Istanbul Part II – The Diabetic Bits…
As with everything in my life, diabetes was with me on my trip to Istanbul. And in a place with a 10 hour time change, foreign, carb-heavy food, and an unpredictable exercise schedule, you can bet I met my fair share of diabetes challenges on this trip – from ill-timed lows to mechanical issues, to interesting security interactions, diabetes was all over Istanbul.
My first challenge was whether or not to adjust my basal rates for the 10 hours-forward time change. As with most pumpers, I have several different basal patterns running on my pump for times when I need more or less insulin (my rates go up, for example by 1/10 of a unit from 3am to 8am – a little dawn phenomenon I do believe). But a 10 hour difference would almost invert my entire schedule by 180 degrees – as if the daily patterns had flip-flopped. Moving the clock ahead 10 hours on my pump might confuse my body even more than the jet-lag was. I could have adjusted a few hours a day and eased into it, but since we were only there 7 days, I would be adjusting backwards right as I reached the goal. After much deliberation, I chose what I felt was the safest option: I didn’t change them at all. My blood sugars were already bouncing off the walls from new foods, hours sitting on a plane, and general fatigue, so I opted to leave the big picture alone and concentrate on small, hourly adjustments. I had planned to rely heavily on my CGM to help me fine-tune my numbers. Epic failure on that one.
Don’t get me wrong – I love my CGM – when it works. Call me a fair-weather CGMer, but when that thing is outta whack, it drives me up the wall. There’s nothing more anxiety-inducing than reading your CGM and finding your finger stick test 100mg/dL off – that’s unacceptable and unhelpful, and was unfortunately happening with the sensor I had on when I arrived. Frustrated, I ripped that one out and inserted a new one.
Which failed about 2 days later, and hadn’t been tracking well anyways. I had only one sensor left (since they last 7 days, up to 14 if I push it, I had only brought three with me – I had in fact planned on wearing the original the entire time I was there). I begrudgingly inserted my last one, which gave inconsistent readings for its first two days. On day three, I accidentally tugged it off while pulling on my jeans, and there went my last sensor, halfway through the trip. Since it hadn’t been tracking well though, I wasn’t particularly upset that I had torn it off. I saved the transmitter, packed up the Dexcom in my carry on, and went back to full time finger stick tests for the remainder of the trip. Its so funny how inconvenienced I felt the whole time – I managed my diabetes like that successfully for 16 years! How spoiled we get with our lovely little devices!
Now, let me get to one of the highlights of the trip: Turkish food. Oh delicious, Mediterranean, savory, marvelous Turkish food. It is truly one of the best cuisines I have had the pleasure of sampling in this lifetime: Chicken kebap sandwiches dripping with tzatziki sauce; hummus sprinkled with cinnamon and raisins; sesame-seed covered simit breads for breakfast; delectably sweet Turkish delight candies; fresh pomegranates from a sidewalk market; soft and fluffy Turkish pancakes with minced meat and tabouleh; meat raviolis with garlic cream sauce; fresh fish from the Bosphorus, and tender lamb kebaps served on a bed of rice and local spices. Oh. My. God. I was in heaven – a heaven of flavors and tastes that made my taste buds dance with every bite. I am simply blown away by Turkish food.
And the carbs. Holy hell the CARBS. Nearly every dish involved a heavy serving of tasty, bolus-worthy carbohydrates, but I had little information for carb counting. Some foods I could guess pretty well – like rice and hummus, but Turkish pancakes? Pide? (a.k.a Turkish pizza…) No clue. So, I did what any person with diabetes does in that situation. I tested. I estimated my insulin. I ate. Then I tested again. And again, and again, and again. Some days I was testing almost 20 times a day – not that big of a leap for someone who regularly tests 10 times a day, but it felt like a lot even to me. And because we were walking around sightseeing most of the time, it was difficult to test on the go (another reason I would have liked a working CGM!). There were plenty of One-Handed-Standing-Test-Maneuvers pulled on this trip (including the one in the photo on this post, in line for the Aya Sofia). Also, the fact that is was pretty chilly in Istanbul made it difficult to get blood out of my fingers on a couple of days, and I had to sit there milking my hand like I was trying to rip a whole finger off! But the adamant testing paid off, because despite some off-the-wall numbers, I managed to keep my range pretty steady. By the end of the trip my fasting BGs were right where I wanted them, and I had the simit breakfast nailed (6 units is the magic number for a simit with olives and cheese, in case you were wondering…).
As if the food wasn’t challenge enough, we were walking the majority of the day – sometimes up large hills to check out a castle (as you do) and other times in smaller spurts between large bouts of sitting (on our boat rides along the Bosphorus). Since walking is exercise, there were times where I had to be a little conservative on my dosing because I didn’t want to crash out low from all the trekking. There were many failures on this front though, including a mind-fuzzying low in the middle of touring the Blue Mosque (don’t ask me what I was looking at on that part of the tour, I don’t remember!), but I had come prepared with tons of GU packets for just such emergencies, and I tried to take the lows in stride with the day and carry on.
By and large, my diabetes went unnoticed by the locals (aside from a few strange looks while sucking down a GU pack in the Spice Market), but there was one interaction that brought a smile to my face. While sitting at an outdoor restaurant, we ordered our food from the friendly waiter who spoke almost no English. We smiled and hobbled our way through the ordering process, pointing at pictures of what we wanted and laughing together with the waiter at our language barrier. I pulled out my testing kit as we waited for the food and checked my blood sugar. The waiter, who was collecting our menus off the table, looked down at my meter and exclaimed: “SUGAR!”
“Yes! Sugar!” I replied and we both smiled in the shared understanding of diabetes. I don’t know if he himself had it or he was familiar because of a friend or family member, but either way, it was a welcome connection that warmed my heart.
All in all, through good preparation and diligent testing, I found my diabetes to be manageable on an action-packed trip in a far-away city. It made me grateful for my years of experience, and for the travel advice I received from many of you readers before leaving. On thing that I was particularly grateful for, which may surprise you, was the Turkish airport security, especially in the wake of the recent bombing attempt on a U.S.-bound flight. For years I have been amazed at the fact that I am almost never questioned about my diabetes equipment, even though I am traveling with sharp objects and liquids. I regularly board planes with syringes and insulin and everything else without so much as a second look from security. But passing through the security checkpoints in Istanbul, I am happy to say they caught-and questioned – everything. A body pat down revealed my OmniPod, and a bag search quickly uncovered my syringes. Security immediately called another inspector, and thanks to the fact that I was prepared with a doctor’s note in both English and Turkish, I was not held up for more than a few minutes. The security there was appreciative of the fact that I had the note in Turkish side-by-side with the original note (written on a prescription pad page), and I felt safe knowing that they were checking everyone and everything. It made sounds strange to be thankful for a security hold-up, but that’s their job and that’s how we keep passengers safe. Well done!
Along the lines of being prepared, its worthy of mention how glad I was for having packed all my medication and supplies (enough for a few days) in my carry on – since that initial flight was cancelled and we were stranded – without access to our checked luggage – for a full day. I would have been in serious trouble if I had not had all my gear with me. Its another reminder that with diabetes, you must always plan for the worst (but do continue to hope for the best!).
Overall, I am so amazed and impressed at this trip to Istanbul – from the city to the people to the food, this place is a must-have on the Life To Do list. I am simply blown away by the magic of this city, and I am so glad that my diabetes didn’t hold me back from experiencing this enchanting place. And I’m inspired to take on 2010 – and its diabetes challenges – with more experience under my belt.
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Comments
Hey Kim – don’t worry! You will be fine! Turkish people are so nice, and so helpful, the only issue is the language barrier – you guys will be FINE! You are more than welcome to send me any questions – email is alexis@irunoninsulin.com.
Email anytime and get EXCITED!!
just read all your tips about your trip to istanbul..i am going there in august with my 3 yr old who has type one….i am a nervous wreck…would you mind if i can send some questions your way? thanks so much