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Insulin pump supplies (equipment)

Ser

New Member
Hi
I will be traveling the Camino for 6 weeks in May and June 2012. I am a type I diabetic and I am currently using an insulin pump. Because of the limited space I have to pack all my clothing and equipment I am seriously considering going back on injections during the Camino because it takes up less space than carrying all the bulky supplies for my pump.
Has anyone had experience with traveling with the pump? Did you mail half the supplies required ahead? Also did the weight of the pack on the hip area (the area I usually put the infusion set) cause you pain or problems with the infusion sites?
Thanks
Serena
 
Perfect memento/gift in a presentation box. Engraving available, 25 character max.
I have never figured out how to post a link to another thread, but if you go to the medical section in the forum and then scroll about a quarter of the way down, there is a thread called Diabetics. Methodist Pilgrim seems like a good person to contact.
 
The 2024 Camino guides will be coming out little by little. Here is a collection of the ones that are out so far.
I copied what Sabine did so I hope this works. The section I saw related to your question is
medical-issues-on-the-pilgrimage/topic6471.html
Using the two different threads, I hope you will find the information you are looking for.
Nancy

I see that did not actually work! The basic message is, there is more than one thread on this in the medical issues section.

[edit: I fixed it (ivar) :-) )
 
Thank you for your replies. I contacted Methodist Pilgrim, since he says he has walked the Camino with an insulin pump and I will wait for his response.
Much appreciated!!!!!!
Serena
 
From my book - Your Camino:

Diabetes

•Use a product called Frio, a crystal-filled pouch that comes in several sizes, to keep the insulin. When submerged for five minutes in cold water, its crystals turn to gel and keep the pouch at an insulin-friendly temperature.
• Take two insulin pens instead of syringes because the needles and vials for a pen are much smaller.
• Take two blood sugar metres, a glucagon kit and extra prescriptions for your medicines.
• Obtain a doctor’s letter for customs, airport security and anyone else who might be alarmed by all those needles.
• Spend a few days getting over jet-lag and acclimatising before starting to walk.
• Carry extra bottles of water and juice as well as high energy bars, nuts, sweets or dried fruit.

Useful websites
http://coolerconcept.com/pages/testamon2momtainclim.htm
http://advancedspanishforpharmacist.wee ... ssary.html
http://www.anfasnavarra.org/html/volunt ... ariado.htm
Read about Dudley Glover, an insulin-dependent diabetic with coronary heart complications who walked the Camino in 2004: http://www.roadtosantiago.org
 
3rd Edition. More content, training & pack guides avoid common mistakes, bed bugs etc
I am going to post some general notes here and then direct Serena to this.

I am a diabetic, not a health professional. The advice and observations I offer here are made on my own experience of walking the Camino and not on any medical training. I offer it in good faith but you must consult your medical practitioner and, if they disagree with me, take careful note of their advice. They know you individually, your health record and complications; I don’t.

I have walked 500km of the Camino in 1998, SJPP to SdC to Finisterre in 2004 and have undertaken sections of the Camino in 2005, 2006, and early in 2007. All of those pilgrimages were as a type 1 diabetic on injections.

I started on a pump in October 2007. In 2008 I walked the Camino Frances from Logrono to Hornillos but back on injections. Not a clever decision. My sugars dropped too low and then I bounced back too high. I struggled to maintain good enough control. Even small amounts of exercise send my sugar levels plummeting.

In 2009 I walked both legs of the Camino Inglés and then SdC to Muxia on the pump. 2010 it was Sarria to SdC and in March 2012 Burgos to León, Rabanal to Ponferrada, both journeys being on the pump. 14 days, 6 days, 11 days respectively.

On my last pilgrimage I passed through the 1600 mile and 2700km barrier.

* The first thing to remember is that if you take a pump you must also take syringe backup. Pumps fail and if you run out of the consumables that are used with the pump you may not be able to replace them quickly - if at all.

Make sure you know both the formula and the figures required to convert the daily pump totals into the amount you pull into the syringe and make sure you have the right slow release insulin for the night time shot.

The added complication is you are going to have to find out by how much you need to reduce the injected insulin while you are walking. That will be trial and error on the Camino but it can be done.

It sounds complicated but having those figures already worked out and written down in your guidebook will help. Likewise you need to make sure that you write down your usual hourly basal rates so that if your pump “forgets” them they can be programmed back in quickly.

I do not change the clock on the pump to local time. My basal rate is set to the amount of sugar my body produces and changing a time zone does not affect that. Be aware that I only have to change this by one hour. Nevertheless, if I take a bolus of 0.8 at 6.00am my body doesn’t know that it is 7.00am in Spain. It still works to GMT. Take specialist medical advice if you are moving across several time zones but do ask, do I really need to reset the basal rate to local time or should I let the pump run to my body’s rhythms?

* Secondly, an obvious point but worth remembering. When you inject with a syringe the insulin is in your body and while it can be neutralised with a glucagon that process removes ALL the insulin your body and that can be bad news.

With a pump you can turn the basal rate up and down while you walk. I found that at first I needed to turn my basal rate down to 30% about half an hour before I started walking and kept it there for an hour after I had finished. After a couple of days walking the accumulative exercise and the effect on my metabolism meant that it stayed at 30% for a couple of hours after I’d finished. After a couple of days I found that at night I had to reduce my basal rate to 80% from the moment I slept to when I awoke.

Every diabetic is different and the rates you need to set will be dependent on your body size, the amount you walk each day, the terrain you are walking over, the weight of the rucksack, how much food you are eating and so on.

While finding my own rates I was prepared to allow my sugar levels run up to 12mmol and if they were at 4mmol at night I made sure I turned the pump down and usually had something to eat – your sugar levels are likely to drop while you sleep. Be sensible about this. You probably only need a couple of plain biscuits and not a bar of cholcolate to ensure that you do not hypo while you sleep.

The longer you are on the Camino the more likely it is you will work out the correct level of basal rate that you require.

The trick is not to hypo while asleep nor wake up with sugar levels over 15.

Many of my readings were between and an excellent four and an acceptable ten.
You are going to have to experiment but if you have used a pump for a while all of this should be second nature and nothing to be frightened of.

* Thirdly, make sure you carry some keytone blood testing strips so that if you struggle to get your sugar levels below fifteen you are not fighting keytones as well as high blood sugar levels.

If the keytones or sugar levels over 15 persist do not be afraid to take a day out and consider if there is anything you are doing incorrectly or could improve? If uncertain take a train, bus or taxi to the nearest city with a hospital and seek help.

One of the things to remember is that there are only a few places where you would struggle to get to competent medical help in a very short space of time.

If I ran between 7 and 10mmol I never worried about being in that range. It may be unacceptable for your home life but on the Camino for 30 to 40 days I doubt if it will cause any lasting damage. You are less likely to hypo as well.

* Fourthly, eat small amounts of food as you go along. I really do mean small. Little and often. It will give you the extra energy that you need as your body is expending much more than normal and it will prevent your sugar levels dropping to hypo levels.

Carry half a bottle of Coke or an energy drink to boost your sugar levels quickly. You will have no problems buying that sort of drink along the Camino. Don’t drink too much and over correct a hypo. Once the Coke is in your body it is there. You can always drink more if you need it.

If you carry high energy bars and half a bottle of Coke (not diet!!) you should be able to cope with a hypo with few problems.

Take plenty of test strips (5 a day minimum) and do plenty of tests. This is especially important if your hypo symptoms are poor to non existent. Do a blood test before you go to sleep. Make sure your testing kit is beside your pillow and if you wake up check your sugar levels. Carry a tiny torch in the bag itself. I have plastic wind up LED torch from Maplins which is smaller than the meter. Be prepared to turn your basal rate up or down. Remember that pharmacies may not have strips that are compatible with your meter so make sure you carry plenty of strips and do not hesitate to send extra to yourself. If you don’t use them you can bring them home.

* Fifthly, Spanish food on the Camino is high in carbohydrate. Take a sensible bolus amount for your meal. Remember how high in carbs both bread and chips are and that the latter may require the bolus being taken over a longer period. Many pilgrim meals offer yogurt as a desert. Don’t forget many are pure sugar. OK if you are going to walk in the afternoon but maybe not so clever if you finish your meal after 21.00 hours.

If I was walking in the afternoon I would do a rough calculation of how much carbohydrate it had in it and then dropped my bolus by 2 units but rarely more than that.

As a rough guide remember that exercise should be dealt with by dropping your basal rate and not your bolus.

* Sixthly, the pump consumables are light but bulky. Think about posting some of them to yourself at the major cities. Pamplona, Logrono, Burgos, Leon, Ponferrada, Santiago. It is likely that you will have posted ahead of yourself too many of some of the consumables. The transfer lines between the pump and the canula and the cartridges used in the pump itself come particularly to mind. The amount of insulin you take will probably drop dramatically and in the March 2012 journey I put a full syringe into my pump at the start of the journey (135ml) and only had to replace it once. I returned home with insulin to spare.

This is not a problem. If you recover a package from the Post Office and you don’t need all the supplies, send them on to the next post office. If you speak good enough Spanish or find a fellow pilgrim who will interpret for you this should be easy to do.

Use the internet or the forum to obtain the addresses of the Post Offices you want to use but remember they will probably only be open in the morning. You might have to put up with a late start that day or even use it as a rest day.

*Seven. I use my hips, my tummy and the top of the legs to site the canula. It is inevitable there will be some rubbing though it will probably not be as bad as you think. I have rested the rucksack hip belt on the canula and not had a problem. In fact it is where clothing moves that I have found most problems ie on the legs.

I changed my canula every day to prevent the skin becoming sore and painful. Yes, I did have to carry more canulas than if I had been at home but it was worth doing.

* Eight. Use the lightest possible plastic container that you can find to carry the consumables in. Make sure it is strong enough not to be crushed under normal rucksack carrying conditions. Many of the boxes used for storing food in the fridge are ok. I paid £2 sterling (less than 2 euros) for my box. Carry it as hand luggage on the plane. Once you start walking there will be little to damage such a box in the rucksack itself.

* Nine. Golden Rule for all pilgrims. Get the weight of the rucksack down to the minimum. If you can ask an albergue warden for a blanket in Spanish then seriously consider taking just a sleeping bag liner. If you are cold at night get into bed dressed with next days clothes on. The lighter and smaller the sleeping bag the more space you have for the consumables and the less weight you carry.

* Ten. Make sure you get plenty of water down you. A camel is worth its weight in gold. Water thins the blood, especially if your sugar levels are running high. Like food, little and often.

* Eleven. Carry the telephone numbers of your doctor, your pump clinic and, if possible, a doctor at home who speaks Spanish. I carry the mobile number of a friend who is a doctor, has been a medical missionary, and who knows me. The information is written in Spanish that this is the person worth phoning first.

If you are solo then I think you must carry a letter in Spanish explaining what people need to do if they find you fainting or unconscious. You almost certainly wont need it, but it would make sense. I would also leave it next your pillow when you sleep. I would have it in an envelope with the words, if I am fainting or unconscious this is what I need you to do for me.

Also bear in mind that albergue wardens look out for ill pilgrims and will call for help if they need to. You will rarely be alone while walking and as the journey progresses may well meet up with a number of people who will look out for you.

If you carry a mobile make sure the device that locates where you are is switched on. Remember that dialling 112 will put you in touch with the emergency services and that someone there will speak English (and many other major languages as well). Let those who are looking out for you know where you are walking to that day and perhaps phone someone at home with where you are and where you intend to be tomorrow night. It will reassure them if they are worried about you.

* Twelve. Check the other threads about how to deal with blisters. Note my own advice on carrying Mepore tape and pads. Do not ignore a blister and treat it ruthlessly.

* Thirteen. This sound hellishly complicated but for a pump user who has been using it for a while it should make sense. A bit of planning ahead will save you all sorts of grief and will make you feel confident about undertaking this trip.

* Fourteen. If you live in Europe make sure you have a valid (not an expired) E111 card. You MUST have travel insurance that covers your diabetes and includes repatriation by air ambulance. Make sure they know what distance you are walking; some cut off at 300km unless you pay extra. Doctors in Spain may treat you and charge you. If you go to hospital try and make sure it is a public not a private one.

As a pilgrim, the hospitals, clinics and doctors will treat you with special kindness but you have a duty to make proper financial provision for medical care.

* Fifteen. The aim of the Camino is to get to Santiago safely. For a pump user this means arriving without having gone into a hypo or keytone coma. If you’re next HbA1C is higher than normal because you’re control has not been perfect, so what? If you have made Santiago without any major incidents that is all you have to do.

Most of what is above is common sense and second nature to most pump users. A lot of it you will be doing already when you go away to anywhere else and when you undertake any kind of physical activity or sports.

The Camino presents a challenge if your Spanish is non-existent to poor and for the fact that it is a physical activity for long periods of the day and that it may be for up to a 40 day stretch.

On the other hand the longer you walk the better the routine and the more experience you will gain.

I currently have stents in my heart, my kidneys are functioning at 80%, I have slight foot neuropathy, some diabetic retinopathy, a frozen shoulder and yet if I return and walk from Ponferrada to O Cebreiro I will have completed the Camino from SJPP to SdC for a second time even though it was in stages.

Don’t rule yourself out of walking the Camino just because you are a pump user. Some proper and careful preparation and a large dollop of common sense will ensure that you will be able to do it.

Finally, I would welcome comments, criticism and other helpful advice as it is by sharing together that we learn from one another.
 

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