Type 3c India Trip

[Mr Steve]

Hello looking to return to India this year after a couple of years of operations etc..
I noted the thread about insulin and the cool bags, very useful.
My question is regarding Enzymes eg Creons.
These are in short supply and prescriptions are limited, as users will know, so can they be procured in India or would one need to take a suitcase full to cover the trip?
Thanks
Mr Steve

 

[Wendal]

Hello looking to return to India this year after a couple of years of operations etc..
I noted the thread about insulin and the cool bags, very useful.
My question is regarding Enzymes eg Creons.
These are in short supply and prescriptions are limited, as users will know, so can they be procured in India or would one need to take a suitcase full to cover the trip?
Thanks
Mr Steve

Hi Steve.Good luck with the trip and can’t help you whatsoever in terms of securing supplies of Creon in India.
However I am managing to get Creon without too much difficulty at the moment and expiry dates on mine are 9/26 so basically I would take enough for my needs and a lot more for insurance and only seek to buy any medication abroad if in an emergency situation only.
The same would apply to any other medication you need on your trip be self sufficient and a big contingency would be my advice .

 

[eggyg]

When are you going? How long are you going for? Do you have enough to cover it? Have you got time to procure more? I wouldn’t chance trying to get it over there, and considering the type of food and the heat you may have a dodgy tummy anyways regardless of your flavour diabetes! As @Wendal says, take at least double of everything. If you’re stuck I have a few tubs spare as I’ve been getting mine no bother after a scare a few months ago. I’m happy to post them out to you. Elaine.

 

[Proud to be erratic]

Hello @Mr Steve, a few things flashed into my mind:

Creon is our European and American descriptor for one of 4x Pancreatic Enzyme Therapy Treatments (PERTs) that might be findable in UK on prescription. Those 4 have slightly different chemical compositions, but each is considered to do an equivalent job to Creon; but that doesn't guarantee that all PERTs ae ideaal for you. There could be more PERT medications on the open market. So any search for sources of Creon or any other PERT (Creon equivalents) will need an open mind about what might be findable in India.

I spent 6 weeks in India in 2018. I came across "Delli Belly" all too soon and as we travelled from the extreme East to the Pakistani border I frequently had to find medications wherever we were. India has a substantial pharmaceutical industry, manufacturing most of the same medications that we encounter, some under different labels, different packaging in different parts of the country. Much of the labelling was helpfully in English as well as local dialects. I can believe that several types of PERT could be sourced locally there; but I wouldn't want to chance this.

A 2021 paper studied Indian PERT resources and concluded there were considerable variations and quality shortcomings. I've only hastily read this paper:

In vitro Comparison of Pancreatic Enzyme Preparations Available in the Indian Market - PMC

Pancreatic enzyme replacement therapy (PERT) involves exogenous enzyme supplementation and is used in the treatment of pancreatic exocrine insufficiency. Clinical efficacy of PERT preparations is a function of physical properties and release ...

pmc.ncbi.nlm.nih.gov

The conclusion says:

Differences exist between pancreatic enzyme preparations in terms of physical properties, dissolution, and release behavior that can affect their clinical efficacy. The present study suggests, therefore, that these preparations should not be used interchangeably.

As others have already said take with you double that you might need. When do you travel and how much do you need?

 

[martindt1606]

I went to Pune in 2018 on a work trip. Day one I was taken down to the staff restaurant / canteen area for coffee and cakes. I got the CREON out and a lady on the next table came over, apologised for interrupting but wanted to say that she was also using CREON. If I remember correctly I think she said she bought it at the local pharmacy.
Travel was a challenge as I did have a case for creon, insulin, pump supplies..., plus two laptop bags (we had a client with strict security which meant our support teams needed to use client provided laptops), plus my suitcase, and a large bag of biscuits and sweets for the team.

 

[Mr Steve]

I went to Pune in 2018 on a work trip. Day one I was taken down to the staff restaurant / canteen area for coffee and cakes. I got the CREON out and a lady on the next table came over, apologised for interrupting but wanted to say that she was also using CREON. If I remember correctly I think she said she bought it at the local pharmacy.
Travel was a challenge as I did have a case for creon, insulin, pump supplies..., plus two laptop bags (we had a client with strict security which meant our support teams needed to use client provided laptops), plus my suitcase, and a large bag of biscuits and sweets for the team.

Very Interesting, I'll likely be spending some time in various canteens...
One of my contacts has suggested an alternative/equivalent 25000 Enzyme under the TATA brand which I will discuss with my oncologist.
How did you get on with carb counting generally?

 

[Mr Steve]

Hello @Mr Steve, a few things flashed into my mind:

Creon is our European and American descriptor for one of 4x Pancreatic Enzyme Therapy Treatments (PERTs) that might be findable in UK on prescription. Those 4 have slightly different chemical compositions, but each is considered to do an equivalent job to Creon; but that doesn't guarantee that all PERTs ae ideaal for you. There could be more PERT medications on the open market. So any search for sources of Creon or any other PERT (Creon equivalents) will need an open mind about what might be findable in India.

I spent 6 weeks in India in 2018. I came across "Delli Belly" all too soon and as we travelled from the extreme East to the Pakistani border I frequently had to find medications wherever we were. India has a substantial pharmaceutical industry, manufacturing most of the same medications that we encounter, some under different labels, different packaging in different parts of the country. Much of the labelling was helpfully in English as well as local dialects. I can believe that several types of PERT could be sourced locally there; but I wouldn't want to chance this.

A 2021 paper studied Indian PERT resources and concluded there were considerable variations and quality shortcomings. I've only hastily read this paper:

In vitro Comparison of Pancreatic Enzyme Preparations Available in the Indian Market - PMC

Pancreatic enzyme replacement therapy (PERT) involves exogenous enzyme supplementation and is used in the treatment of pancreatic exocrine insufficiency. Clinical efficacy of PERT preparations is a function of physical properties and release ...

pmc.ncbi.nlm.nih.gov

The conclusion says:

Differences exist between pancreatic enzyme preparations in terms of physical properties, dissolution, and release behavior that can affect their clinical efficacy. The present study suggests, therefore, that these preparations should not be used interchangeably.

As others have already said take with you double that you might need. When do you travel and how much do you need?

Staying with my regular Creon does make sense to me notwithstanding a few times when I've switched to Nutrizym due to shortages etc..
I guess an adjustment is required when packing to allow more focus on space for meds.
Planning to go in December for approx 3/4 wks..

 

[Mr Steve]

When are you going? How long are you going for? Do you have enough to cover it? Have you got time to procure more? I wouldn’t chance trying to get it over there, and considering the type of food and the heat you may have a dodgy tummy anyways regardless of your flavour diabetes! As @Wendal says, take at least double of everything. If you’re stuck I have a few tubs spare as I’ve been getting mine no bother after a scare a few months ago. I’m happy to post them out to you. Elaine.

That's very kind of you thanks however I have plenty of time to prepare for a December trip fro 3/4 wks.
Double of everything sounds like a plan!

 

[martindt1606]

Very Interesting, I'll likely be spending some time in various canteens...
One of my contacts has suggested an alternative/equivalent 25000 Enzyme under the TATA brand which I will discuss with my oncologist.
How did you get on with carb counting generally?

Generally not an issue. We had a big team in Pune which meant lots of people would visit so we had a good corporate deal at a hotel with multiple restaurants. Breakfast was pretty much normal, if we ate in during the evening it was Italian or Indian so again no real difference from being at home. If you eat out after work there’s plenty of familiar choices eg burgers. The biggest challenge was going out for lunch with some of the team and having street food because they’d pick something up at every stall to be tried. I’d heard others say how good this was before I went out so knew what to expect and therefore bolused when the first snack arrived, tried to keep a running estimate so I could bolus once we were on the way back to the office. I then kept an eye on blood sugar levels throughout the afternoon in case I needed a correction bolus.
Taking creon was more problematic. I’ve never really been comfortable with the standing up walking around meal. I like to have my creon and a glass of water on the table to pick up and use throughout the meal. There’s nothing worse than looking round for somewhere to put food and drink down or asking someone to hold them whilst you get out some creon capsules.

 

[nonethewiser]

Staying with my regular Creon does make sense to me notwithstanding a few times when I've switched to Nutrizym due to shortages etc..
I guess an adjustment is required when packing to allow more focus on space for meds.
Planning to go in December for approx 3/4 wks..

There's a lot of spare space in those creon containers @Mr Steve , if going away for a while I'd be inclined to fill them up to save luggage space.