How to avoid High glucose when travelling

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Justinjroberts DAFNE Graduate
Central Middlesex Hospital
9 posts

I have just returned form a couple of short business trips: Dublin last week and Amsterdam the previous week. For both trip I was only away from early Wednesday morning returning Thursday evening. On both occasions my blood glucose level hit 10 15 13 10 12 10 while in Amsterdam, then 15 18 13 12 11 10 14 16 12 15 when in Dublin, prior to my travelling my levels where normal 5 and 6 with a 1 to 1 ratio. When in Dublin I doubled and tripled my fast acting insulin and it still had no affect, instead of taking 10 I would take 30 and still it stayed high. I always find I need to up my dosage when eating in hotels and restaurants , however it always goes back to normal and I have never before experienced such a run of very high levels. I would be interested to hear any comments as I can only think on either not travelling or eating nothing while away. The whole experience was utterly unpleasant and made it very difficult to work normally due to the extreme tiredness the high levels caused.

Peter DUAG Committee Member
University College London Hospitals (UCLH)
109 posts

In my experience the biggest problems with traveling are caused by time zone differences and dietary differences at the destination. These typically make long distance travel more different than short haul. Based on your DAFNE centre I'm assuming your travel was from UK and so neither of the factors mentioned should have had a large impact. The other possibility may be stress arising from whatever business activities you were undertaking whilst abroad. I certainly find it more difficult to maintain good control whilst traveling, but never to the extent you're describing. If I were to triple my QA I would end up in hospital, but I do find that it's very easy to eat more carbs. than usual at all meals, so do ensure that you are applying the DAFNE principles correctly to each meal. Also do you stick to the same routine whist away e.g. same time of day for BI injection(s), same time difference between QA and eating? For me the latter is always more of a challenge when traveling as when cooking at home I know in advance both when the food will arrive and how many carbs. there will be, allowing insulin to be taken in advance. Neither of these are certain when traveling which results in more post-meal corrections which, in my case, are nothing like as efficient as insulin taken 15-30 minutes before eating.

I spent 2 days in Prague last week, and had a couple of readings above 10, but corrected those as usual. This week it's Atlanta, which certainly brings timezones into play, and portion sizes are the usual challenge whilst eating Sad I've been regularly traveling on business for many years, so it can be done without the extreme measures you suggest.

The best solution would be CGMS or a pump. Suggest you discuss that with your HCP at your next visit. However, from personal experience, neither of the solutions are easy to get hold of. However, I'm certain that you should not be having to think about not traveling or not eating whilst away. DAFNE should be giving you the tools to cope. If it is such a concern for you, then talk to the HCPs and push for a pump or perhaps for loan of a CGMS during your next trip to see if that helps. I was lucky enough to have a CGMS on loan for a period of 6 weeks, and learnt more in that time about the management of the condition than I had in the previous 40 years. Good luck.

Garry DAFNE Graduate
North Lincolnshire
328 posts

Welcome to the forum Justinjroberts Smile
May I ask which QA insulin you use?
Regards
Garry

Justinjroberts DAFNE Graduate
Central Middlesex Hospital
9 posts

Thanks for your thoughts, and when I visit my HCP in April I will certainly ask about the CGMS. Regarding my insulin my QI is Novorapid and my BI is Humalin I! I was on Lantus but had some problems last Autumn and had to split the doe to morning and evening and was also having to check my glucose levels and correct with Novorapid around 5.30am every morning, at that time of day my Novorapid worked on a ratio of lowering of 1 to 1 so one unit of Novorapid would only reduce my glucose levels by 1. I have only been on the Humalin I for three weeks after spending a week on a DAFNE course, having last been on the course 11 years ago.

Justinjroberts DAFNE Graduate
Central Middlesex Hospital
9 posts

Dear Peter,

Just wondering how did you manage to borrow a CGMS for 6 weeks. I would have happily tried anything to keep my BG under control while travelling. I can see how it would be a great help and avoid having to test continuously to avoid rapid fluctuations, also it is not always possible to keep testing. With regard to DAFNE, how dose it work as I have always been told to avoid testing between meals and only test when I want to eat, exercising, driving or when ill? And correct at meal times, my concern however was that I had such high levels which was making me unwell I had no option to test and correct, which worryingly still did not bring it back down.

Peter DUAG Committee Member
University College London Hospitals (UCLH)
109 posts

Justin, I got the CGMS through my role as Chairman of DUAG which means that I am one of the user representatives on the DAFNE Executive which is the group the runs the DAFNE Programme in the UK and RoI. One of the other members of the Executive mentioned in a meeting that their centre were reviewing CGMS and so I commented that I'd be interested in trying one. A few weeks later I was contacted ans asked whether I'd be prepared to provide input into the instructions that were being written for the use of a CGMS in "exchange" for getting one to use myself for a period. Unfortunately not a route that will help you or others much.

I think the main reason that the advice says only correct at mealtimes is to avoid correcting between meals and then correcting again before the next meal and as a result ending up hypo. For me it takes time for a correcting does to work, and so if I test between meals because I'm not feeling right I will correct at that time. The other critical fact to remember is that it can take time for the insulin at one meal to counteract the carbs eaten. This is especially true if you inject after a meal. That's why the 2 hour rule exists as, for most, there will be a peak in BS readings sometime in that period, and if there is no need to correct for that as the pre-meal QA will sort that out eventually.

Assuming you have some knowledge of how long your body usually takes to return the BS to pre-meal levels, then you should be able to identify an unexpected peak which should be treated before the next meal.Unfortunately though, as with all these discussions, what works for one does not necessarily apply to another. So you should only move outside the standard advice if you're confident you know what you're doing, ideally you're not abroad the first time you're doing it and, of course, you've discussed it with your HCP.

Good luck

Peter