Traveling with a diabetic child
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.