pens or some had only Novo insulins.
GG: When you backpacked through South East Asia, what places did you travel through? What was the most “diabetic friendly” place?
Thailand, Laos, Cambodia and India. None of them were diabetic friendly as far as food options but Thailand was the most diabetic friendly for medical care. I quickly learned how to read “carbs” in different languages.
GG: I understand you were on MDI (Multiple Daily Injections) while in Taiwan and during your 6 months backpacking. How did you keep your insulin? Where did you buy it? Did you need a prescription for anything while abroad?
Wow. This might take awhile to answer, I apologize in advance! Well Bangkok is basically the hub of south-east Asia for backpackers. We used to go to Bangkok for the weekend since it was a cheap 3 hour flight from Taiwan. Needless to say I knew it VERY well and treated it like my second home. The first thing I did once arriving was to go to the recommended hospital for foreigners and start poking and prodding around to get some information. Armed with my “list” from my CDE I knew that Bangkok would be my best bet. The doctors I saw here were extremely friendly, knowledgeable and helpful. This is where I was first introduced to Lantus! I received a months worth of supplies. Pen cartridges, pen needles, bottle of Lantus and syringes. It wasn’t cheap, I had to pay full price for it. From here I decided it would be easiest to just return to Bangkok once a month for refills. The other countries were much lower class and it was unlikely I would be able to find what I needed. Also, traveling 16 hours on overnight buses/trains/boats and staying in cheap guesthouses with zero luxuries meant that carrying more than a months supply was impossible. We had, however, planned on spending 2 months in India in which getting insulin there was going to be a necessity since Bangkok was now an expensive flight away. I spent the first two days in New Delhi traumatized by the insanity of the city all the while getting sent on wild goose chases just trying to find where I could buy it. I couldn’t get it through hospitals like Bangkok (I was led to believe) and although Indians speak a lot of English they were the least bit helpful. I eventually found some random little apothecary/booth thing that looked eerily untrustworthy and they sold me a disposable Novorapid pen at an outrageous price. Luckily I never had to use it because I cut the India trip short. I don’t remember him pulling it out of a fridge either.
GG: Now that you use a pump, do you think you would have been able to do all this on the insulin pump? How do you think having a pump would help or hurt experiences like the ones you’ve had?
I don’t think a pump would make it any more difficult except the fear of what happens if the pump malfunctions. This was also a number of years ago and who knows what’s changed as far as insulin availability in other countries. I would still need to get vials of insulin somehow. Pump supplies I would certainly carry them all with me. It would probably be easier with a pump. It might even be easier to research it nowadays. It would require a bit more careful attention. Like when swimming around in waterfalls/oceans or scuba diving.
GG: What was the hardest thing, diabetes-wise, about your experiences abroad?
Knowing I couldn’t travel on a whim. Everybody else was just going with the flow and I envied that. I never got to visit Vietnam like we had planned because of time constraints on my insulin. I spent an extra two weeks in Cambodia before going back to Thailand because we were having such a good time and we were days away via bus/train/etc. I had been running my insulin for over 6 weeks in insane heat. I know I wasn’t feeling so hot. Keep in mind I didn’t know nearly as much as I do now. Oh the other hard parts were having hypos in strange places like the killing fields in Cambodia, or the middle of the night in a sweaty strange grungy guest house. Oh and its hard to drive a scooter hypo.
GG: What advice would you give to a diabetic interested in doing something similar?
- Have a plan.For example, I used the “shoestring lonely planet guide to South-East Asia”. So I was following dirty hippy cheap backpacker routes (YAY!) So I knew I couldn’t rely on refrigeration. I went armed with some decent health insurance also. Traveling in 3rd world countries as an insulin-dependent diabetic just meant I had to be extra careful which I was.
- Have a friend.My boyfriend at the time was always looking out for me. He understood the dangers of traveling with a type1 diabetic. Trust me, I needed him on more than a few occasions. He was often running around in search of sugary drinks when I ran out of whatever I had with me.
GG: What is your greatest memory from your trips?
Climbing up the Himalayas with snowshoes above the treeline in Northern India and experiencing a touch of altitude. Then snowboarding back down.
Was diabetes there? I can’t even remember! I can’t forget all the adventures of teaching English in Taiwan. That was an experience I’ll never get again and I loved it all.
GG: Would you do it all over again, diabetes and all?
MOST DEFINITELY! These are some of the best memories I’ve ever had. I’ve daydreamed about doing something like this again ever since. I laugh now at the gallivanting around Delhi in a rickshaw trying to find an insulin pen. Most importantly, I barely remember diabetes distracting me. It certainly wouldn’t have been the best for my Diabetes management to do this for say a year. We gotta give in somewhere. I wouldn’t trade that experience for anything. Even if I did end up in a strange room half passed out in some mountain village in India with a doctor spending an hour trying to find a vein to insert an IV into me. I’m happy to forget that experience though.
Thanks so much for answering all these questions, Chris! I never realized how hardcore you are until now. I’m sitting here quite amazed.