Traveling with a diabetic child
Stephanie Brookes, Contributor, Jakarta
When our daughter, aged seven, was diagnosed with Diabetes Type 1, it took us all by surprise. The task of being educated, the medical responsibility and dealing with the deterioration of our daughter's health were very difficult to cope with.
It didn't help that we were living away from our home country, Australia, having just moved to Jakarta, on a corporate posting with my husband's company. We had taken our daughter, Aspen, to the local SOS clinic in Jakarta, suspecting she had the flu.
Within 5 hours, she was medivaced to Singapore, admitted to intensive care and was diagnosed as Diabetic Type 1 insulin dependent.
A complex disease
Diabetes is a complex disease that occurs when there is too much sugar in the blood. With Type 1 diabetes the pancreas no longer produces insulin, a hormone that regulates and balances blood sugar levels and makes it possible for the body to utilize the food consumed.
Insulin must be taken by injection and not in pill form because the acid in the stomach would destroy it.
Type-1 diabetes is a chronic illness. It is the severest form of the disease. Type-1 diabetes is mostly diagnosed during childhood, which is why it is also know as juvenile diabetes. However it can be diagnosed at any age. My own mother, for example, was diagnosed Type-1 insulin-dependent (adult onset) at the age of 44.
With Type-2 diabetes the body still produces insulin, but it is either insufficient or not used efficiently by the body. Taking pills, dietary modification and lifestyle changes are ways to manage Type-2 diabetes.
Delicate balance required
Diabetes involves balancing food, exercise and insulin. Daily injections of insulin and regular food intake ideally balance blood sugar levels to achieve a normal range. The amount of insulin injected is expressed in terms of mmol/l.
This range is between 4 mmol/l to 10.0 mmol/l, which allows the body to feel well, with enough glucose feeding the brain and body. A combination of long-acting insulin, to cover the basal rate, and short-acting insulin, covering meals eaten, allows the body to naturally mimic the response to food, blood sugar and metabolism.
It is a daily challenge to keep insulin, food and exercise in balance. There are many obstacles to overcome, including the dawn phenomenon, when blood sugar levels rise high in the early morning, bouncing blood levels caused by a growth hormone that is released during sleep and delayed exercise reactions.
Exercise burns sugar and thus lowers blood sugar levels. A quick remedy is to eat an extra snack before exercise.
However, it is possible for the blood sugar level to lower hours later as a delayed reaction, which is something we experience often with Aspen. Stress, emotional disturbances and illness can also affect blood sugar levels.
Ketoacidosis
Ketoacidosis is a result of too little insulin and too much sugar in the blood. The body slowly becomes poisoned by acids (ketones). Aspen was admitted to hospital with ketoacidosis.
If there is not enough insulin, the blood sugar will rise and the kidneys dispose of the excess sugar in the urine.
Diabetes Mellitus (the medical term for diabetes) was first recognized in 1500 BC by an Egyptian medic, and comes from the Latin mellitus, meaning honey (or sweetness) and diabetes, meaning siphon (relating to the draining of the body liquids through frequent urination).
Hypoglycemia
Hypoglycemia ("hypo") occurs when the blood sugar level is too low (under 4mmol/l). It must be treated immediately with sugar (seven small jellybeans or similar) followed by a slow-acting carbohydrate (muesli bar, bread, milk or similar).
If the hypo goes untreated, then blood sugar will lower to a level where the child will become unconscious or have a fit.
Most diabetic children will experience mild hypos. Severe hypos are rare and must be treated with an injection of glucagon (if it is on hand) and then straight to hospital if the child is not responding.
A hypo is usually felt and recognized by the child. Aspen describes the feeling as "wobbly" and knows immediately when she is having a "hypo". Whenever Aspen leaves the house, even to visit the neighbors next door, she always travels with her hypo-kit bag, her blood glucose meter and two packs of hypo food.
Other signs of a hypo can include paleness, shakiness, sweating, headache, dizziness, irritability, mood change, crying and weakness.
On the road
Since my daughter's diagnosis, I have improved my knowledge of diabetes, my confidence in giving injections, adjusting insulin, and routinely testing blood sugar levels four times to six times a day. I boldly put this self-assurance to the test when our family decided to travel with our diabetic daughter.
It took a little more planning than usual. We found out in advance where all the medical clinics and hospitals were located, and the phone numbers. We took extra supplies of insulin, a small ice box/pack to keep the insulin cool, extra syringes, a spare blood glucose meter, batteries and glucagon.
Diabetics need to eat every two hours to three hours. As long as we carried lots of carbohydrates with us, we eliminated the stress of finding food at regular intervals for Aspen.
We went to the supermarket beforehand and bought one box of food which included a carbohydrate supply of long-life milk in lunch-box sizes, small 100 percent-no-added-sugar juices, Aspen's favorite crackers, a week's supply of jellybeans and muesli bars, a few tins of fruit, plus powdered diabetic cordial.
We simply taped up the box, added it to our luggage at check-in and it came everywhere with us on the trip.
Komodo island
We flew to Sumbawa and set sail on the Ombak Putih, a traditional Indonesian Bugis schooner bound for Komodo island.
Before we left, we called ahead and found out how the boat crew would deal with a medical emergency, should this happen. We were assured there was satellite phone connection on board and if necessary an airlift could be arranged.
This gave us peace of mind as we knew we were going to be in some fairly remote areas.
The other issue was food. Our carefully planned carbohydrate snacks that we brought with us were not necessary as the boat had plenty of rice, milk, bread, fresh fruit and crackers on board and they operated an all-day snack menu.
At our request they stocked the boat with 100 percent pure juices instead of the high-sugar carbonated soft drinks and made other diabetic dietary adjustments.
The sailing itinerary was well planned. We sailed in the night and every day woke up at a new island. The mornings were spent visiting interesting places by bus and the afternoons allowed us time for relaxation and snorkeling.
On these snorkeling expeditions we had to leave the boat. In preparation for Aspen's diabetic needs, we took the hypo kit and packed the handy extra carbohydrate snacks and felt confident to stay out all afternoon.
We visited some totally isolated and remote islands, with magnificent beaches, tropical fish and beautiful pristine coral reefs. The marine life in this part of Indonesia totally exceeded our expectations. It was nothing short of spectacular.
We sailed for a week through the Lesser Sunda Islands and took in the highlights of Flores, including a trip up to the famous colored lakes. We climbed volcanoes, saw Komodo dragons in the wild, visited tribal villages, enjoyed hot sulfur springs, toured remote places only accessible by boat and enjoyed fantastic five- star food on board every day.
We were able to manage our daughter's diabetes just as we would at home, with her two daily injections of insulin, routine blood testing and regular food and exercise every day.
Hope for the future I would encourage anyone with a love of traveling and a diabetic child to continue venturing to new places. With a positive attitude and a little forward planning it is possible to travel anywhere, even to a remote destination like the Lesser Sunda Islands.
I believe diabetes can be a gift that teaches us so much. As a family we are closer than ever, and for me as a mother, that is a gift.