In Which Travel and Diabetes Mix Poorly

Mr. Engineer grew up in Wisconsin. I grew up in Michigan. By a strange twist of fate, we met shortly after moving to Kentucky separately, and that's where we've chosen to stay and raise our children. This is despite the fact that neither of us intended to stay in Kentucky long term.

We love our home, but we don't love the fact that we have no relatives nearby. Since we want to make sure our kids grow up knowing their extended family, and we don't want to break the bank buying plane tickets several times a year, both of our kids had to get used to long drives early in life. 

The good news is, both of our kids have turned out to be pretty good travelers. They've embraced audiobooks, coloring books, and other vehicle friendly activities. Neither child has ever gotten carsick. They did go through a long phase during which we were seriously tempted to leave one or the other by the side of the road because they fought like cats and dogs during every trip, but they've even outgrown that.

However, since February of 2017 we've had an additional travel companion: diabetes. Diabetes has a way of keeping you on your toes when you're traveling. First there's the sheer amount of stuff you have to bring with you, which I covered in yesterday's post. However, the stuff is nothing compared to the blood sugar challenges.

As your activity level changes, you insulin needs change. Normally, Kittygirl's pump settings are modeled after her activity level on a standard school day. We have two additional profiles: one for day camp or other super active days and one for summer, when she's normally more active than during the school year. Sometimes we also turn on one of these during a super active weekend or vacation day during the school year. 

In the case of the camp and summer profiles, Kittygirl needs less insulin because she is more active. In case you don't know, insulin is more effective the more physically active a person is. This is true both of the insulin your body makes and for synthetic insulin like Kittygirl and other people with diabetes use. This is why exercise can be such a powerful part of treatment for people with type 2 diabetes whose bodies are processing insulin inefficiently.

Spoiler alert: when you spend 8-10 hours in a car, it is really difficult for the insulin you take to work effectively. The first few times we took long trips after getting the Dexcom, Kittygirl's blood sugar would go up past 300 the first time she ate something and stay up there for the whole trip.

We're fairly typical Americans when it comes to car snacks. We tend to snack on pretty carb heavy things like crackers, goldfish, chips, etc. For awhile after we discovered how the combination of travel and high carb snacks affected Kittygirl's blood sugar we tried to limit her to summer sausage, berries, and popcorn on trips. However, it didn't feel right to limit Squirrelboy to those things, and it made for an unhappy girl. 

We went back to letting her eat regular car snacks within reason and went back to the drawing board regarding figuring our how to control her blood sugar better within the car. I don't know why it took us so long, but, a few months into getting her insulin pump it occurred to us that we could increase her basal rate while traveling and that might help to keep her blood sugar under control.

We started small with an increase to just 125% and it made a small difference. We slowly upped it until we were doubling her basal for every trip over 2 hours. It has made a huge difference. Mind  you, her blood sugar still isn't perfect on every trip. Today's graph was mediocre. Her blood spiked quite a bit higher than we like to see it several times. However, if I go back in the history and compare it to the Thanksgiving trip of 2018 I can see that things have improved.

Living with diabetes presents challenges in every area of life. Sometimes the challenges are easy to overcome. Sometimes they take a lot of trial and error and you still fail on occasion even when you think you've got it down. Long car trips are our nemesis right now, but I'm told that the might look laughably easy once we start dealing with puberty. We hopefully have at least a couple years before that starts. I'm crossing my fingers for an amazing closed loop system before that time, but I'm sure that even if that happens we'll need to learn how to troubleshoot through the new challenge.

P.S. I chose to focus on car travel here. We've flown once since Kittygirl's diagnosis, but it went really smoothly, so it's not really worthy of comment. Sometime in the next couple years we're hoping to fly to Sweden again (we last went when Kittygirl was 3), so that may merit its very own post.

In Which I Pack for Thanksgiving Travel

Thanksgiving is in two days, and we always travel to my parents' house in Michigan (almost 500 miles away) to celebrate the holiday. We'll leave tomorrow, and my intention was to spend the whole time the kids were in school packing and making sure I had all my ducks in a row for traveling. A small wrench was thrown in my plans when I stopped by Kittygirl's classroom this morning and asked if there was anything quick I could do for her teacher before I left. Long story short, I ended up popping and bagging popcorn for 102 kids - the entire third grade. More on that in another post when it's no longer diabetes awareness month.

I remember back before Squirrelboy was born Mr. Engineer and I could travel for four days and bring two suitcases. For just an overnight or a weekend we might get away with one suitcase. Then after we became parents it felt like we were moving anytime we went anywhere overnight, even for just one night. We'd bring a stroller, we'd bring a pack and play, we'd even bring bottles and formula despite the fact that Squirrelboy was breastfed. Add the huge bag of cloth diapers and a few baby toys and we had quite the haul.

Just as we had begun to pare down our packing when Squirrelboy was in kindergarten, Kittygirl was born and it started all over again. We'd learned a few lessons by then. Kittygirl never really liked the stroller so we stopped bringing it "just in case." It was a whole lot easier to just throw a soft carrier into the trunk. We also drew the line at bringing things like formula that we knew we would actually never use. However, we still brought an awful lot of stuff.

Yet again, we had begun to cut back a bit when what feels like our third child was born - diabetes. Having a child diagnosed with diabetes is like having a newborn in a lot of ways. You're sent home from the hospital with a minimum of instructions and expected figure out how to do all kinds of new stuff and not accidentally kill your kid. There's also a lot of new stuff that enters your world. Instead of diapers, onesies, and breast pumps you're introduced to insulin, glucagon, and test strips.

Diabetes stuff adds an additional bag to our luggage, and I (almost) always pack way more than we're likely to need. Kind of like when I was packing for a newborn, I want to be prepared for every eventuality.

Including two days for travel, we'll be way from home for 5 days. If all goes well with sites and sensors (which is almost always does) we will need to do two site changes, one cartridge change, and no sensor changes while we are gone. We will probably have to treat 2-4 minor lows a day. Because the Dexcom is usually super accurate we may never use a blood glucose meter. If we do, we'll probably use it no more than half a dozen times.

I have packed the following:

2 Dexcom sensors

6 pump sites

6 pump cartridges

10 stickers for going over pump sites/sensors

Scissors to cut said stickers into the cat shapes that Kittygirl insists on

1 bottle Unisolve

Uncounted bag full of alcohol wipes and Unisolve wipes

1 extra glucagon (in addition to the 1 in my purse)

1 extra meter

1 extra insulin pen (just in case the pump fails and the insulin pen in my purse then fails)

2 extra containers test strips

1 container ketone strips

2 large bottles glucose tabs

15 packages fruit snacks

8 juice boxes

Tomorrow just before leaving I will add 1 Basaglar pen and 2 Novolog cartridges in an insulated lunch box with an ice pack.

Yes, it may very well be overkill. Okay, it's totally overkill. Maybe there will come a time when I just throw some amount of supplies that's closer to what we'll really need into a bag. I somehow managed to forget test strips when we traveled for Christmas a couple years ago, though, so now I'm anal about checking off more than we need of everything. Thankfully, after I posted about my need on Facebook a D-mom local to my parents whom I'd never met came to the rescue with a bottle of test strips. I have never yet forgotten insulin, which is the one thing we absolutely positively can't go without. 

Even though my dad comments nearly every time we visit that his grandparents managed to move across the ocean from Europe with only one suitcase, I'd rather be overprepared than underprepared. Maybe this year we'll skip the bag of board games we never play. Then again, maybe not. You never know when a Ticket to Ride emergency might crop up :).