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Travelling around the world with diabetes ?


Six months before I set off, I decided to have a series of medical check-ups so that I could travel with peace of mind.

The first was to analyse my blood and get a true picture of my health.

My main fear was cancer, because in my family we've had and still have various cases, so the expression 'better safe than sorry' made perfect sense.


The results arrived, my doctor asked me to come and see him and his first question was: when was the last time you had your blood tested? I told him it was in 1995, when I was pregnant with my son. I could see by the look on his face that he wasn't very happy.

He tells me the figures:

  • Cholesterol - 359 when I should be between 100 and 130

  • Sugar - 262, which should be between 80 and 150

  • HbA1c - 12.6%, whereas for a 65-year-old it should be between 6.5 and 7.5%.

I grimace, it doesn't look good, but I don't yet realise the consequences. My doctor tells me that I urgently need to make an appointment with an endocrinologist to find out if I'm diabetic and if so, what type: 1 or 2.

Am I diabetic? The image that comes to mind is insulin. Hell, I don't even want to inject myself.


An appointment was made with the endocrinologist at the AZ Sint Jan Portaels hospital in Vilvoorde.

This was no longer a laughing matter; my doctor was very serious and didn't respond to my sense of humour. She told me that, given the abnormally high levels, I had to go back to the diabetes clinic for 3 nights to have tests and a scan and to learn about diet. I'll be having insulin injections.

I try to find a solution, but she tells me that I'm not responding to the medication, that my pancreas must be so saturated with sugar that it's no longer responding and isn't eliminating it properly.

She wants to try to eliminate the sugar, reactivate the pancreas and see in September if I can, when I go on the road:

  • continue without insulin, perhaps with medication only;

  • have just one injection a day of slow-acting insulin;

  • continue with 3 injections of rapid insulin and 1 of slow insulin a day.


What is a diabetes clinic ?

It's a clinic that provides treatment for diabetics, teaching them how best to control their blood sugar levels and avoid chronic complications in the long term.

We have a treatment plan, learning what diabetes is and how to use an insulin pen, dietetics courses, psychological advice and information on how to look after our bodies, such as foot, eye and dental care.


In my head, I'm ready. I tell myself that I've made the most of life for 65 years, eating what I wanted, drinking soda, juice and cola to my heart's content, naturally overdoing the quantities, the cakes and our Belgian cheeses... The rates prove it, so I might as well comply with what the medical staff tell me to do, because frankly, I want to enjoy life for 20, 25 years in good health.

You've read that the van isn't cheap, I've invested quite a bit of money in it, and my desire to travel is great .... Sacrificing chocolate and other sweet things won't be an obstacle to my travelling dream.

Data on diabetes worldwide

Around 425 million people worldwide already suffer from diabetes. In Belgium alone, the number is estimated at 810,000.

A recent article in 2024 (Le nombre de diabétiques augmente fortement en Belgique - Le Soir) reports that the number of diabetics in Belgium has risen by more than 5%, accelerating the trend of previous years. The AIM estimates that one Belgian in three is affected by diabetes and does not (yet) know it.

Here are the statistics from the University of Sherbrooke, Quebec, Canada.

Germany 6.9; Belgium 3.6; South Korea 6.8; France 5.3; Spain 10.3; United States 10.7; Hungary 7; Ireland 3; Israel 8.5; Italy 6.4; Japan 6.6; Luxembourg 5.9;

The + Pakistan 30.8 and the - Benin 1.1


What causes diabetes ?

Sugar is an energy supplier for the body and is transported into the cells by the hormone insulin. Diabetes develops when this process is disrupted. The causes and treatment options vary from one type to another:

Type 1

This autoimmune disease occurs when the beta cells in the pancreas, which produce the insulin needed to regulate blood sugar, are destroyed by the immune system. The body can then no longer produce insulin.

Type 2

The pancreas does not produce enough insulin or the body cannot use it effectively to convert blood sugar into energy. This is known as insulin resistance. This type is most common in overweight people and those over 50. However, in recent years there has been an increase in the number of overweight children and adolescents. Obesity and lack of exercise are the main causes of type 2 diabetes.

Gestational diabetes

Gestational diabetes generally occurs during the last trimester of pregnancy and disappears after birth. The main risk factors for the development of gestational diabetes are age, obesity and hereditary predisposition.

Prediabetes

This is a condition in which blood sugar levels are high but not high enough to be classed as diabetes.


What are the symptoms and risks ?

One in five people are unaware that they have the disease. The symptoms go under the radar and the person observes no signs.

  • Frequent urination, especially at night;

  • Constant thirst and hunger;

  •   vision: blurred vision;

  • chronic fatigue;

  • very slow healing of cuts or wounds;

  • tingling sensations or numbness in the hands or feet;

  • unexplained weight loss.


Personally: nada, I don't have to urinate often even though I drink my two litres of liquid a day. I have a wee at 3am unless I don't drink anything after 7pm.

When she asked me about my thirst, she asked me if I often had a dry mouth and I made a joke by telling her that I had a dry mouth if I saw a good-looking guy and that I was desperate to do something about it. This didn't have the desired result, the endocrinologist raised her eyebrows and stared at me. I thought to myself that my Flemish version must not be up to scratch in terms of translation or that she didn't have a well-developed sense of humour. Oopsss

As far as tiredness goes, everything's fine, I go to bed around 1am. Weight loss, nonsense, I would have liked to have had that symptom.

Only one reaction corresponded to me: tingling in the toes and the sensation that the soles of the feet near the toes were becoming thick. Sensation but not reality.


 The endocinologist then listed the risks and complications:

  • cardiovascular disease: brain damage, high blood pressure and narrowing of the blood vessels;

  • neuropathy: nerve damage that can lead to tingling, numbness, burning and even pain. The loss of feeling starts at the tips of the toes or fingers and gradually spreads upwards (for men, this can lead to erectile dysfunction).

  •   kidney damage, which can lead to regular dialysis or a kidney transplant;

  • eye damage such as cataracts, glaucoma and, worse still, blindness;

  • dermatological diseases such as bacterial and fungal infections;

  • slowed healing that can lead to amputation of a toe, foot or leg;

  • sleep apnoea , particularly in cases of obesity;

  • risk of Alzheimer's disease and other neurodegenerative disorders.


It gave me a bit of a chill, but the positive feedback was that my heart, kidneys and liver were in good condition. I was just as relieved when the results of the ophthalmologist and chiropodist came back: no sugar in the eyes and the tingling is due to a slight deterioration in nerve connections, but I can walk as I like.

The dentist is due at the end of July.

 To sum up, the causes of my diabetes are :

  1. genetic: my father was a diabetic and the family factor is very important. I've informed my children of this, and from now on they'll be checked every year.

  2. an unbalanced diet

  3. a lack of physical activity

  4. I'm overweight- I weigh 105 kg in the nude.

Setting up a skincare routine

  • Always wash my hands, as touching fruit or having cream on my fingers can distort any measurements.

  • Check my blood sugar levels with my finger, and keep a diary.

  • 7h / 12h / 18h --> I start with rapid insulin before each meal. Humalog is comparable to human insulin. Its action is rapid and very brief, appearing about 15 minutes after injection and wearing off after 2 to 5 hours. The injections are given in the abdomen. I also have to take a pill with every meal, Metformin 500, which provides cardiovascular and anti-tumour protection.

  • 7h --> I have a slow insulin injection that I now take in the morning because in the evening I used to have a tendency to have a nose dive or I'd forget. Lantus is close to human insulin, and works in the same way as natural insulin, but over a longer period. It is absorbed more slowly and more regularly, so you only need to inject once a day. This injection is made into the thighs.


How much does the treatment cost ?

The INAMI and a specialised centre have an agreement called a 'Convention' which, from 1 July 2023, will allow full reimbursement by the mutual insurance company.

Insulin and related medicines such as Metformin are free.

The Sint Jan Portaels centre supplies me with sensors, tigettes and blood glucose meters, with the exception of injection needles (€14 for a box of 100 pcs).

What should I do in addition to the injections ?

  • 30 minutes of exercise is highly recommended to lower blood sugar levels and control them better, as muscular contractions burn up energy. I've started 30 days of abdominal training using the Homework app, with three days of exercise and one day of rest. I've added the thigh exercise. I feel great, I'm full of energy.

  • Understand my diet and make sure I get the right balance. No food is forbidden, only the proportions take into account the sugar intake. I need to enjoy myself, but with full knowledge of the facts.


What to know if you encounter a diabetic with hypoglycaemia ?

Hypoglycaemia can cause sweating, trembling, visual problems, double vision, sudden tiredness, hunger pangs, dizziness and difficulty concentrating. If I'm in this state, I need to take about 4 lumps of sugar or 150 ml of normal cola.

If the hypoglycaemia is severe, it can lead to behavioural problems comparable to drunkenness, convulsions or even loss of consciousness. An injection of Glucagen is recommended.


What about my trip ?

It's all a question of preparation, knowing the risks and being organised, especially if I have to travel by plane, which involves the risk of time changes, as I can't unbalance my treatment. My doses will have to be adjusted to take account of any jet lag. Many airlines now offer meal trays for diabetics.


For life in a van, this won't be a problem, as my meals will mainly be home-cooked, so I can adapt the quantities, vegetables, sauces and energy requirements.

If I'm planning to visit a town or go hiking ...., I'll need to pack the necessary doses of insulin and medication in my rucksack, as well as an emergency snack combining slow and fast sugars: sandwiches, dried fruit, biscuits, etc.

I'll need to check my blood sugar levels more frequently and carry dextrose and/or a can of Coke if I start to feel hypoglycaemic.


Insulin is sensitive to temperature, and I need to keep it at the right temperature:

  • for unused insulin: around 25°C, away from light;

  • for my insulin stock: between 2 and 8°C if possible;

  • Take the necessary quantities with you when you travel, and stock up for a year;

  • when travelling by plane, insulin should not be put in the luggage hold, as extreme temperatures can destroy it.

I've bought myself an isothermal insulin kit, so if I'm away for a day in the sunshine (hope springs to life and we've forgotten the definition of the word sunshine in Belgium ;)), I can keep it safe.

I'll have to check my dietary intake by adapting it to local products:

  • identify local starchy foods and test how they fit into my diet;

  • avoid eating fruit that is too sweet or food that is too spicy;

  • I may need to adjust my insulin dose accordingly.


I also have to pay attention to my daily physical expenditure because I'll be doing a lot more physical activity than I do now:

  • visits, so walking all day,

  • hiking

  • swimming, weather permitting.

I'll need to drink plenty of fluids regularly.


In the event of diarrhoea, as with anyone else, I'll need to drink plenty of fluids and eat cooked rice for carbohydrate intake.

I'll be careful with my skin, especially my feet. I must avoid walking barefoot and clean any wounds directly.


To avoid problems with customs and regulations when travelling, the diabetes clinic has provided us with a signed document informing customs that I am entitled to travel in the cabin with insulin, needles, water, a snack and ..... I need to present the document, my diabetes card and all the necessary equipment in a separate bag in my hand luggage.


In a future blog, I'll explain the impact of diabetes on the C1 driving licence and the resulting obligations.


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