Diabetes and the Aussie Adventure

We’re back from Australia — have been for about 30 hours. That, coincidentally, is about how long our Friday was. As always, the first night we slept soundly due to being completely wiped out by the trip home; but the second night (last night) the jet lag hit. Usually, I have a loud soundtrack going through my head the moment that I wake up too early after a trans-oceanic flight; but this morning it was a small murder of crows that woke me up, and then the soundtrack kicked in once they moved on:

As I write these lines, I’m “watching” the Tour de France prologue and waiting for my temporary basal insulin rate to kick in, since I’m going to go for a run in a few minutes. This will be my first since Alice Springs about three weeks ago. That morning was cold! So cold — 3ºC — that I could see my breath, shivered whenever I stopped to photograph birds or whatnot, and wished that I’d brought a long-sleeve running shirt. (Today we’re supposed to have big-time summer heat at home. Lisa is already out for a walk, not having slept at all overnight.) Despite the lack of running, I managed to lose weight on vacation — though I was quite surprised to see the number of the scale. We’ll see how much all of that hiking and walking has helped with my muscle tone and how much “outback lunch” has hurt.*

Testing in Watarrka NP, Australia

Testing in Kata Tjuṯa

Time passes . . . Running went well. No jiggly-ness in places where there shouldn’t be. No gasping for breath. No sluggishness. No hypos or high blood glucose readings. Those are all good signs. I guess we did manage to keep active on our trip, probably more throughout each day than we typically would have been sitting in front of our computers at work.

All that activity wasn’t enough to reach blood-sugar nirvana right off the bat, though. In fact, it was kind of a weird diabetes trip, all things considered.

First off, I’ll get a confession out of the way. I’m pretty obsessive when it comes to traveling with diabetes. I carry almost twice as many supplies as I’m going to need, and I worry that I’m going to forget stuff.

I bring more supplies (even though they take up a ridiculous amount of space) because I almost ran out of infusion sets in Chicago in 2003 when I got a bunch that I just couldn’t get to work and had to keep changing them until on the morning of my return I was contemplating how to give small amounts of insulin by syringe for the next ten hours.

Diabetes Supplies

Diabetes Supplies

And I worry about forgetting supplies because in the past I (a) left my meter at home at the beginning of a two-week road trip and had to buy a new one in Milford, CT, (b) I left my insulin in the minibar fridge in Shimla, India and was lucky enough to have one of the hotel staff track me down on my way to the railway station, and (c) I didn’t bring a quite enough insulin with me on an unexpected trip to Kansas last year.

So I obsessively carry lots of stuff with me. On this trip that really came through for me.

See, my pump broke in the middle of nowhere in the Northern Territory of Australia about three weeks ago. Yup that’s right: dead. A button on the controller got stuck, and that was enough to cause the pump to give up the ghost.

This isn’t the first time this particular error — “Button Error” — has happened to me. In fact, it happened about a year ago. In the US, this is an annoyance: Call Minimed, explain the problem, have a new pump the next day. In the interim, I’ve used my older Minimed 511 pump. (It uses all of the same supplies and is mine to keep because my health insurance system lets me get a new one every five years or so; and Minimed is eager to help me get the latest model.) It’s a pain, but it could be much worse.

But in the Outback in Australia. In a campervan. Without a fixed itinerary, without my own phone, without the Internet. It’s a bit more difficult. I had my backup plan, but it was now only one failure away from EPIC failure. My safety net needed me to do something. Fortunately, I had three things going for me:

  1. I brought a backup pump.
  2. I had the foresight to bring the list of Medtronic Minimed distributor phone numbers that comes in every box of supplies.
  3. I have a naturally sunny and charming disposition. Okay, that’s a bit of a stretch, but I wait to freak out until after I’ve taken charge of the situation.

Getting a replacement pump in Australia is not the same 24-hour experience as it is in the USA. First, dial Medtronic Minimed from a pay phone. Hang up. Deposit 50 cents. Dial Medtronic Minimed. Tell them I’m in the Northern Territory. Hang up. Dial the free call number (1800 777 808). Listen to crappy hold music. Get connected to US Minimed tech support. Explain the problem. Tell them I’m in the Northern Territory. Get put on hold. Listen to more crappy hold music. Give them the location of my next fixed address in Alice Springs in a week. Tell them to have the Australian office leave a message on my home voice mail (which we were checking via Skype when we had Internet access) if they need to.

Me in a phone booth calling Minimed in Australia

A week later, show up in Alice Springs. Find no pump at the hotel. Get on Skype with the Aussie office of Minimed. “Your pump left Hawaii this morning. It should be there in a few days when you return to the same hotel after going to Watarrka and Uluṟu.” Go to Watarrka and Uluṟu. Pick up new pump about two weeks after it failed. Program all of the settings that I had (fortunately) written down on an index card I keep with my meter… you know, just in case. E-mail nice dude at Aussie Minimed to ask what to do with the broken pump. Put the pump in my luggage as a souvenir until I get home.

Swapping out the pump

My 'new' pump

So what did we learn for the next time?

  • Assume that a pump is going to fail at some point. Over the last decade, I’ve had at least two fail with the “Button Error” locking failure and one fail with a motor sensor problem.**
  • Carrying a backup pump is a necessity (if you have one).
  • When leaving the country, bring along Lantus or some other kind of long-acting insulin as the backup plan for the backup plan.
  • Carry manufacturer contact info.
  • Wait until you get to the US (or home) before contacting Minimed about getting a replacement pump. I suspect supplies would be easier to get if they got lost, etc.

Other than that, diabetes didn’t really affect my trip any more than normal. Hiking and swimming are things we do frequently, and I managed the trip to the Great Barrier Reef pretty well. I probably could have used a little more insulin before disconnecting my pump and putting on my wetsuit; that’s good to know for next time, but this was the first time, and I feel it was a good trade-off.

112 mg/dL reading at the beach

Not exercising and changing my diet and eating schedule exposed a few problems with my basals . . . or at least required some changes. After those changes, I did pretty well for the rest of the trip. Sitting on a plane for long periods of time is going to suck for so many reasons, so just increase every bolus insulin dose 10% and hope for the best.

Now it’s late, and I’m hoping for a bit more sleep tonight. Wish me luck!

* — Remember, “outback lunch” = ice cream + chips/crisps + Diet Coke + optional Oreo cookies.

** — I suspect, but cannot prove, that this is related to water getting into microscopic fractures in the pump casing. I try to keep the pump dry, but I’ve noticed it twice after steamy summer exercise sessions. So I’m trying harder to keep the new one in a less humid environment, putting it in a plastic zippy bag when I run or ride and keeping it out of the steamy bathroom when I shower. We’ll see. Let’s hope the FDA takes notice.

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