Nepal and diabetes

[Fleetwood]

I seem to remember someone on the forum has travelled in Himalayas - we are moving to Kathmandu on 4 year posting next month and I was diagnosed with Type 1.5 LADA two weeks ago (after initial diagnosis of type 2 in February). NHS has been great and has given me a Dexcom one but my BGs are all over the place from 3.8 to 14 (in the drop of a hat and 3 dextrose tablets) and I am on a bit of an insulin rollercoaster. I am getting a bit anxious about our move so if any of you have any advice about travel and your experiences I’d be really grateful if you’d share them!

Currently on 8 units Abasagla basal and 4 units Novorapid for meals. Luckily NHS say they will continue to monitor me on the Dexcom app and provide treatment as we will be abroad for UK gov so currently investigating replacement prescriptions at post etc.

 

[Proud to be erratic]

Having prior experience of working for UK Gov and posted abroad, but over 20 years ago, coupled with my more recent experience of my diagnosis and insulin dependency I think I would start a dialogue with the HR dep't. I would be cautious how I do that; I loved overseas postings and would certainly be thrilled to get one in Nepal - so I wouldn't want to cause my future posting to be put at risk.

But in former times there was always a final medical confirmation that I and my family were fit and well. Also I sometimes had been on the "other side of the coin" having to tell a postings branch that we (overseas) were not equipped to deal with certain medical conditions - either simply because we didn't have the medical skills to cover that diagnosis or because the working or living conditions effectively precluded certain disabilities. Before anyone feels this is outright discrimination .... which it sails close to ... this was pre 2001 and in practical terms if the receiving organisation simply couldn't provide appropriate support then it was more sensible to make that clear from the outset. This wasn't always about affordability (although budget constraints were ALWAYS present) sometimes a job needed certain mobility and /or assurance that the incumbent would, within reason, be fit when needed.

So I would ask the postings organisation to clarify exactly what the medical cover arrangements are in Katmandu, both in terms of support nursing and access to specialists such as an Endocrinologist. Way back in the 1980s the medical cover in Katmandu was simply poor for all UK folks - despite a longstanding UK relationship with Nepal. I suspect there are much better International Hospitals with great capabilities, today, possibly a Chinese sponsored facility as well. But has your Gov't Dep't got formal arrangements with these facilities? Will you be one part of a tiny organisation in Nepal or amidst a good sized community. Will you get relatively unrestricted paid travel back to UK should you need that, or somewhere a fair bit more modern and with accredited facilities?

Although there is a danger of "waking the sleeping lion" and causing alarm about your forthcoming posting, I think you do need a fairly open dialogue with your HR agency. Your recent diagnosis should not prevent you from travelling and working abroad. But you, presumably, have a huge and steep learning curve ahead of you with respect to your diagnosis and that might prove challenging just now, to say the least, for you and your ability to seamlessly step into a new job and a 4 Yr commitment. Some caution is needed I think. Nepal is relatively isolated from the western world.

 

[Fleetwood]

Having prior experience of working for UK Gov and posted abroad, but over 20 years ago, coupled with my more recent experience of my diagnosis and insulin dependency I think I would start a dialogue with the HR dep't. I would be cautious how I do that; I loved overseas postings and would certainly be thrilled to get one in Nepal - so I wouldn't want to cause my future posting to be put at risk.

But in former times there was always a final medical confirmation that I and my family were fit and well. Also I sometimes had been on the "other side of the coin" having to tell a postings branch that we (overseas) were not equipped to deal with certain medical conditions - either simply because we didn't have the medical skills to cover that diagnosis or because the working or living conditions effectively precluded certain disabilities. Before anyone feels this is outright discrimination .... which it sails close to ... this was pre 2001 and in practical terms if the receiving organisation simply couldn't provide appropriate support then it was more sensible to make that clear from the outset. This wasn't always about affordability (although budget constraints were ALWAYS present) sometimes a job needed certain mobility and /or assurance that the incumbent would, within reason, be fit when needed.

So I would ask the postings organisation to clarify exactly what the medical cover arrangements are in Katmandu, both in terms of support nursing and access to specialists such as an Endocrinologist. Way back in the 1980s the medical cover in Katmandu was simply poor for all UK folks - despite a longstanding UK relationship with Nepal. I suspect there are much better International Hospitals with great capabilities, today, possibly a Chinese sponsored facility as well. But has your Gov't Dep't got formal arrangements with these facilities? Will you be one part of a tiny organisation in Nepal or amidst a good sized community. Will you get relatively unrestricted paid travel back to UK should you need that, or somewhere a fair bit more modern and with accredited facilities?

Although there is a danger of "waking the sleeping lion" and causing alarm about your forthcoming posting, I think you do need a fairly open dialogue with your HR agency. Your recent diagnosis should not prevent you from travelling and working abroad. But you, presumably, have a huge and steep learning curve ahead of you with respect to your diagnosis and that might prove challenging just now, to say the least, for you and your ability to seamlessly step into a new job and a 4 Yr commitment. Some caution is needed I think. Nepal is relatively isolated from the western world.

You are absolutely right and we have already been in touch with HR and the medical clearance people. Luckily it’s my spouse doing the job itself so at least I don’t have to cope with that too on top of everything else!

 

[trophywench]

I think the member you are thinking about could be @IrvineHimself - dunno if it is he but he's certainly well travelled.

I wonder if Abasaglar/Novorapid and Dexcom are even available in Nepal? I've only ever been to southern India (Goa and Kerala) for a few fortnights on holiday and therefore just taken the usual 'twice as much of everything I might need whilst there' same as we all have to on holiday anywhere - but never lived anywhere abroad even in mainland Europe. Both insulins are Danish and Accu Chek everything basically German, thing Dexcom might be USA based but not sure. Not like insulin can be sent in a diplomatic bag since they presumably would not be refrigerated.

@Proud to be erratic definitely seems to know a lot more about such postings than I !

 

[helli]

@Fleetwood i have trekked in the Himalayas and am incredibly jealous of your posting. It is fantastic fascinating country with wonder friendly people.
I had no issues with my diabetes management due to the country or the food. There were a couple of things related to the trekking
- Blood glucose meters are affected by altitude. So, if you will be very high, it is advisable to make sure you have hypo awareness. My travel was before the advent of CGMs so I do not know how they are affected.
- Because I was trekking for 8 hours a day with many climbs, my insulin needs plummeted. I was taking less than half my usual basal.

Your diagnosis is very recent so it is not surprising your levels are all over the place. Be nice to yourself and allow yourself to learn.

 

[Fleetwood]

Thanks - we are really looking forward to it so it was a bit of a shock to get my curveball diagnosis- it’s really reassuring to know someone has managed it already! And really useful to hear about the basal. Did you find that out by trial and error I wonder?

 

[Inka]

Great advice above @Fleetwood I’d also add that you should, if possible focus on learning as much as possible so that you’re reasonably confident with self-management. An important thing to learn is how to carb count and adjust your mealtime insulin. This will give you more flexibility and can only help.

I’d also echo @trophywench about the availability of your insulins. That would be very important to check. It could be, for example, that analogue insulins aren’t readily available. If that were the case, you’d be better off swapping to a regular human insulin before you go so you can get some experience of it. Some parts of the world might even have different strengths of insulin still. That would be crucial to check.

Type 1/1.5 is a pain in the bum but most things are do-able with extra thought, knowledge and commonsense. I hope you enjoy your time in Nepal 🙂

 

[Leadinglights]

When my daughter trekked the Himalayas she said the difference in temperature between day and night was quite extreme so how that might affect blood glucose monitors and sensors might be worth finding out about.
She went with an organisation called American Health and they set up mobile clinics to bring healthcare to remote villages, lack of basic health care was the norm. It was 20 years ago but I suspect it is not much better now. It was a fantastic experience.

 

[helli]

When my daughter trekked the Himalayas she said the difference in temperature between day and night was quite extreme so how that might affect blood glucose monitors and sensors might be worth finding out about.

Heat does not affect meters although they are unhappy when they get very cold. Just think of it like a cold winter’s day when you can go indoors and sit around a blazing fire. When I was trekking, I was waking up with fresh snow on the tent but stripping off to a t-shirt later in the day.
Overnight, I kept my insulin and meter in my sleeping bag with me and used my aluminium water bottles as hot water bottles. The drinking water was boiled at night to sterilise it and, in the morning it was cooled to use during the trek.
If the OP is living in Nepal, I doubt if she will be camping very much so the cold will be more like living in Canada or Scandinavia.
However, the meters are affected by high altitude which you cannot change by stepping indoors or sitting around a fire.
This is very high altitude. Considerably higher than Kathmandu for example. It is unlikely to be a problem in towns and cities but could be an issue in mountain villages and tea houses.
(I stayed in a tent because some tea houses at the time were not as clean.)

 

[Leadinglights]

Heat does not affect meters although they are unhappy when they get very cold. Just think of it like a cold winter’s day when you can go indoors and sit around a blazing fire. When I was trekking, I was waking up with fresh snow on the tent but stripping off to a t-shirt later in the day.
Overnight, I kept my insulin and meter in my sleeping bag with me and used my aluminium water bottles as hot water bottles. The drinking water was boiled at night to sterilise it and, in the morning it was cooled to use during the trek.
If the OP is living in Nepal, I doubt if she will be camping very much so the cold will be more like living in Canada or Scandinavia.
However, the meters are affected by high altitude which you cannot change by stepping indoors or sitting around a fire.
This is very high altitude. Considerably higher than Kathmandu for example. It is unlikely to be a problem in towns and cities but could be an issue in mountain villages and tea houses.
(I stayed in a tent because some tea houses at the time were not as clean.)

All these experiences are really interesting to read about and how people manage with some ingenuity in extreme conditions. Yes I wondered about altitude but though if they are OK on a aeroplane would be OK.

 

[helli]

Yes I wondered about altitude but though if they are OK on a aeroplane would be OK.

Commercial airplanes are pressurised so you don’t experience the altitude.
However, I was very aware of it at 40,000 feet in the mountains.

 

[Fleetwood]

Heat does not affect meters although they are unhappy when they get very cold. Just think of it like a cold winter’s day when you can go indoors and sit around a blazing fire. When I was trekking, I was waking up with fresh snow on the tent but stripping off to a t-shirt later in the day.
Overnight, I kept my insulin and meter in my sleeping bag with me and used my aluminium water bottles as hot water bottles. The drinking water was boiled at night to sterilise it and, in the morning it was cooled to use during the trek.
If the OP is living in Nepal, I doubt if she will be camping very much so the cold will be more like living in Canada or Scandinavia.
However, the meters are affected by high altitude which you cannot change by stepping indoors or sitting around a fire.
This is very high altitude. Considerably higher than Kathmandu for example. It is unlikely to be a problem in towns and cities but could be an issue in mountain villages and tea houses.
(I stayed in a tent because some tea houses at the time were not as clean.)

Although I’ll be living in Kathmandu, we will be travelling around a fair amount, sometimes at altitude and trekking, so your comments are really useful, thanks.

 

[IrvineHimself]

Sadly, although it was high on the places I wanted to visit, I have no experience of Kathmandu, Similarly, my travelling days were pre-diabetic, so I have very little advice I can offer based on direct experience of your situation.

I would echo @Proud to be erratic's comment about working closely with your HR department. Other things to watch out for are frequent changes in altitude. Based solely on news articles, apart from the roads built by the Chinese, I believe most of the transport network dates back to the Silk road and is hundreds of years old. As a result, bearing in mind the geography, when travelling around the country, I expect it will be a bit of a roller coaster with ascents of a couple of thousand metres or more quickly followed by a descent of a similar magnitude. Even the SAS can suffer from complications brought on by this type of travel, so pay attention to any fatigue, tingling or any other unusual symptoms and immediately consult a medical professional.

Also, prepare a number of personal emergency plans to cover the unforeseen. Primarily this will be what to do if your meds are delayed in the post or what to do if stranded overnight in some remote village, but you should also consider what to do about your meds if you need to be evacuated. Remember, this area of the world is a potential war zone: In addition to the simmering conflict between India and Pakistan, there are also underlying tensions between India, China and the west.

Basically, you want to keep some kind of "Go Bag" in the fridge with enough meds for three or four days. When you get a new supply of meds, refresh the "Go Bag" meds with the new ones so that the newest meds are always the ones in the "Go Bag".

I must admit, I am jealous. This sounds like a great adventure and something you will remember for the rest of your life. Enjoy it to the hilt.

 

[Fleetwood]

Sadly, although it was high on the places I wanted to visit, I have no experience of Kathmandu, Similarly, my travelling days were pre-diabetic, so I have very little advice I can offer based on direct experience of your situation.

I would echo @Proud to be erratic's comment about working closely with your HR department. Other things to watch out for are frequent changes in altitude. Based solely on news articles, apart from the roads built by the Chinese, I believe most of the transport network dates back to the Silk road and is hundreds of years old. As a result, bearing in mind the geography, when travelling around the country, I expect it will be a bit of a roller coaster with ascents of a couple of thousand metres or more quickly followed by a descent of a similar magnitude. Even the SAS can suffer from complications brought on by this type of travel, so pay attention to any fatigue, tingling or any other unusual symptoms and immediately consult a medical professional.

Also, prepare a number of personal emergency plans to cover the unforeseen. Primarily this will be what to do if your meds are delayed in the post or what to do if stranded overnight in some remote village, but you should also consider what to do about your meds if you need to be evacuated. Remember, this area of the world is a potential war zone: In addition to the simmering conflict between India and Pakistan, there are also underlying tensions between India, China and the west.

Basically, you want to keep some kind of "Go Bag" in the fridge with enough meds for three or four days. When you get a new supply of meds, refresh the "Go Bag" meds with the new ones so that the newest meds are always the ones in the "Go Bag".

I must admit, I am jealous. This sounds like a great adventure and something you will remember for the rest of your life. Enjoy it to the hilt.

That all sounds very sensible, especially the Go bag. Thank you - very much planning on enjoying it once I’ve got my head round all the logisitics!