Well, not alone. He will be traveling to Italy with a group of scholars for an educational tour and leadership summit in Milan. By alone, I mean: without me.
We have a few months to prepare. I plan to simulate the experience at home as best I can. This will include Italian cuisine, varying levels of exertion, and the most challenging aspect: independent overnight care. This is the only area where Caleb is usually not involved. I prefer he sleep and let me do the number crunching.
Since Caleb was diagnosed with type 1 diabetes, I’ve been committed to not letting diabetes drive decisions about what he does. Having an older son has helped. We let Colin travel to Prague last year with his school jazz band. So when Caleb showed an overflowing enthusiasm about applying for a scholarship for a Global Summit to Europe, I knew I could not discourage it.
The fact that Caleb himself was not letting the thought of managing his diabetes alone in another county deter him is a significant progression in his self confidence.
So here we are. On Friday he received the news that he was awarded the scholarship. After initial shock, I’m in planning mode and am asking you for advice and suggestions.
We traveled as a family to Italy last summer. Blood sugars worked out pretty well as far as vacations go. Lots of increased basals overnight and extended bolus’ to deal with pastas, pizzas and gelatos. Temp basals to deal with daytime activity of walking seven miles a day in August heat resulted in no traumatic events. So I have an idea of what to do. Caleb does as well, but I was the one making the lion’s share of those decisions, so he needs to hone these skills.
The biggest issue is that Caleb just does not wake up at night. I hear Dexcom’s urgent low alert from his phone on the other side of the house and it wakes me up. It’s next to his head and he doesn’t stir. Given the complexity of activity and food, I think it will be necessary for Caleb to check at some point each night. But he has to wake up.
Here are some of my current considerations:
- I’d like to try a split basal regimen – half long acting insulin, half pump basal insulin. The reasoning behind this is I found that the margin of error was more forgiving when Caleb was on injection therapy. The longer action of NPH he was using seemed to soak things up like a sponge, whereas all fast acting requires a more laser precise dosing amount. This, however, was 10 years ago, when he was 4 and newly diagnosed.
- For months, I’ve been trying to figure out if we can get a #DIYPS project going . Caleb is an OmniPod user, and we have no current access to a compatible pump for this project. I’ve gone through the websites and forums, and am simply having trouble figuring this all out. However, given the reality of this now, I’m going to give it another go. I am welcoming of any help, aka: handholding, anyone is willing to offer. This seems like the ideal scenario for Caleb, and a commercial option won’t be available in time for his trip.
- I will definitely make sure he has international cell service and am interested to know if anyone has experience with “following” Dexcom internationally.
- New Dexcom inserter?! I’ve been watching for this – I thought it might be available by now. This will make one thing easier. Anyone with any info?
- I am always open to new fast acting carb ideas, particularly those that can travel in the heat.
Thank you for any input, suggestions, shared experiences and ideas!
This is Caleb... 
I wish I had some advice. When Kay was about same age I went WITH her to Mexico and was still nervous. So I am sending support-you-to-the-moon -and-back vibes. So wish I had advice.
What an amazing opportunity for your son! I have no experience with pumps or CGMs but I’m a mum of a son with t1 and a teacher in Australia who will be taking a student with T1 to Canada later in the year.
1) does your son speak Italian? Get a couple of small laminated wallet sized cards in Italian which explain about his diabetes. I take trips overseas with my students every two years and have always done this for those with medical conditions. It gives them confidence and they don’t have to worry about explaining. I can help you do an Italian one if you needed.
2) my son has no night time hypo awareness and it’s the think that scares me the most too! He uses insulin pens though. He recently went to the other side of oz on a cricket trip and I was lucky enough to have him stay with a family where the mum (who has a sister with t1) got up every morning at 3am to wake him so he’d check his levels. I will do the same for the student I’m taking to Canada. It might not be the same situation but is there anyone going who could wake him up?
3) Frio packs for insulin storage. They are the best and far more reliable than fridges whose temps can be way out.
You probably just need help with the technical end and have this stuff covered as you’ve travelled before but you never know, it might help! Good luck with it all! Maureen
I was scared to death of going to Beijing by myself on a business trip last September, I was not afraid going by myself to London. My main fear was that they would not know what my supplies were and would confiscate them at the border. My second fear was that I would pass out (has not happened in the 6 years since diagnosis) and no one would know what to do despite wearing a Medic Alert tag . I did have a colleague who was meeting me there, and so once I got there I was comfortable.
In the end , it all worked out ok. I ran a little higher than normal with the local food, and I did not get aggressive with corrections. No problems at the border.
I am far more comfortable traveling in Europe as I know the medical systems there are knowledgeable about diabetes and I am more comfortable with the languages. Since you went as a family to Italy already, you know how it all works, and that should give both you and Caleb comfort.
The first time I traveled I was not on the pod , and my endo suggested cutting my daily basal dose 20% on the day of travel just to provide some margin with the extra exertion. With the pod , I am more comfortable making such changes on the fly. Sometimes I create a travel basal program with lower basals just to be safe/compensate for the higher levels of activity. You may want to remind Caleb to change the time on his pump and Dexcom when he arrives.
The nice thing about technology today is that phones just work overseas….and you can be in touch with him as easily as you could at home. It may cost money, but the peace of mind may be worth it.
Would using the Share help? We had free coverage through T-Mobile in Germany and were comfortable leaving our 8-year-old with a friend at a kids-only playground for half a day, because we could see blood sugar (he had low treatments with him). That’s nowhere near a whole trip, but if you can get the coverage and another adult and/or friend on the trip can be a backup and have the Share on their phone, maybe that would be the safety net you need? So great that he’s doing this!
We tried the split basal thing last summer, because I too, remembered how much more forgiving the long acting insulin basal was then the fast acting insulin in our daughters pump and I thought it would be great for summer with swimming she wouldn’t have to worry how long her pump was off. Our endo was very supportive and encourages us to try new things. However the long acting insulin was NOT as wonderful as I had remembered. AND there was definitly a lack of control that I missed with using our pump basals, and once the injection is in, it’s in, no turning it down, no shutting it off. Now I will say that we tried the majority of her basal with the long acting insulin and just a very small amount coming from the pump. We did not do half and half it was more 90/10. It didn’t last long, it was frustrating. The moments I remember of it being wonderful, I think, fully belong to the honeymoon phase, unfortunately. But if you do decide to give it a try, I would give yourself several months to try it before he leaves because it can get tricky. After we stopped doing it our endo informed us that they had a feeling that we might give it up because they see it happen all the time when people try it. You never know though maybe it will be just what he needs during his trip. But I just wanted to share our experience with it.
What an exciting opportunity for Caleb. When I was 20, and my younger brother Jon, who has diabetes, was 17, we traveled alone to Europe for a two week trek before I settled in for a semester abroad. I know my mom was very nervous as we left her at the airport. I was nervous too. My brother had, by that time, become very good at managing his diabetes, but, as our plane took off, I realized that I was the “adult” for the next two weeks of our lives and I had to be on my game too! Jon and I traveled throughout Switzerland, Germany, Amsterdam and ended in London. We had a fantastic time, without any incident whatsoever. We also learned a lot about ourselves, and my brother’s confidence in managing his diabetes definitely was enhanced through this experience. These were days prior to insulin pumps, so we had to have a lot of paperwork ready to get my brother’s supply of syringes through border stops and airports, but we managed.
Best of luck!!