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Backpacking with Diabetes

A lot of people have asked me about my experiences backpacking in Asia being a Type 1 Diabetic. I thought I would write this blog entry about it since others might find it useful too.

For background info, I traveled to Hong Kong, Vietnam, Cambodia and Thailand for seven and a half weeks in total. I've previously also traveled for six weeks in Europe, two weeks in Egypt, and many other one to two week business trips throughout Europe and North America. While some of my trips were quite long, they were not anything like the 6 months or multi-year trips that many of the other people you meet on the road are taking.

Planning Ahead - The first thing I do before going on a trip is to carefully plan how much insulin and how many test strips I will need. I prefer to always bring all my supplies with me. Even if going for a few months this really isn't a problem. At room temperature insulin will keep for around two months and most of the time on the road you will find fridges.

I always plan for many test strips since I find I test more often on the road. This is mostly because life isn't as "regulated" as it would be at home and I'm less confident in my insulin doses. For my Asia trip - even with generous planning - my test strips just lasted to the end and I went to the pharmacy the first day back in Canada to get more. Therefore I really don't think you can bring too many test strips.

For insulin I plan ahead using my normal daily dosages as a baseline. In general I always use less insulin when traveling, so this way I will end up with a comfortable surplus of insulin at the end of the trip. I suspect I use less insulin when traveling since I am much more active. Hot climates seem to result in me using even less insulin, possibly because of the influence of the sun, because I eat less when it is hot, or simply because I'm even more active in a sunny climate. Note that the reduced insulin usage is only for pleasure trips. For business related trips I find I use more insulin, probably because I eat too much restaurant food, sit in too many meetings, get less exercise and am more stressed. Yes, business travel really isn't that good for you.

I also always bring a good supply of sugar tablets (Dextrosol) and energy bars (Clif Bars). These work very well when low on sugar. I recommend Clif Bars over other brands since they keep very well in all climates. They don't freeze solid when it's cold and don't melt when it is hot. Also, they generally taste quite good. Dextrosol tables are always good to have, although they tend to get soggy in humid climates.

Caring for your Supplies on the Road - One of my main concerns going to hot places was keeping my insulin cool. However, I've never had a problem with this. Almost all hostels or guest houses I have stayed at had either a shared fridge or a fridge in the room. Especially in Asia it is very common for the guest houses to have a mini-fridge in the room. That means I can easily leave my insulin in the fridge during the day. Basically the only time your insulin isn't refrigerated is while you are traveling from one place to another. This means that even for longer trips it shouldn't be a problem bringing your insulin, since it will last a long time when refrigerated.

I have also never had a problem with theft of any kind while on the road. This may just be lucky, but in general I think leaving your medical supplies in a shared fridge is fine. I don't think anyone would have any interest in stealing that. Still, for safety I do always keep one vial of each insulin type and extra test strips in my backpack. When I need to refill my pen I use a vial from the backpack and then replace it with a new one from the refrigerated supply. This ensures that even if my main supplies get lost or stolen I still have enough to last for at least a week.

Getting more Supplies on the Road - This is an interesting problem I've never had to deal with. In general I would assume this is only a problem in the developing world. In developed countries you should be able to get whatever you need, although the expenses will probably be out of your pocket. Even in the developing world the pharmacies in the bigger cities seem to be well stocked, although they might not have the exact brand/type you are used to. For example, in Thailand I checked in a pharmacy in Samui and they had blood glucose meters and test strips, but only for one type of meter. Samui is a smaller town, so I bet in Bangkok I could have gotten what I wanted.

I try to save the sugar tables and energy bars I bring along for emergency situations and use local food instead. Coca Cola seems to be readily available in even remote places. Carrying around a can/bottle of coke to use in low sugar situations is a very easy solution. Buying fruit at the market is always possible, but it doesn't keep very well in a backpack. Finally each country usually has some sort of local snack that you can buy at the markets. For example in Asia one can always find various nut-based snack bars that are held together by caramelized sugar. These keep very well and work great for snacking or when low on sugar.

What else to bring - Bringing a dry bag is a good idea when spending time on or near the water. It's great for carrying the insulin pen, test kit and food, for example when kayaking or boating.

Buying one storage bag for all supplies is a good idea. I bought a nice first aid kit bag at MEC and use it for all my test strips, insulin, needles, sugar tablets, etc. Then I can just take the whole bag and put it in the fridge or put it in my luggage. It holds everything together and keeps it organized.

Also, make sure you bring a letter from your doctor explaining that you need your medical supplies in carry on luggage. Since 9/11 I've always carried one with me but have so far only needed it once: in Hong Kong before flying back to Vancouver.

Hong Kong and Home

I survived the Full Moon Party and made my way back to Hong Kong. The party was pretty cool, but not as crazy as I expected. I'm not really sure what I was expecting, but basically it is just like a giant club right on the beach. There's a bunch of different stages that play different kinds of music. Techno, club music, hip-hop, etc. It was definitely way more packed than the previous night with a couple thousand people on the beach. Boats were dropping off people directly on the beach coming from other islands and beaches. I was pretty tired from the previous night, so I ended up taking it pretty easy during the Full Moon Party. At least I got to take it all in. Overall the coolest part for me was from the first night when an awesome band played. It could have been Bob Marley himself up on stage.

The other cool thing was all the fire dancers on the beach. There had been fire dancers on Ton Sai Beach also, but the guys at the Full Moon Party were just over the top. It was unbelievable how fast they moved, tossing flaming sticks way up into the air and all sorts of other crazy moves. In general there was a lot of stuff with fire, such as: the flaming limbo stick, the giant burning skipping rope, the ring of fire, etc. It makes perfect sense if you think about it, get people drunk and let them play with fire. ;-)

Anyway, after the party I had a day to recover then I flew to Hong Kong. I got there on July 1st which happened to be the 10 year anniversary of Hong Kong's return to China. I had no idea what was going on, but the friendly lady at the tourist info told me about the fire works that night. They were by far the biggest and longest fire works I've ever seen. It was almost ridiculous how long they went on, I think something like 45 minutes?? I'm not sure, but it was cool to see. There were thousands of people lining Nathan Street and the area around the art museum. I only got about half way down Nathan Street, so the fireworks were framed by skyscrapers on the left and right. It was pretty cool to catch this, especially since I had no idea about it before.

Now I'm back in Victoria sitting in my parents living room. It's almost surreal to be back here. Everything in Canada is so clean and tidy and organized. And there is so much space and it's not all crowded with people. Wow! It's going to take a while to get used to this again. :-)

Thai Cooking

This morning I took a half-day Thai cooking class. It was good times and I learnt how to cook the different kinds of currys and other dishes. The class was in Ao Nang which is a town about 20 minutes by boat from Ton Sai beach. I'm going to spend the rest of the day here and check out the place, although it is not very big.

Tomorrow afternoon I'm going to leave Ton Sai beach for the full moon party. A bunch of other people from the beach are coming along too, so it should be fun. It is definitely low season now. The weather is not as nice as before (more cloudy and rainy, but still not too bad) and we are down to around 15 people at the beach. With around eight of us leaving tomorrow it's going to get really quiet there.

Climbing, Climbing, Climbing

I've been at Ton Sai Beach a few nights now and I really like it. I'm going to stay here until the end of the trip when I'll head to Kho Phanang for 2-3 nights to check out the full moon party. There are about 35 people staying here at the beach and every morning we all meet for breakfast. Then different groups of people split off to go kayaking, snorkeling and of course rock climbing. It's really great and everyone gets along very well. There are people from pretty much all over the world here: Germany, Austria, Switzerland, Italy, Britain, Iceland, Holland, Sweden, South Africa, Australia, New Zealand, USA, Singapore, Malaysia --- funny enough I am the only Canadian. The whole place just has a really awesome vibe. After a day of climbing everyone meets again for dinner and then a few drinks at the beach side bar.

I've been climbing some pretty difficult routes. The easiest routes close to the beach are 5.10a/b. Everything else quickly gets more difficult. I've seen some really amazing rock climbing around here. Since there aren't many easy routes and most of the other climbers are really good I've been pushing myself and climbed a 5.10d today. Pretty big achievement and I feel great. I've also been learning how to lead climb which still makes me pretty nervous. :-)

Tomorrow we are going deep water soloing. Basically you get in a boat and pull up next to a cliff. Then you climb as high as you can or feel comfortable doing and then just fall back into the water. It should be fun.

Also, I should say that I totally jinxed the weather with the last blog post. It rained for almost three days straight afterwards! Today it is sunny again and luckily many of the climbing walls are protected by overhangs so you can climb even when it rains.

Ton Sai Beach

I'm at Ton Sai beach now. It's the hangout for rock climbers and a really awesome place. Very laid back and rustic. There are a lot of little bars along the beach that put pillows and blankets out at night. Some of these places are just built out of driftwood. Then you sit on the beach, have a drink, listen to some relaxing music, and reflect on the day of rock climbing. Pretty awesome. They only have power and Internet here in the evening when they throw on the generators. Other than that there is no power. I'm staying in a nice little bungalow set back from the beach for just $3 a night.

The rock climbing here is incredible. A lot of the routes are really hard, lots of 5.12, 5.13 and higher. I've been taking it pretty slow, but tomorrow is going to be the first full day of climbing. There are some easier routes along East Railay beach which is where I'm heading tomorrow. I did complete a 5.10a/b today, so that was a good start.

Because it's low season there aren't that many people here and a lot of them are very experienced climbers. That is good for getting advice, but at first I was worried about not finding anyone to climb with. Now I did end up meeting a few other average / novice climbers, so that is who I'm going climbing with tomorrow. The rock here is really interesting to climb with many overhangs and also stalagmites that you can use for climbing.

Ko Phi Phi Pictures

I'm leaving today to catch the ferry to Railay beach. Everyone (including Brandie at the office) says it's supposed to be awesome. I'm probably going to stay at nearby Ton Sai beach which is where most backpackers stay. It's also the main rock climbing area, so I think I will stick around for a few days to rock climb. I've attached a couple pictures from Phi Phi to this post.

Also, it rained for the first time last night. Other than that the weather has been awesome. In fact, it hasn't rained since my last blog post where I said it rains every night. It just did that for three days in Cambodia and then stopped again. Even if it does rain it only lasts for a few hours at most. Thailand is not as hot and humid as Vietnam and Cambodia, so it's much more pleasant. Basically, I'm just not sure why it's not more busy here. It seems they could extend the high season by a few weeks with no problem. Or maybe I'm just really lucky with the weather?

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