spicy peanut butter, low on a top bunk and frozen insulin: haiti.

A week ago I got home from my second trip to Haiti.

DSCN0665
Cite Soleil. Photo: Rey Nungaray.

To be honest, the “re-entry period” where I’m suppose to ponder why I need a laptop, desktop, ipad, cell phone, blue tooth speaker, heated seats, fitness watch, gps, and ALL the conveniences we take for granted, was… quick. Nearly non-existent this time. Maybe it was the TWO HOURS we spent slowly making our way through Atlanta customs, or jumping back in to work the next day, but I just didn’t seem to be bothered by the fact that I was heading back to a society that nearly requires the use of technology and convenience to get along efficiently with the rest of the humans around. I feel a little bad about this. But also, I don’t. I think it is a step in the direction of starting to understand the stark difference in culture. How society runs in

IMG_5709
“Traditional” Tap-Tap

the U.S. seems that it wouldn’t work in Haiti. And, I KNOW, there are common practices in Haiti that wouldn’t fly in the US… case-in-point: need public transportation in Haiti? Run along the side of a pick-up with seats built into the back, tap the side and hop on when it slows down. This is called a “Tap-Tap.” And is basically the bus system. I’m still not sure how they pay for their ride, how they know where the Tap-Tap is going, or how the drivers police distance ridden. The Honor System at its finest?

Haiti is a beautiful, sad, hopeful, happy, disheartening and wildly fascinating country with an even more interesting history. I could discuss and question the things we saw in Haiti all day. I can’t wait to return and soak up some more of the sunshine, heat and instant love provided from all those that call Haiti home. If you would like to discuss further, reach out — I would love to hear from you!

FullSizeRender 24
Goats everywhere.

 

FOR THIS BLOG though… let’s talk about T1D. And what happens to your T1D-management when you travel to a country with a climate unlike the one you currently reside in. There are a couple answers here. 1. absolutely nothing, or 2. ALL THE CHAOS.

The first time I went to Haiti, I over-prepared for all possible situations that could go wrong. And, everything was fine. Absolutely option 1. Despite the higher-carb fare we were eating, BG’s (Blood Glucose levels) stayed in check. The most dramatic moment of my 2015 trip was when I had to move my OmniPod to my stomach for the first time so the kids we were visiting didn’t pull it off my arm. But all in all — T1 was not an issue.

DSCN0599
New soccer balls!

This time, I over-prepared again. And actually, even more over-prepared than the first time solely based on new knowledge, changes in how I manage my T1, etc. I dutifully packed multiple vials of insulin and traveled with Frio packs. I brought insulin, extra Pods (insulin pump cartridges), syringes and needles out in the field during the day in the event my Pod failed due to heat or any other unknown. I had gummy chews and energy bars and alcohol swabs and back-up insulin pens and extra test strips and ALL. THE. THINGS.
But, I was still expecting everything to be normal protocol based on my previous Haiti experience.
Well…. T1D decided that since I already had a smooth Haiti trip, why not mix things up a bit? He (diabetes is a “he” right?) pulled out all the fun: insulin resistance, a faulty CGM sensor, my 2nd-lowest all time low, a pod failure, and a site change in a dirty tap-tap that required getting crafty with leftover insulin… Needless to say, it was like my T1D went on MTV’s spring break and left me to try and keep up.

FullSizeRender 68
After-school dance-off.

Interested in what happened?

For the first 2-3 days, I didn’t dip below 200. Correction after correction and that GCM line was staying flat.

On day 3, after increasing my basal rate by 25%, I dipped below 200 for the first time and was SO. EX. CITED. Like — yay! I’m not broken! My pump works! My CGM works! We’re into insulin again! Then, I ate dinner. And life was back above 300 again before bed. [Insert all correction needs here].

Then, after two days of being high, I DROPPED. In the middle of the night, because of course. 32 mg/dl.

For my new friends outside of the US, somewhere between 1.5-2.0 mmol/L.

For those who don’t speak blood glucose, you want to live your life between 70-120 mg/dl (note: I’ve heard variations of this range from different medical personal I’ve met and I like this range the best. I’m not a doctor and this should not be taken as medical advice). As a reference, when I’m at 70, I can start to feel my brain slowing down. At 50, I’ve probably broken into a cold sweat. So, 32 is low.

This was my 2nd-lowest all time low. My lowest has been 28, so we’re gettin’ close. Also, did I mention I was on the TOP BUNK. I literally. can’t. even. think about how it would have ended if I had to scale down the side of that bed to scavenge for sugar. Luckily, I had filled my LifeKit(TM)* with gummy treats and was basically sleeping with it in my hand. No life-threatening bunk-bed acrobatics to deal with. Just the life-threatening lack of sugar in my body to attend to. I killed a pack of gummy things and thought about how I would never put my kid with T1D (if I have one) on the top bunk [wait, did all kids with T1D miss out on the epic-ness of being a kid with a top-bunk?] while I waited the necessary 15-20 minutes to see if my BG was trending back on the up and up. I actually went back to sleep happy that I was seeing evidence that my BGs were trying to trend in a normal range again.

Then I woke up and Dex was like, HIGH.

HAITI GRAPH
Fun with Dex.

wtf. I mean, I knew I might have eaten a couple extra gummies during the night, but I was so low, and my BG has been CRAY, and they tasted so good… how could I not? But I didn’t think I ate THAT MANY.

“Dex” (as many affectionately refer to it) is short for “Dexcom” — the brand of CGM (Continuous Glucose Monitor) I wear. Dex is a small sensor and transmitter that uses interstitial glucose to measure a persons blood sugar at any given time. Dex sends the information to an app on my phone via bluetooth. Interstitial glucose is not the most 100% reliable read of your blood sugar, so I still prick my finger when I need to dose insulin or need an accurate view of my BGs. But, Dex is great for reviewing trends and monitoring your blood sugar over time. It reads HIGH with anything over a BG of 400. Remember when I said you want to be in 70-120? It also won’t graph anything higher than 400 – see pic above.

Appalled that I could have gone so high from a few gummy treats, I tested with my meter (this is when we do the finger prick). 140. I tested twice to confirm. Beautiful. So, I was in range, but Dex was freaking out. Ultimately I got Dex to calm down and he was prettttty good the rest of the trip. I had some trust issues though.

IMG_5641
Tried to get a game of Lightning going, despite the language barrier…

The next night I woke up low again (in the 50’s I think, so not as dramatic), and the same sequence ensued: test by the light of my phone, eat pack of gummy things, wait 15 minutes. The good part about this story/low was in regards to an event that had happened earlier in the night. We saw a mouse. In the house. After attempting to get it outside, we lost site of it in the commotion and weren’t sure if it escaped IN the guest house, or outside of the guest house. This would be whatever for most, but I have a friend who is TERRIFIED of mice – we’ll call her “E” – and she was on this trip, staying in my room. After the mouse incident and before going to bed, we purged our room of any and all possible food items, at her demand. I didn’t tell her I had kept a couple low treats with me. But I’m on the top bunk and my treats are with me, so we’re good. Fast-forward to the middle-of-the-night-low. I’m annoyingly eating candy in my bed in the darkness, and I see a flash of light come on from the bottom bunk across the room. I look over to see a seriously panicked look on E’s face in the light of her iPhone. She is looking down at the floor, in the corners and along the wall. I all but laughed out loud when I realized the noise I was making with the package of gummies sounded like a mouse up to no good. I quickly calmed her fears with a — it’s just me, I’m just eating snacks in the middle of the night — and she went back to bed. But probably not the deepest sleep she’s ever had.

FullSizeRender 32
All the girls got new dresses! All dresses sewn by my sister, S.

THE NEXT DAY, was a pretty light day in terms of service work and we were spending the
second half of the day in a town about 45 min from where we were staying, visiting some elderly and then going for pizza at a Haitian-run pizza place. With the lack of service work in the morning, I wasn’t really thinking about what to pack in my bag for the day and left the guest house without my typical extra insulin, syringes or needles. Super, Abbey. So, OF COURSE when we’re the furthest away from home base, my dear OmniPod decides to ERROR OUT. Just for funzies. When the Pod errors out, there is no way to re-start it. You have to take it off and toss it, along with the insulin in it. I’ve heard of people trying to get the insulin back out of the Pod when this happens, so as to not waste insulin. But I’ve also heard that once insulin is put in the pod, it should not be removed or recovered. It doesn’t really seem sanitary or healthy to me anyway. BUT. Here I was. Middle of nowhere (for all intents and purposes). On a Tap-Tap (NOT a clean environment). No working Pod. BGs trending UP. On my way to PIZZA. I did have an extra un-opened OmniPod with me. But NO INSULIN to fill it with. Then I was like I’ll draw the insulin out of the used Pod with a syringe and inject directly… oh, but nope, none of those with me either. My brain was like… you just need to find a way to get any insulin into your body. We weren’t heading home for another few hours and I knew there was SOME insulin left in the error’d pod. It hadn’t even given me the “50 units left” warning yet. So, I decided to do some OmniPod surgery. Everyone was off the Tap-Tap visiting the elders at this point, so I held back and got out some alcohol swabs. Side note: I’ve never seen such a dirty alcohol swab after I cleaned my hands. Ew. I used like 5 of them. I opened the new OmniPod and grabbed the small syringe that you would normally use to draw insulin out of a vial. This time, I stuck it in the small hole of the old Pod where I would normally inject the insulin to fill it. And I pulled back on the syringe. Minimal liquid filled the reservoir. In fact, some shot out the canula at the other end that is used to inject the insulin in the body. I just kept drawing insulin from the cartridge and then pushing out the air, drawing insulin and pushing the air. When I figured I had gotten out as much insulin from the used Pod that I was going to get, I had just under 100ml of liquid. The MINIMUM you need to fill an OmniPod is 100ml. When you fill the cartridge, you’ll hear 2 beeps at the end of the filling

FullSizeRender 20
The Tap-Tap we ride around in. Reiser Relief stays at the Healing Haiti guest house.

letting you know you can activate it. If you don’t hit 100ml, you won’t hear this beep and you can’t activate it. You will also lose whatever insulin you put in the cartridge at that point. So, to recap the current sitch… I’m using my last OmniPod (that I had with me), which is currently the only vehicle I have to get insulin into my body, ready to fill it with salvaged insulin from an old Pod and I’m just shy of the needed amount of insulin to fill a Pod. If I fill it and it doesn’t sense 100ml, I’ve now lost all of that insulin as well. So… I added air. Those of you with T1 or with a pump or managing a kid’s pump know that air is NO GOOD. But, I really wasn’t sure what else to do. I figured maybe the air would trick the pump into thinking I was filling it with 100ml. My rationale being that even if there is air in the Pod, I just need to get the pump to connect and activate. Then I can worry about getting the right amount of insulin in my body. Remember, I said I’m not a doctor and this is not advice?  Well… IT WORKED. And I corrected for my high. And, I ate Pizza. I don’t know if it was the air that did it. Or if I just got it to activate. Or honestly, in Haiti, probably it was the hand of God.

Finally, on the last evening as we were starting to pack, my insulin disappeared. Like, all the extra insulin I had been storing in the fridge ALL WEEK, was gone. After a few moments of panic, I found it in the freezer. You’re not suppose to freeze insulin…. so… awesome. Turns out, those Frio packs really look like ice packs if you don’t know what they are. Luckily, the temperature of most freezers in Haiti is not quite the same cold we use for our own freezing needs. The insulin was still liquid (does insulin actually freeze? I really don’t know) and I don’t think I’ve seen any lingering affects from the almost-frozen-haiti-death of my insulin.

So… that was T1D in Haiti.

DSCN0526
Cite Soleil. Widely considered one of the poorest slums in the world. Photo: Rey Nungaray.

Actually though, the whole pump-failure thing in Haiti… kind of ironic. Here I am with all my cool tech and access to insulin and it fails me in a 3rd world country. At that moment, I was hardly better off than a Haitian person living in the slums, allocating and salvaging the little insulin they may have. A lack of access, understanding or affordability is a major problem for anyone diagnosed in Haiti. It can often be a death sentence. It is moments like this when we realize how truly lucky we are. This is a topic I hope to explore further and look forward to further discussion.

 

IMG_3780
I was too busy eating the stuff to take a good pic of it… SPICY peanut butter!

Okay last thing because I can’t believe you’ve made it this far… SPICY. PEANUT. BUTTER. Those that know me have a certain level of concern for the amount of nut butters I can consume if I let myself. So you’ll understand that the discovery of spicy PB is life-changing. I don’t understand how I’ve lived 29 years without this product. Or, why this isn’t a thing ALL OVER the US. I don’t even think this is a ‘you-live-in-the-midwest-and-don’t-know-about-cool-things-right-away’ thing. I think it’s a ‘you-live-in-the-US-and-like-food-bland-thing’. SPB is amazing. On toast. On apples. On celery. [that is the extent of my experiments so far] I absolutely smuggled a couple jars (2 different brands because, I’m in marketing) back for further research. Stay tuned.

 

OKAY… should I let you be done? You’re never coming back to my blogs again, probably.

Prestige cheers!
-a

IMG_5688

 

*LifeKit(TM): a term of endearment, I [think I] coined, for my little clutch/bag that holds my pump, insulin, etc. — AKA: my LIFE.

 

 

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s