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Scared to go on holiday

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Veilofignorance

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I was diagnosed T1D two weeks ago and I think the magnitude of the diagnosis is starting to sink in a little bit. Last night was rough, I had two hypos overnight including one at 3.0 mmol (according to Libre). Neither hypo woke me up and I stupidly had my phone on silent. I've been awake since 4.30am, low-key worrying. I started carb counting two days ago and haven’t yet got it right (I also had two hypos during the day yesterday) so that’s worrying me too, as I considered carb counting a way to take control.

Anyway, on 22 December I am due to go on honeymoon to Sri Lanka. Docs and nurses have said there’s no reason we cant go, but last night has got me doubting it for the first time. It’s a scary thought to be stuck thousands of miles away for three weeks with newly diagnosed T1D that isn’t yet under control. Not sure what the purpose of this post is. I just need to “say this out loud” to other people with this condition. Any advice or words of wisdom appreciated.
 
I think your concern is valid @Veilofignorance Not because I think anything would go horribly wrong, but because it’s absolutely normal to be anxious and still very much in learning mode after a Type 1 diagnosis. I was diagnosed more than 30 years ago but I’d certainly have been stressed going abroad on holiday a month after diagnosis.

How long would you be going for? Would your insurance cover a postponement? What does your partner think?

Always ensure you can hear Libre alarms at all times, and if you get a Low alarm overnight remember it might be a compression Low (ie false) so do fingerprick. You mention daytime hypos so presumably you fingerpricked to check those? If you keep getting lows, it’s possible your insulin doses are too high. What meal ratios have you been given? Remember they’re just an estimate and you should adjust them if needed.
 
Thanks @Inka, we’re due to be away for three weeks, travelling around Sri Lanka. In many ways a holiday is just what’s needed, I just wish it was later on when my diabetes was under more control.

On the hypos, I finger pricked for the day ones but (another issue) my lancets didn’t go deep enough to extract blood from my fingers when I woke up this morning. I have Renaud’s syndrome so often it can be like getting blood from a stone! I haven’t been given any meal ratios yet, I’m just trying to cover every 10g carbs with 1 unit Novorapid at each meal.

Thanks for all the advice.
 
Veilofignorance said:
On the hypos, I finger pricked for the day ones but (another issue) my lancets didn’t go deep enough to extract blood from my fingers when I woke up this morning. I have Renaud’s syndrome so often it can be like getting blood from a stone!
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I took have Reynauds so can empathise with this. For the first 10 to 15 years after diagnosis, i use to beg for a CGM (they weren't that common then) without success. So, I had no choice but to finger prick (sometimes more than 10 times a day) so I had to find a solution. The main thing was to warm my fingers. Usual, this is with a hot cup of tea but I also invested in usb charged hand warmers which helps to bring blood close enough to the surface to make finger pricking easier.
 
I also have Raynauds @Veilofignorance I find having the lancets at the right depth and washing my hands in warm water, as well as shaking them to the fingers usually works.

I haven’t been given any meal ratios yet, I’m just trying to cover every 10g carbs with 1 unit Novorapid at each meal.

The 1 unit to 10g is a ratio. It’s often used as a starting point but usually needs adjusting. Many people need more insulin for breakfast and less for evening meal. So example ratios might be 1:8g for breakfast, 1:12 for lunch and 1:15 for evening meal. Those are just examples - your will differ. Some newly diagnosed people only need 1:20g or 1:25g or even less insulin, eg 1:30g.

While you’re working out your ratios, it helps to keep breakfast and lunch the same. You can then get an idea of those two ratios before moving on to your evening meal.

To my mind, you have two options: postpone your trip, eg to Spring 2025 or spend the next week or two working out your ratios and really getting a handle on your insulin doses then go on your trip as planned. Remember you’ll need insurance that covers pre-existing conditions now you have Type 1.
 
I also totally understand your concerns and it will be challenging, especially as you are going to a hot country from a cold one as that will likely change your insulin needs. Personally I think your new diagnosis will impact your ability to enjoy the holiday as you will be preoccupied with trying to manage your levels and it will likely be more challenging than being at home. You are almost certainly in the honeymoon period and it may be that you will need to adjust both your ratios and basal doses whilst you are away, plus you will likely be eating and trying to dose for mostly unfamiliar food. I definitely could not have done it so soon after diagnosis, but it is a very individual decision.
There is an awful lot to take in during the first few months of diagnosis without factoring in a quite long trip like that. That said, the forum will be here to support you with any wobbles you have if you do decide to go. You need to take at least double of everything diabetes wise in case of loss, damage or failure and ideally get a letter from your DSN to show to airport security if you are challenged about any of your diabetes paraphernalia. It almost never happens but best to get a letter to cover you plus an up to date prescription list.

As regards the overnight hypos, could they have been compression lows where you lay on your sensor during your sleep, causing a false low? This is one of the limitations and quirks of sensors. Usually you can tell from your graph if there is a sharp dip into the red and then a rebound when you roll off it again and release the pressure, as oppose to a more slow and steady descent into the red with a genuine low. If you want to post your Libre graph showing those nocturnal hypos, we may be able to alleviate your concern on that a bit. What often happens is that the rebound gores back slightly higher than it was before the compression low and then settles back down to the original level. That doesn't always happen depending upon how high your levels were before the low, but it can be a bit of a signature of a compression low.

If you have not already come across it, @helli composed a really helpful list of the quirks and limitations of CGM here...
H

Thread 'CGM limitations and precautions'

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors.

MarinaDE said:
My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of hypos while I sleep and this morning I had a hypo alarm.
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If these are very short periods of lows and occur overnight, they are more likely to be compression lows - when pressure is applied to a sensor, it will report a false low. The reason I say this is more likely to happen at...
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Good luck whatever you decide to do, but don't forget the forum is here to support you and answer any questions you have if you do decide to go.
 
Pack snacks, lots of snacks, the worst thing while abroad (imo) is not being able to source food in the evenings/overnight to deal with hypos and the like. When I used to travel for work (and holidays) I'd take enough sweet stuff + biscuits to either cover the whole trip (e.g. India) or a week's worth until I could find somewhere to resupply without it causing massive timing and planning hassles (e.g. places with supermarkets - USA, Australia, Europe, etc.)

I would also accept running on the higher side while you're away (I used to always run low all the time but especially when on holiday or away for work doing stuff.) You may even run high initially though due to stress/excitement (though I start running low as soon as I head to the airport, so YMMV.) but perhaps best to see if it settles before upping doses and then writing a day off as you're trying to sort continuous hypos.

As others have said sounds like you've perhaps got too much insulin for the carbs (bear in mind that the ratio can change across the day, the month, and also depending on what you are and have been doing. It does get easier to spot the patterns though so don't worry.) If it were me, I'd be reducing the ratio, however.... CGMs are not necessarily correct.

If the hypos didn't wake you, are you sure you were hypo? CGMs are somewhat hit and miss both with their calibration and with e.g. compression lows. You will in all likelihood know that you are hypo. While I know people talk about loss of hypo symptoms, I quite happily spent the majority of my childhood years only occasionally doing blood tests (but lots of urine tests) because I knew I'd always be running low and would feel this and eat, lots. Even at uni once the blood testers had improved to the point of being painless enough to endure using them (and I was testing regularly), I would always know if I was running low (which was pretty much all the time!)

I hope you can go, diabetes shouldn't change what you do, though I completely understand the timing is far from ideal and that you may decide that you'd prefer to get more of a handle on it before embarking on new adventures 🙂
 
I, too, completely understand your concerns about your holiday. But …
You were diagnosed 2 weeks ago and your holiday is not for another 4 weeks. Think back to how you felt 2 weeks ago and, if your diagnosis was anything like mine, you may realise how much improvement you have seen in that time. If that improvement continues, 6 weeks after diagnosis, you may feel even better.
You say carb counting is not working but you have only been doing it for 2 days and haven’t got the right insulin to carb ratio for you. It takes a bit of trial and error but 4 weeks is plenty of time for that. Plus, if you set your Libre low alarm to something around 5.0, you should have time to treat a potential hypo before it happens.
I know we are all different and I am very stubborn, but the most important thing I was told upon diagnosis was “diabetes should not stop you doing what you want”. I have lived my life since diagnosis proving that mantra. It has taken some prep but, for me, it was very very important for my relationship with diabetes that I do not let it control me or my life.

However, whatever is right for me is irrelevant. You need to decide for yourself. No one can tell you if taking a holiday now is good for you. Only you know.
 
rebrascora said:
I also totally understand your concerns and it will be challenging, especially as you are going to a hot country from a cold one as that will likely change your insulin needs.
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To me, this is a red herring.
Sri Lanka in December is not that hot and heat does not affect everyone’s diabetes. It depends how your body copes with temperature between about 18 and 25 degrees (as I say, not that hot). Sure, if you cannot cope with this, your diabetes may be affected but if it does not stress your body, it is not particularly relevant.
I think the usual stress of different food and daily regime will have a bigger impact. But, for most people, that is not a reason to avoid an adventure.
 
@helli "You were diagnosed 2 weeks ago and your holiday is not for another 4 weeks."

By my reckoning, the 22nd December is just 2 weeks away or am I missing something?
 
rebrascora said:
@helli "You were diagnosed 2 weeks ago and your holiday is not for another 4 weeks."

By my reckoning, the 22nd December is just 2 weeks away or am I missing something?
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No. My mistake.
I am thinking (hoping?) Christmas is further away 🙄

Still 2 weeks is a fair time to learn more about diabetes management if you put your mind to it and don’t panic.
My point about progress in the last two weeks still stands.
 
helli said:
No. My mistake.
I am thinking (hoping?) Christmas is further away 🙄
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Yes, I was half hoping I was wrong too! Where did the last few weeks go?
 
Veilofignorance said:
I had two hypos overnight including one at 3.0 mmol (according to Libre). Neither hypo woke me up and I stupidly had my phone on silent
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You must fingerprick to confirm hypos, and fingerprick to confirm you’ve risen after. You may not have been hypo at all.

Veilofignorance said:
I started carb counting two days ago and haven’t yet got it right (I also had two hypos during the day yesterday) so that’s worrying me too, as I considered carb counting a way to take control.
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If you’re expecting to have good blood sugars with no highs or lows then your expectations are way off. You will have highs and lows, even with carb counting, and you’ll learn to deal with them. Follow the medical advice and go and enjoy your honeymoon.
 
Also if you haven’t already, if you bought your travel insurance before the diagnosis check that it covers any diabetes related issues whilst away. Pack plenty of spare supplies and split it between yours and your partners hand luggage.
 
Up to you.
Will you enjoy it?
Or will you be going to 'prove a point'.

Are you going with others?
What do they think about it?

Are you going alone? If so, can you make yourself understood enough to locals to get help if needed?

I know when i was 2 weeks in i was still holding on to the dsn nurses phone calls like they were a lifeline, and struggling to go for a walk longer than 15 min without plummetting.

Go if you'll enjoy it, and can keep safe, and want to.
Otherwise, don't.
 
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