July 26, 2000
Question from Virginia, USA:
My daughter will be travelling throughout Australia (including the Outback) this summer. Do you have any ideas on how she can store her insulin? I read a question you answered previously that recommended the DiaPak, but this requires you to refrigerate/freeze a gel pack to use. She will not have access to facilities to do this. At home, she often keeps her insulin unrefrigerated with no problems, but I am concerned about when she is traveling outdoors in high temperatures. What foods do you recommend she bring for snacks? She will not have access to stores while she is there and is also very limited on the amount of luggage she brings. She will be gone for 18 days. Her main meals will be provided, but she needs food for afternoon and bedtime snacks, plus for lows and when meals are delayed.
I’ve used a wide mouth nalgene bottle, 1 liter for drinking and storing insulin. It won’t get hot in an insulated sleeve.
Carbs are the issue: take some food bars; there are lots of choices that give energy and food value. Check with your dietitian.
Additional comments from Dr. Donough O’Brien:
This sounds like quite an adventure. The manufacturer’s upper temperature limit for insulin is 85F, so when you consider that ‘summer’ in the U.S. is winter in Australia, your daughter should not have too much trouble. Just the same I would have a careful look at the itinerary and see just exactly what is meant by the ‘outback’ and find out if there are any overnight stops that have no access to refrigeration of some sort (which I think unlikely). If there is to be a different stop each night then if the DiaPak can be left in the cool overnight it should stay below 85F for the day.
For evening snacks she might consider Extendbars or Nitebites, which are supplied through a pharmacy. For other snacks, crackers, granola bars or power bars, which can be found in the supermarket are fine. I have only dealt with the issues of temperature and snacks so your daughter should talk to her diabetic team about insulin adjustments during the long flight and for increased exertion and I think you need to have an idea of what medical backup there might be in case of need.
Additional comments from Dr. Tessa Lebinger:
I have not actually seen them (though I have ordered some to evaluate), but Frio makes wallets for insulin that they claim keep cool for up to 3 days by just putting the wallets in water for 15 minutes. See: http://www.friouk.com/
I recommend that she bring high protein bars with her for emergency food (make sure they don’t melt in the sun!). They come in various combinations of carbohydrate/protein/fat. The power bars are very high in carbohydrate (averaging around 45 grams carb/bar and 7-14 grams protein/bar. Choice bars are about 15-20 grams carb/7 grams protein. Balance bars are about 22 grams carb/14 grams protein. You can go to pharmacies and sports stores to see what is available locally. If she brings an assortment, she can vary what she eats according to her blood sugars.
I would also bring many bags of cookies that won’t spoil and crumble in “1 serving” portions. There are many small bags of cookies available containing anywhere from 15 grams carb per bag to 45 grams carb/bag. I would also bring many tubes of cake decorating gel for emergencies and/or coke syrup in plastic bottles (the syrup, not the actual drink — very sweet and won’t spoil).
Good luck and have fun.
Additional comments from Dr. Stuart Brink:
Australia is mighty civilized so that there will be plenty of small and large stores for her to stock up on snacks, drinks, etc. Glucose tables would be well to take along since they are obviously small and compact and travel well in suitcases and back packs.
Depending upon temperatures in Australia and exact locations she’ll visit, a cool pack would still work very well. Somebody at a hotel would likely be able to “freeze” her cool pack at least every other evening and it is likely to retain its colder temperature enough to prevent any heat damage while traveling.