Managing my A1C during Long-Term Travel

Managing my blood sugars this year has been an adventure, in and of itself.

This is partly because keeping my numbers in range felt like a new and different challenge than during any previous travel.

  • During a previous one- or two-week vacation, I wouldn’t worry so much about higher numbers, because it would be “averaged out” by better numbers at home.
  • During my study abroad in Greece, I spent most of my time in Thessaloniki where I had the advantage of somewhat regular cuisine and a schedule.

But on this round-the-world trip, we are moving around more frequently (we’ll be staying at 83 different places this year – 83!). And the duration is a whole year, so high numbers won’t exactly average out with my numbers from home.

At the beginning of the trip, I saw the instability and frequent change wreak havoc on my blood sugars.2015-11-11_Vietnam_Hanoi_andA1C-7

After our first three months in South America, a lab test confirmed that my A1C was 7.8%. It wasn’t a number that I (or my husband) was comfortable with me staying at for a year. My ideal A1C is in the mid-6%s; it’s where I feel my best, physically and mentally.

Since then, I’ve been diligently working on figuring out how to improve my A1C while traveling long-term. And I’m very happy with the progress I’ve made in the last seven months in Southern Africa, Europe, China and Southeast Asia: My meter average has gotten down to the ~140 mg/dl, and the two A1C home tests I’ve done have shown a 6.8% result. 

Managing my A1C While Traveling: What Helped

If you’re about to start a travel adventure of your own, with a faulty pancreas in tow, here are my tips for keeping your own A1C in a healthy range.

Please note that I am not a doctor, so this is certainly not medical advice. Just a recounting of what has worked for me personally. So take what you will and leave the rest. 🙂

  • Continue to prebolus…despite the risks. My post-meal blood sugars are always better if I bolus my insulin 15-20 minutes before I eat. This is exceptionally hard to do while eating out in foreign countries, where you may not speak the language, you’re unsure of carb counts, AND the culture may have a very different sense of time.Because of this, I struggled to prebolus in South America and had worse results on my meter. When we arrived in Africa, I put some thought into this and realized that I was just really scared of a bad low, in a foreign country, if my food took forever.With a bit of trepidation, I decided to take the risk of prebolusing and see how it went. And you know what? There are very few instances that my food took so long that I actually dropped low; 99% of the time I’m fine.If you decide to prebolus while abroad, here are some tips:
    • Take a few days to get settled into a new country before starting to prebolusing; take that time to get a sense of timing and how quickly their food is usually served.
    • Like you would at any restaurant back home, try to gauge how busy the place is and how long other people have waited, and base your timing on that.
    • If you’re unsure of the carb count in your meal, bolus for the amount of carbs you’re absolutely 100% sure will be in it, and bolus for the rest when your meal actually arrives.
    • Keep glucose on hand, just in case the meal does take too long to arrive.
  • Give up the dream of uninterrupted sleep. I wake up in the middle of most nights to test my blood sugar or check my CGM, and if necessary,  do a micro-correction of either insulin or glucose.This was never a regular habit at home; however, I find that while I’m traveling each new location has a slightly different routine and I can see those differences reflected in my blood sugars overnight. The changes aren’t dramatic (i.e., they’re not enough to wake me up because I feel off), but they can move a 100 mg/dl to a 50 mg/dl or a 180 mg/dl overnight.Since the bedtime hours constitute 1/3 of my day (and therefore 1/3 of my A1C), keeping those numbers in check is important to me. I want to wake up at the same number I went to bed at, and so I continue to set my alarm.
  • Factor in adrenaline. Adrenaline, excitement and stress do crazy things to blood sugars, and this has been more pronounced while I’m traveling and having more unusual experiences that I typically do at home.While traveling, I suggest you pay attention to how your blood sugars respond to adrenaline, so you can figure out how to prevent any associated high blood sugars.For myself, I’ve temporarily increase my basal by 25 – 50% for 2 hours before anything that has to do with heights or any activity I’m particularly excited about. And then I check my numbers as often as I can and correct.
  • Take advantage of the dawn phenomenon. If your blood sugars rise in the morning as you’re waking up (i.e., a dawn phenomenon), make use of that rise to get any exercise in. That way, your blood sugar does not have to be as high when you start exercising, keeping your numbers in a better range.
  • Master the art of carb-counting rice (or whatever the country’s carb of choice is), and then stick to it. Unlike the U.S. and Europe, many countries have very repetitive forms of carbohydrates, and the quicker you can learn how to carb count it, the better off you’ll be.I’ve become highly gifted at the art of eyeballing one cup of rice over this past year, which was everywhere throughout South America, southern Africa and Asia.In addition, if I am given a choice of carbohydrates, I will always go towards what I know (in my case, rice) and can carb count.
  • Limit your carbs at each meal. This is a tactic I use at home, and I’ve found it consistently helpful while traveling. I try to limit my carb intake to 50 carbs or less at each meal. This results in less of a postmeal spike, and there’s less room for error when carb counting.
  • Go with the flow and adjust I:C ratios and basals. If I’m having repetitive highs or lows, and it seems to be a pattern, I try to make changes to my I:C ratios and/or my basals—conservatively. I don’t make drastic changes (since I’m not consulting with my doctor), but I will nudge my settings one way or the other and take note of what changes help.

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