Reflecting on my Spanish holiday and TIR

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Peely66

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Relationship to Diabetes
Type 1
Just returned from a holiday to Granada in southern Spain. It was ostensibly a trip with a group of artists of varying levels of ability with the intent to spend some of the time painting and sketching at various locations in this beautiful Andalucian city.

My concern was how I was going to deal with my diabetes in this context. Breakfast was the only meal that had any consistency as it was at a regular time and had the same choice of items, generally bread, cheese, jam, eggs, coffee. I also had the added challenge of coming down with a cold just before setting off which then went on to develop in the first two days. Straight away I could see it was going to be difficult to achieve 70% TIR (which I'm still struggling to achieve at home with very few variables at play) I decided that if I could do 60% I would be fairly happy and that would have to do. I didn't want to ruin my holiday ruminating over what I had got wrong whilst I was away.

At the end of the week I had slipped down to 50% TIR and now I'm home I can look back and think about some of the challenges and see what others on the forum think.

First night there we went to a small local bar and ordered food which took an hour and a half to come which was a bit alarming having bolused with a correction! Maybe the cold kept my levels up as it didn't seem to come down.
After that experience I decided to not pre-bolus and a good job too as on two more occasions the food I ordered never arrived whilst everyone else was tucking into theirs. The second time this happened I spotted someone with Libre at another table and really wanted to go over and ask how the hell she was coping with it all. Of course she may have been Spanish and so not havng to cope with restuarant dining every day but I never got to find out. I had spent 6 months trying to learn some Spanish so that I could cope with some of these situations but discovered that 6 months is a woefully inadequate time spent acquiring a language. I was quite pleased to be able to say "No postre para me". Also after spending the afternoon lying on my bed, having not eaten since breakfast, wandering out to find some sustenance and pointing at a table and saying "es possible aqui?" when I wanted to sit at a table to eat and the waitress asked "Para comer?" and I understood. (Apologies to anyone who speaks better Spanish) That was probably the nicest meal I had and it was vegan.
Reading menus was also an issue but many places have English translations particularly in a city like Granada with a large tourist influx.

So no regular meal times, uncertainty as to how long the food might take to come, illness, heat (30C most of the week) - a perfect storm. I feel far from refreshed after the experience and now begin the long crawl back to 60% and (hopefully) beyond!
 
Sorry your holiday was not as relaxing as you hoped.
Over time, those of us taking insulin learn to deal with things like eating out. For example, I never pre-bolus (unless I need a correction) until I see the food in front of me. I would rather inject for each course than over bolus.
I am not great at languages so I use things like Google translate for menus or make a note of key things that I expect to see or just guess and see what arrives. As I don't eat meat, I often learn to recognise chicken, beef, ham, pork so I know what to avoid.
As you are taking a basal bolus insulin regime, the only reason irregular meal times should be an issue is if you are hungry. I find this can happen to me so usually carry a stash of cereal bars in my luggage when I go away in case meals are further apart than I want/need.
Illness is unfortunate any time but more so when on holiday and heat is something you can either tolerate or not.
Hopefully, can will be able to look back on this trip as a learning experience and next time will be more chilled.
And given everything you were up against, 50% in range is not bad at all.
 
Hi Peely,
Like helli sorry if your Spanish experience was spoiled by worrying about your TIR and the insulin regime.Helli gave some good advice re bolus timing especially when eating out abroad.
I had a situation a few weeks after being diagnosed that I should have attended a Company event in Seville ironically to launch a new diabetes product but I decided not to go as I was still trying to get stable and was afraid my trip abroad where I would have little control over what and when I ate and I had very little experience of managing g my insulin/ carbs etc.
So at least you got to go whereas I missed out but I am glad I did it as it was just too early in my diabetes journey and it would have put me back several weeks as you say because of delays in eating and not being in at that time my normal regime.
It is all a learning experience and have found I can now get decent TIR in most situations but eating out does present ne with the biggest challenge.
ATB
 
Hello, when in situations like this I focus on getting my basal straight. Meal times can be ad hoc.i personally find the less I try after adjustment on basal on holiday, the easier it pans out with the bolus?
 
At the end of the week I had slipped down to 50% TIR and now I'm home I can look back and think about some of the challenges and see what others on the forum think.
I'm pretty sure I had discussions with the dietician about something similar, and she said not to worry about it. Important to be safe (so no significant hypos and spikes not too bad). Also really important to enjoy the holiday and the food. It's only a few days, after all.
 
I'm pretty sure I had discussions with the dietician about something similar, and she said not to worry about it. Important to be safe (so no significant hypos and spikes not too bad). Also really important to enjoy the holiday and the food. It's only a few days, after all.
Yep. I agree. This was my thinking when I could see my TIR slipping. Take my foot off the pedal a little and not worry too much as it is only a few days as you say.
I think I probably underestimated how much the cold was affecting my levels too.
 
Never pre bolus for food 'out' whether in England or Timbuktu. You don't know when it will arrive or whether you'll actually like it enough to eat all of it, let alone judge the carb value on which to base your bolus insulin amount.
 
Never pre bolus for food 'out' whether in England or Timbuktu. You don't know when it will arrive or whether you'll actually like it enough to eat all of it, let alone judge the carb value on which to base your bolus insulin amount.
Sometimes I will have a unit or two pre-meal out when I’ve ordered just to get something in my system to try and prevent the spikes being too crazy. But never nothing a few sips of coke or a snack I have in my bag couldn’t fix for the reasons you say above.
 
Never pre bolus for food 'out' whether in England or Timbuktu. You don't know when it will arrive or whether you'll actually like it enough to eat all of it, let alone judge the carb value on which to base your bolus insulin amount.
I did pre bolus at a cafe recently, which I never ever ever do unless I can see the food on the way, anyway I did and then my husband decided when ordering that we weren't eating there as it was a 45 minute wait on food. I managed to stop my pump part way into the dose and I had snacks enough to cover the amount. But wow did I feel sick / nervous about the whole experience. We then found a very good fish and chip shop and all was forgotten but I really could have smacked myself.
 
I almost always prebolus before I am served when I eat out, however I always have enough JBs in my bag or pockets to cover it if the food doesn't turn up or is late. I keep an eye on my Libre after injecting and if my levels start dropping and there is no sight of food, I will either have a sup of my partner's drink (usually J2O or other fruit drink) or I have a bit of bread or I have a JB to slow the drop.

Now that we have CGM I don't see this as a problem. It would be another matter if we were still just finger pricking and didn't have a means to check frequently to see if the insulin was kicking in yet. It is likely that I will need to correct later anyway, so I don't need to see the food to do a guestimate carb count, and if it has more carbs than I have injected for when it comes, I can either jab more insulin or leave the extra carbs.
 
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