April 3, 2006
Question from California, USA:
I am 25 years old and was diagnosed with type 1 diabetes when I was five. My most recent A1c was 5.7 and I remain in excellent health by testing regularly, etc. I just received a fellowship to spend a year living and working in a country in Southeast or East Asia. The process as to where precisely I will be placed is currently beginning and I was hoping to receive some advice as to the types of concerns I should be considering. I have told the organization that I am diabetic and have requested that I be located in a large, fairly modern city that has decent medical facilities in the event I should fall ill. I have never lived outside of a modern,"western" country before and I am somewhat apprehensive as to the different types of diseases that I might encounter in Asia. In addition, having never been to Asia before, I am also unfamiliar with the extent to which I might be able to find supplies such as testing strips and insulin in some of the countries there. Any advice, whether general or specific to a country, is much appreciated.
In any of the large cities around the world, you should be able to get supplies fairly easily. The exact ease and system will be somewhat variable. Alternatively, all your supplies could be Fed Ex’d within a few days to you from your family/friends at home without much problem. Insulin can travel quite easily with cold packs in Styrofoam, if necessary. In smaller cities, you may have problems, but this would also likely depend on exact country location. Assuming that your excellent A1c reflects good knowledge about diabetes and how to manage daily vicissitudes with frequent blood glucose monitoring, I would suggest that you discuss this directly with your own diabetes team since they know you best and can give you specific advice. If you are in a large enough town with a medical university, then emergencies could likely also be handled by local university surgeons and other physicians. There is some generic risk with infectious diseases, but reasonable common sense approaches should work. Immunization are available for some and for some others, such as malaria, prophylaxis, may be required.