Travels with Nellie

A few brief notes on overseas travel:

1. I always worry about security issues when I take my pump and supplies through new airports. Nellie and I navigated the airports of Rome, Bologna, and Brussels without disruption.

2. That said, for the first time ever, I was asked to produce documentation of my need to carry diabetes supplies. This was in the Brussels airport, pre-boarding for my flight to return to the U.S. I had my endo's letter with me, and it was accepted without question. (The agent was also willing to accept something called a "health card," whatever that is.) The letter was briefly taken from me, and I was told that it would be shown to the pilot. It was returned to me within a few minutes and I was allowed to board.

3. The same agent asked me in a rather pointed way, "You are carrying only the supplies you need for this flight, correct?" She was tipping me off as to what to say, it seemed: she practically winked at me as she spoke.

I was carrying a lot more than that, of course--to be specific, my entire stash of leftover pump supplies and backup syringes from a week-long trip. Nobody in their right mind would board an overseas flight with exactly 8 hours worth of supplies and no more. Imagine if the plane were diverted or had mechanical problems or who knows what. I bring all my supplies in my carry-on, period.

I answered, "I'm carrying what I need plus backup in case my pump has problems." Technically true, depending on how broadly one defines "problem."

That worked for the agent.

4. Had I followed the advice of Dr. Reassurance (see post below) on adjusting the pump clock for the 6- to 7-hour time change--she said to simply update the time when I arrived and watch for trouble, my body would catch right up--I would have had serious lows.

Insulin needs are indeed closely related to physical activity, so it makes sense that over a period of a few days the body would adjust to a time zone change. But I hadn't wanted to make such a drastic change all at once because it would have placed my highest basals, which are more than double the lowest, right smack in the middle of the period when my body was expecting the lowest dose. It seemed moronic to blithely change the time on a delicately calibrated medical device without making ANY compensation for the fact that my body, for the first couple days, was pretty sure it was 11 PM even though the actual local time was 6 AM.

One of my pump resources, SMART PUMPING (published by the ADA), recommends that for a time zone change longer than a couple hours, you should adjust the pump clock by 1.5 per DAY until you're caught up to local time. That made a lot more sense. In the end, I took a sort of middle road and made up my own adjusted basal regimen with the main premise being that I really couldn't handle a major low on this business trip. I allowed myself to run slightly high until I felt very confident that my body had decided to catch up to local time.

I also had to adjust for my different insulin-to-carb ratios throughout the day, a topic not addressed in any of my books. I went a conservative route here too, using my lunchtime ratio for both breakfast and lunch (instead of taking significantly more insulin at breakfast as I normally would). As far as I could tell, over 7 days my meal ratios NEVER normalized to local time. Again, had I reset the pump clock per the advice of Dr. Reassurance, I would have seriously screwed myself.

Hmm, a very practical post for Violet. I'll navel-gaze more next time so that you can all feel confident the real Violet hasn't been kidnapped by aliens and replaced with a stoic number cruncher...