The ground shook under my feet. The customary wail pierced through the rumble of the crowd. As the train strode into the railway station, its regal light infused the platform with a golden glow. This juxtaposed well with the darkening blue sky. I tried to reach my compartment. However, it took time as I had to move against the tide of people trying to move in the opposite direction. Finally, as I was boarding the train, my feet seemed to tremble. I realised then, that I had missed the green signal and the customary whistle. This meant that as I was climbing onto the train, the train was already in motion. I almost slipped and fell back onto the platform. Fortunately, a strong arm grabbed my arm and firmly pulled me into the train.
“Hi, take it easy,” he said. He looked to be in his early twenties and appeared lean and wiry, yet strong. “Thanks,” I replied.
Later we found that we were on adjacent seats on the train. I was traveling for a meeting and it turned out that Amol (that was his name), was going to attend a relative’s wedding. We chatted away. It had started raining outside the train, which was now gathering speed.
At 8 pm, dinner was being served on the moving train. Today it was a railway thali, that famous Indian plate of rice, roti, curry, fried potato, dal, salad and pickle. As we were about to eat, Amol opened his bag, took out a pencil box. Inside was an insulin syringe and vial (those days insulin pens were expensive for most common people). The box also contained a glucose meter and lancet. “You have Type 1 Diabetes, “I said. “Why didn’t you tell me?” “Doctor, you didn’t ask! And now let me ask you. My blood glucose is 180 mg/dL and I am going to eat this meal. Traditionally I take 18 units rapid acting insulin before dinner. How much should I take now?”
Quickly, I told him about carbohydrate counting and explained that we would have to first increase the insulin dose a bit because his pre-meal glucose was high. We also needed to increase the dose even a bit further given that tonight’s meal was carbohydrate rich. After thanking me, he injected the new dose of insulin and we had the meal together. At night, before he slept, he took his bedtime dose of long acting insulin. My destination arrived that night itself. As I got down from the train, I found that the rains had just stopped. I said goodbye and wished him well.
Mr. Amol had Type 1 Diabetes - a condition where the body is unable to make insulin. Such people need insulin injections lifelong. In the human body insulin is produced throughout the day (basal insulin) and a small burst (called bolus) of insulin accompanies the meals bringing down the blood glucose. Thus, people with Type 1 Diabetes require a long acting insulin at bedtime and three or four shots of short acting insulin, one with each meal. This insulin can be given more accurately via an insulin pump. The newer pumps can even give insulin after continuously monitoring glucose. However, these advanced technologies are not available for common people because of the cost. But among my patients using insulin pump, glucose control is much better.
Traveling with Type 1 diabetes or any type of Diabetes is a chore. Carrying glucometer, lancets, injections, cartridges, strips,sensors,readers,not tomentioninsulin pens and pills and needles: all this makes itvital to have a checklist before travel. Then there is question of traveling across time zones, during which people with Diabetes have to periodically eat in moderation, to prevent very high as well as very low blood glucose levels.
For those trekking in the icy mountains or the hot deserts, injectable treatments for diabetes have to be carried carefully. Indeed, for people with insulin dependent Diabetes who are traveling to very high altitudes with constant snow, it is advised to keep their “friends close but the insulin closer”. The body warmth could help prevent the insulin from freezing and thus getting damaged.
These are just some of the many travel tips that you will find in this special issue of Diabetes Health, with our cover story focusing on traveling with Diabetes. “Not all those who wander are lost,” wrote the legendary author JRR Tolkien. In this issue, even as you wander during your travels, we will help you with tips for traveling safely if you have Diabetes.
We guide you on carrying the right gadgets, following good physical activity and eating the right food during travel. So that you can wander, but never feel lost about what to do with your Diabetes when you are on travel! Wishing you a happy and healthy summer ahead!