Travelbetic.

Preparing for a Month Long Surf Trip with Type 1 Diabetes – What to Pack and Tips for Managing Blood Sugar Levels

Nothing quite rivals the feeling of anticipation leading up to an epic trip. Teaming with excitement as I type this from the terminal gate, waiting to board my flight to Costa Rica, a month of tropical weather, hollow waves and no worries await me. But for me and my fellow type 1 diabetics, pre-travel anticipation is compounded by the stress of ensuring we are prepared to manage our blood sugar in unfamiliar, ambiguous and sometimes adverse environments. Careful planning and precautions must be taken when traveling for extended periods, especially to places where medications and supplies are not readily available. In this post I’ll share with you how I packed, prepared and planned to manage my diabetes on this month long Costa Rican surf adventure. As well as provide updates throughout the trip to tell if my preparations were sufficient or if further adjustments are needed.

What to Pack
Playa Negra, my destination in Costa Rica, is a village about 2 hours from the closest hospital and some 2,000 miles from my local CVS Pharmacy. So it is imperative that I packed everything I will need and more.  I packed back ups of my back ups’ back ups. Without them, in the case of lost or stolen supplies, I would be, as they say, sh*t out of luck. Here is a list of some essential (and hopefully not too obvious) items and tips for packing your diabetes supplies on a trip such as this one. Since I have chosen to not be on an insulin pump or constant glucose monitor my needs may be different then yours (I will discuss this decision in a future post.)

The Essentials 

Before embarking on a trip of this length be sure to refill all of your prescriptions. Then bust out the calculator and carefully plan what to take based on your daily needs. Here is a quick breakdown of the essential diabetes supplies I packed.

  • Insulin pens – 7 short acting Novolog pens & 5 long lasting Toujeo and Lantus pens. (I choose pens over an insulin pump because its nearly impossible to surf with a pump.)
  • 200 Ultra Fine Pen Needles
  • 3 Freestyle Glucomoters
  • 200 Freestyle Test Strips
  • 250 Alcohol Prep Pads
  • 150 Lancets

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Travel Case 

When packing for a long trip it’s important to stay organized. Special diabetes travel cases make organizing your supplies and medication easy and compact. There are even travel cases equipped with a sleeve for an icepack to keep your insulin cool such as the one pictured here. My travel case goes in my carry on bag so that I can keep an eye on it.

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Multiple Glucomoters 
The most important part of managing type 1 diabetes is closely monitoring blood glucose levels. This is impossible without a glucomoter. Pack a back up in a different bag than your primary glucomoter in case something happens to it, or the bag. I packed 3 for this trip, 1 in my fanny pack that never leaves my hip, 1 in my checked bag and 1 in my carry on. Also be sure that your back up glucomoter uses the same test strips to avoid having to pack different kinds. Also don’t forget a back up lancer and lancets!

Insulin Temperature Regulation 
As I am sure you know, insulin must be temperature regulated or it becomes useless. Once insulin reaches room temperature it has a half-life of about 30 days. Pack a small cooler with a couple ice packs for your insulin and strap it to your carry on bag. Be sure the ice packs are completely frozen upon arrival to the airport. Any partially melted gel or ice will not be allowed on the plane. It is also a good idea to declare the ice packs to security agents before going through security check. This will save you from any extra hassle. Don’t forget to put your insulin in the fridge and ice packs in the freezer when you arrive!
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Costa Rica is close to the equator, meaning it’s going to be hot, insulin doesn’t like hot. In order to keep my meds at a proper temperature while on the beach and hiking through the rain forest I will keep them protected in my Frio sleeve. This must have for any active type 1 diabetic keeps insulin cool with water activated gel crystals. I’ll be posting my review of this awesome product soon!

Tons of Glucose Tabs, Sweet Tarts (or preferred fast acting sugar)
Pack loads of fast acting sugars such as Sweet Tarts (my preferred method) or glucose tabs especially if you will be surfing or staying very active everyday as I will. These items may be hard to come by in more remote areas so take plenty. No one wants to ruin a day of vacation by struggling with hypoglycemia.

Glucagon Syringe 

With the amount of surfing and physical activity I will be taking part in, dealing with hypoglycemia is one of my main concerns. While I have plenty of Sweet Tarts, a glucagon pen is good to have on hand in case my sugar gets too low and I am unable to manage on my own. This life saving medication is essential to have around and its important to teach your travel companions how to administer the injection in case you need it.

Travel Letter From Your Doctor and Copies of Prescriptions 

With the continuous increase in airport security it is always a good idea to keep these items in your carry on luggage in case your insulin or diabetes supplies come under question by security agents.  A travel letter should plainly state that you are diabetic, under the care of an endocrinologist and that all supplies are required for your health.

Diabetic Alert Tag 
You never know what could happen while traveling. In an emergency situation its important that EMTs and other medical staff know you are insulin dependent. If you don’t already, wear a diabetic alert bracelet, necklace or other tag that clearly states you are on insulin. Or get a diabetic alert tattoo! (I have an appointment to get mine when I get back!
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Back Up Kit – Be Prepared for the Worst Case Scenario 

Each piece of luggage should have everything you need to survive in case one is lost or stolen. Sacrifice a couple pens or vials of insulin as back ups and pack them in your checked bag. They won’t be kept cool and will therefore go bad soon but they will be there in case your insulin cooler goes missing. Better safe than sorry!

Insulin Dose Adjustments and Carb Loading 

Before my trip I made an appointment with my endocrinologist to discuss my diabetes care regimen while abroad and refill all my prescriptions. Parallel with mine, my doctor’s main concern is hypoglycemia caused by over activity while surfing. Currently I am on an insulin dose of 23 daily units of long acting Toujeo and a bolus ratio of 1 unit of Novolog per every 10 grams of carbs I consume. My endo suggested I half my long lasting insulin (Toujeo) dose to 11 units a day and avoid bolusing for meals prior to surfing. (::Disclaimer:: these adjustments were recommended to me by my doctor based on my individual health. Consult your doctor before adjusting insulin doses).

*Update*

So far, after the first 5 days, the above adjustments have worked pretty well. I have only had 1 low after a long surf session, most likely caused by not eating enough carbs at breakfast. I have had a few high blood sugar readings in the morning caused by the lower Toujeo dose. When this occurs I correct with my fast acting insulin and then eat a carby meal without bolusing before I paddle out. 

*Update 2* 

After a scary low following a surf session and continued high readings in the mornings I decided to start taking my long lasting insulin dose at night before bed. I also devised a method for keeping all of my supplies cool while leaving them on the hot beach. I place my fanny pack in a 1 liter Sea to Summit dry bag (a great xmas gift from my aunt) inside my insulin cooler with an ice pack. This keeps my test strips from getting too hot and granola bars from melting. 

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*Update 3*
Woke up from a deep sleep last night, shaking and sweating. Knew immediately I had gone hypo, and knew exactly why. A new swell filled in yesterday so I surfed my ass off before dinner. Ate a whole pizza to myself and administered my normal bolus rate for that amount of carbs (9 units) then went to sleep. Big mistake! Totally forgot to lower my bolus ratio after the long session. Always be cautious of meal boluses after extended physical activity! Other than that everything has been gravy. Still playing around with carb loading quantities and meal times and having to get out of the water to check every couple of hours. Don’t we know how much of a guessing game type 1 can be?! 

Also, a question arose this morning while checking the surf after breakfast. How long is it safe to leave a meal uncorrected before performing physical activity? I ate breakfast at 7am today (french toast and eggs) without any insulin, and didn’t paddle out until 9:30. My bg was 295 just before hitting the water. Not bolusing was the right call because I was at 68 after my session but I am little nervous about the onset of ketones during these carb loading periods pre-surf. Any ideas how quickly ketones can enter the blood? 

Hopefully you found some useful information here. It definitely helps me to write down and recollect my thoughts and if I can somehow help others through this process it would bring me great fulfillment.

Thank you for reading and if you have any comments or questions feel free to email me at zachtoth91@gmail.com. Pura Vida!

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3 thoughts on “Preparing for a Month Long Surf Trip with Type 1 Diabetes – What to Pack and Tips for Managing Blood Sugar Levels

  1. Diabetes Life Balance

    Great list and tips! We learned the hard way in Costa Rica (Playa Guiones) that pumping and surfing is rough mix. Especially if your out for hours. I got really high ketones because I didn’t eat enough and then didn’t bolus at all before hitting the surf. The combo of not enough carbs for energy and not enough insulin to use for the carbs for energy, made my BG skyrocket and ketones come quickly. I avoided a trek to the hospital by eating a good amount of food and drinking a ton of water, along with lots of extra insulin. It was a rough few hours though. Keep us posted!

    1. travelbetic

      Thanks! Interesting that your BG shot up from lack of carbs while surfing. I am always concerned about hypoglycemia in the water and usually eat a very carby meal without bolusing before paddling out. Crazy how every type 1 is different! Thanks for commenting