Alexis at the ruins of the ancient city of Sukhothai in Thailand
It’s barely 10:00 AM, but it's already roasting. We got up before the sun that day so we could see the stunning sunrise over Ankgor Wat, a glorious, ancient and enchanting temple in Cambodia. The scene that morning was nothing short of spectacular, but as my fiancé Jacob and I toured the temple, all I could think about was that the temperature would soon crest 100 degrees and I had to keep my insulin from roasting away to ineffectiveness. Just another day in our three-month trip to Southeast Asia!
Extended Travels with Diabetes
When Jacob and I decided to take an 88-day trip through Thailand, Laos, Vietnam, Cambodia, Indonesia and Singapore, we knew there would be challenges. Besides the language barriers, budget constraints and deciding what islands to visit in Southern Thailand, there was the big looming challenge of traveling with diabetes for an extended period of time. I culled through blog posts on travel and diabetes, and posed questions to other folks who had done similar trips. I researched the best hospitals in Southeast Asia in case of emergency and I had my doctor's notes translated into Thai, Vietnamese and Balinese.
Packing My Diabetes Supplies
Packing was a whole project of its own. I decided to bring all of my diabetes supplies with me on the trip, which meant finding space for 400 needle caps, 18 pens of rapid- and long-acting insulin, 20 bottles of test strips, 10 CGM sensors, lancets, alcohol swabs, glucagon pens, and of course, snacks for low blood glucose. By the time I threw all of that in my carry-on suitcase I barely had room for my clothes. It's a good thing Jacob and I are close, because my t-shirts got re-worn a few times too many on our trip!
For the most part, all the planning really paid off. I never had to deal with trying to get new diabetes supplies – I had more than enough to manage my diabetes well in the chaos of changing cities every few days. It seemed like I had planned for everything. Everything except one thing: the searing, unrelenting, 100+ temperatures of sunny Southeast Asia. It seemed as if each country was hotter than the next. Culminating in the toastiest of them all was Cambodia.
I had tried to plan for this. Each time we moved cities, I stashed my main luggage out of the sun right away in our new hotel room. My main luggage contained all my extra diabetes supplies. When our bags were stored in a cool hotel room, the insulin was just fine. The insulin in my bag was tougher to manage, but by using a self-cooling pouch (that only needs to be splashed with cool water to activate it), I was able to keep it safe. Good to go, right?
Storing Insulin in the Heat
The heat of Southeast Asia proved to be a challenge with diabetes at times I least expected it. For example, sometimes we would need to walk from the hotel to the bus station with our luggage. Even though it might have been a short 15-minute walk, if temperatures were above 100 degrees, that 15-minute glare of sunshine on my bags was enough to render my insulin useless. And once we got on the bus/ferry/train/whatever rickety transport was available, large bags were often stored underneath the vehicle where they would not only be subject to the outside temperatures, but also get additional heat from the vehicle’s engine or wheels. Prime insulin-destroying territory.
So, Jacob and I got creative. If we had to walk more than 10 minutes with our luggage, we would buy two ice-cold bottles of water and I'd tuck my insulin in between them inside a plastic bag. That kept things chilled for at least an hour and we could buy more water if we needed it for longer. I got in the habit of taking all my insulin out of my luggage when we got on a bus or train. I would keep all of it in my purse with the water bottles while my large bag got stashed underneath. While touring during the day I'd refresh my self-cooling pouch every hour with cool water, then wrap it in the shawl I kept with me in my purse (covered shoulders are required to enter many temples in Asia), which kept it from heating up too quickly.
If we were lucky enough to be staying at a hotel with a mini-fridge, I was able to freeze a small re-freezable ice block I had with me, which helped tremendously. And for true emergencies where I couldn't get in the shade or get cold water, I packed six emergency cold packs with me. The cold packs (available at drugstores) are meant for treating sports injuries on the spot, but are a great tool to take for people with diabetes traveling with insulin.
Handling New Situations with Diabetes
Overall, I felt very prepared for the trip in terms of diabetes management, but the one thing that truly surprised me was how tricky it was to navigate the high temperatures in the region. It goes to show you that you can try to plan every last detail, but some things will pop up that you never thought of. If this trip taught me anything though, it's that it can be done; you just have to think outside the box.
Whenever I encounter a new situation in my diabetes management I like to remind myself that I am probably not the first person to have tried to do this. Then I try to find the folks with diabetes who have already done it and get some advice. Just knowing someone has gone before you and made it work really boosts your diabetes confidence. So if you're planning a trip to Southeast Asia anytime soon, know that you can absolutely make it work. And be prepared to buy a LOT of water bottles.