Travelling with Diabetes in Egypt

Dec 29th, 2008, 05:22 PM
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Travelling with Diabetes in Egypt

I will be chaperoning a group of 41 students aged 15 - 19 to Egypt in March 2009. We will be travelling for 14 days, doing the typical Egyptian stops, Cairo, night train to Aswan, 4 day Nile cruise, 4 nights in Hurghada and back to Cairo. I travelled under similar circumstances in March 2005.

My question for this panel of experts relates to the medical conditions of my students. Two of my students have been diagnosed with diabetes, one many years ago (and he is on an insulin pump) and one very recently.

Does anyone have any experience in circumstances such as these? How easy is it to maintain proper sugar levels and eat properly? Has anyone had any concerns about medical care available for foreigners? Are there any other questions I should be asking before we depart?

Thanks for your help.

teacherCanada is offline  
Dec 29th, 2008, 05:53 PM
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First suggestion would be to make sure they have travel insurance in case of medical emergencies.

I just got back from Egypt - Globus tour, Nile cruise and 3 days on our own. I don't think you will have any problems with food. Wide varieties are usually available. I suppose your students will watch their diet just like they do at home. I don't think you have to worry.
rfbk50 is offline  
Dec 29th, 2008, 06:03 PM
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Silly of me not to mention that - yes all students have purchased the RBC Gold travel insurance which includes emergency evacuation etc. Thanks for your response rfbk50.

teacherCanada is offline  
Dec 29th, 2008, 07:25 PM
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I agree ,your students should have no problem maintaining proper sugar levels in Egypt.

The one student on the insulin pump, knows exactly how much insulin he requires, and should he up his activities or increase his food intake,he will just "up" his insulin a bit .....and I am sure he know how to do this.

The one diagnosed he on insulin also...I would think he would be.?!

There are such simple,painless machine now to check one's sugar daily .

They have good medical coverage.

These two Diabetic student ,I am sure have learned a lot about Diabetis.

Are their parents worried about them going to Egypt !?

Percy is offline  
Dec 30th, 2008, 06:04 AM
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Thanks for your reply Percy.

The student who was diagnosed with diabetes many years ago is quite able to balance his activities, food intake, rest etc. His parents appear to be a bit more protective than most (and I understand this). The government Health Unit has not prepared any special information for travellers with diabetes that I am aware of.

The other student (female) was diagnosed about two weeks ago and I am sure she and her family are anxious about her pending travels. She will also be using insulin, but I don't believe will be on an insulin pump.

I believe both students are intelligent and capable of dealing with diabetes. I was searching for advice on situations we might encounter that I had not experienced. I do appreciate any first hand advice or suggestions.
teacherCanada is offline  
Dec 30th, 2008, 01:27 PM
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As a spouse of an insulin-dependent traveller to many, many countries around the world, I do have a suggestion or two that you might consider.

My husband travels with an 'Insul-Pac' bag ( whenever we go to hot countries. It is a bag with it's own thermometer and an ice pack. Last time I ordered one they were not shipping to Canada, but perhaps they are now I had it shipped to a friend in the Seattle & then we picked it up from him. My husband has had two over the last 10 years they last a long time. We take two ice packs (the gel kind, also sold on that same sight) and we ask the guide/hotel/concierge etc to freeze one for us each night & morning and swap it out in the morning and evening. It keeps the insulin cold all day, which gives my husband peace of mind in hot countries. Theoretically most insulin can be kept un-refrigerated for a few days, but my husband takes one kind that cannot, and he just feels better keeping all of it cold.

Sometimes it is a real challenge to get some to understand we want it in the freezer, not the fridge, but mostly that provides us with a good laugh after the fact. I have since learned to write out the word 'freezer' in about 20 languages.

When flying internationally over the last few years, we have put the gel pacs (not frozen) in the checked bags as we did not want to risk a customs official telling us we can't take it on the plane and then throwing it out.

This bag also keeps everything one needs in one place, which is good. Jim has it with him at all times. And leopards like it - Talek, the orphan cub that is now back at the Kenya Wildlife Service loved it and REALLY wanted to get it from my husband! (sorry, I digress...)

That's my main suggestion, other than to say that there has been no problem with eating right on any of our trips. Porridge, which is Jim's sure-fire breaksfast staple is usually available as an alternative in most countries to western bacon & eggs, or Asian noodle breakfasts. The few times that it hasn't been available he has asked for hot water and made up a package of the instant kind that we bring along just in case.

The level of activity is up higher on most of our trips than what we experience at home, so he does adjust accordingly and tests often. There's the key for the new girl on insulin - test often & be sure. Jim carries his own sharp disposal container on our trips, he is very concious of not throwing anything like that away. He also carries ready-snacks in the bag - a granola bar or two, pkg of Dad's oatmeal cookies, or other such portable hearty snacks that we can bring or find along the way. He always carries a supply of hard candies too - just in case - he prefers Werther's as they fare fairly well in hot countries. The only place the Werthers in his pocket was a problem was the Taj Mahal, but our guide diffused that situation by showing his "I am a diabetic" card to the guard, who in turn let Jim keep the candies with him.

Both kids should carry a card - or purchase the bracelet before they go in case they get separated from you. Jim always tells everyone that we travel with that he is a diabetic on insulin and this works really well. All of the other kids should know about the two with diabetes, and it just wouldn't hurt for you to go over with everyone the signs to watch for in case of low blood sugar - call in a public health nurse for some info on this if you can. I know a lot of people do not like talking about it, but their travelling buddies should know what to watch for as it can creep up at the strangest times.

Jim and I ran a week long Cub Scout Camp back in the 80's, and one of the young leaders helping us went into a very low blood sugar situation, and was just about in a coma when one of the kids alerted Jim, who in turn acted upon it immediately. Without that cub scout that knew something was wrong, the ending could have been different - as it was this young leader was in the hospital for the next month as they tried to stabalize his blood sugar before releasing him.

As for medical care, I can't comment on Egypt as I haven't been there, but I have always felt safe in any country we have visited. I do make sure that we have plenty of coverage of course, including Flying Doctor service when we go to East Africa.

Mind you, there's a been a new cog thrown into the wheel since I heard about the firefighter from BC, in Goa, India who was refused treatment after an accident, as they were not sure she had medical coverage. She died unfortuantely & that's pretty scarry, apparently she was turned away from 3 hospitals. I would imagine that we will make good & sure we carry our policies at all times, even when just out for a stroll along a street in a foreign country.

Sorry this became a book, guess I really wanted to extend my lunch hour today!!!
LyndaS is offline  
Dec 30th, 2008, 03:22 PM
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Hi LyndaS

Thanks for your detailed response. I treasure advice from those who "have been there and done that". Your comments are especially important to me because you speak as an experienced traveller familiar with diabetes. I will pass on some of your comments to the parents of my students.

teacherCanada is offline  
Dec 31st, 2008, 06:37 PM
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We returned from Egypt just yesterday, my husband is diabetic and had absolutely no problems,a healthy diet is easily maintained and the hotels will cater for any special needs or diets should it be necassary. the only problem my husband had was denying himself the delicious desserts.
Any tummy troubles you may encounter and the local pharmacey are great, Cipro is easily available and they have a better diarhea formula than Immodium more suited to Egyptian tummy.
Hope this helps.
keah05 is offline  
Jan 1st, 2009, 10:43 PM
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Thank you keah05

I certainly appreciate hearing of travellers to Egypt who have diabetes, and have only good experiences. My worry, since parents will not be present and I will be acting as "in loco parentis", is what could go wrong and what facilities are available to deal with upsets. I know I sound like an insurance agent when I talk like this, but I do need to prepare myself and my students for unexpected occurences. Does anyone have experiences with hospital or emergency care in these situations?

Thanks for your patience.

teacherCanada is offline  
Jan 1st, 2009, 11:17 PM
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I live here and have several doctors that I know and have had 3 surgeries since I've lived here. I find everything fine around Cairo, but that is partly because I live here and actually probably have low expectations for what they would be like.

I think I would have a sit down with all the students and let them know that if there is an emergency that requires a doctor and a hospital, that it will not be like being in America. First, while their doctor will speak English (some anyway, if not perfectly), he is probably going to be the only one at the hospital that does speak English, so they will have a harder time understanding what is happening, but that these people are professionals and they will be looked after well.
Diabetes is a big problem here in Egypt, so the doctors do know how to handle it. It won't be a big deal for them, I'm sure.

If you have an Egyptian guide working with you on this end, do let him/her know that you have these two teens with you and there is the chance something could happen. The guide should be ready with doctors names and hospitals in each area you will be in. And the guide should be asked to stay with the student or find someone else that can speak English clearly to stay with them in the event of any emergency to translate for them.

Insha'alla (God willing) nothing is going to happen and everyone will travel safe and be happy and healthy for the trip.

I guess I could explain a little bit about the hospitals I've been in and what they were like, in the event you have to go.

Once I was admitted quickly into ICU at a hospital in Dokki (Giza area). I think it is called The International Hospital. I was coherent so I could evaluate the surroundings. The staff was fine. They were very close to me and could have eye contact with me almost all the time through the window into my room, which was good as there wasn't a working "call button" for me to push if I needed something. There was a TV in the room with satelite reception so I could watch English TV. There was no toilet near my room which seemed wierd that I had to go down the hall with my IV attached to pee, but considering most of the others in ICU were not getting out of bed at all, I guess that might be why they didn't design the rooms to have bathrooms attached. The other 2 hospitals I've been in both had a bathroom in the room. All my rooms have always been private rooms.

Another thing you might need to be ready for is cash payment for services. I am not real sure how accepting of just taking English format insurance papers they will be. I kind of doubt they are going to be ready to bill the insurance company. Be ready for that anyway. I have always had to pay cash before leaving the hospital. If that is the case, you will have to gather enough cash to pay the hospital and then turn in the receipts to the insurance company. Don't worry though - the cost won't be anywhere near what it is in the states. My ICU bed cost right around $100 per night. Cheaper than a 5* hotel...but I had to walk down the hall to pee.
Casual_Cairo is offline  
Jan 2nd, 2009, 07:37 AM
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Thanks for responding in such an informative fashion.

We will be travelling with an English and Egyptian speaking guide. We will also be travelling with the co-owner of the travel company. She travelled with us in 2005, was (and remains) a stickler for details. She is very caring and ensured all our students were well cared for.

I do appreciate your comments about what to expect if any of us were to be taken to hospital. Those are insightful and I will share them with my student and parent travellers.

The cash payment issue will not be an important one for us - our travel agent can smooth over most items like that - and we will have access to cash if needed. It is nice to know what differences we will encounter. We will also be well insured.

Thanks again for your comments.

teacherCanada is offline  
Jan 21st, 2009, 07:03 AM
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We're only 44 days before departure. The two lead chaperones will be meeting with both sets of parents (and the students travelling with us who have diabetes) and a Diabetes educator in a few weeks. We will have a chance to review protocol and answer any questions parents or travellers might have. One of my biggest concerns is how the time zone difference will affect their food consumption regimen. Thanks very much for all the responses.

If anyone has any other suggestions/hints I would love to hear them.

teacherCanada is offline  
Jan 22nd, 2009, 06:56 AM
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I travel all over the world and have had Type 1 diabetes for 25 years. My best tip is take several tubes of glucosomine tablets and make sure several people have the tablets tucked in a pocket or fanny pack. These tablets are easy to travel with, but you do want to keep them in the plastic tube they come in if there is heat or humidity as they will "melt" in a sugar mess.

My time is usually spent in the southern part of Africa, and what I try to do is eat a balanced breakfast and have a snack with me. I immediately change over to the time zone I am in with my insulin, and do take the 24 hour Lantis, so that helps. Also, have the kids check their blood sugar more often, but above all, please do not make it such a big deal that they feel out of place.

I do get travel insurance in case I ever needed airlifted out of some remote area, but luckily, have never needed such help.

Walking, heat and not drinking enough water are the three things that effect me. Walking is fine, but miles of such excersise just requires an extra tablet or two. It takes about ten minutes for someone with low blood sugar to get back to normal. Just be patient and be careful not to overfeed them where the blood sugar level goes back over 300.

Most of all have fun!!!! Please do not ask them every ten minutes if they feel okay, do they need food or constantly remind them to take a shot. My guess is these kids are pretty smart and would not be going on this trip if they were not.

Hope that does not sound like I do not care, always cautious about postings on these sites, but just giving you my two cents as what drives me crazy when travelling with an overly-cautious companion. It is a good idea to have a box of juice and snacks in the hotel room at night in case of a low blood sugar night visit. Low blood sugar for those of you new to this is usually a reading under 65 on a blood sugar monitor and the signs are blurred speech, sweaty and clammy skin, and in my case, an increased heart rate. Of course, only I can feel that.

One last suggestion, probably would be a good idea to have someone else carry a back up supply of one meter, extra insulin, strips and syringes just in case anything happened. Also, I have not had issues keeping the insulin cool as once opened, it is okay to be a room temperature. Avoid having the insulin in heat over 80 degrees or in direct sunlight.

Mine post became a book as well, but appears to offer a different set of worry-free ideas. Please do not hesitate to ask any other questions as my guess is all these answers will help others as well.

ShellCat is offline  
Jan 22nd, 2009, 07:12 AM
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I can't speak about Egypt specifically, but as the sister of a long time diabetic my best suggestion is to ALWAYS have convenient fast acting carbs/sugar on hand. Even if you've just had a meal. Even if you are on your way to a meal. They should keep supplies on them at all times, but you should too. You never want to be in the situation of having to ask around saying "does anyone have any candy?"

No matter where in the world you are (even at home), you can encounter a delay, or a diabetic can begin a hypoglycemic episode for no apparent reason. The more conveniently you can handle it yourself immediately, the better your chances of totally avoiding emergencies.

Here are some general principles:

If they start looking or acting 'shaky' or confused, have them test their sugar levels immediately, even if they checked recently. Also, be aware that irritability can be a symptom. Agree with the parents and students beforehand that you have the right to ask them to check their sugar at any time, and do not be deterred if they get annoyed at you. On the other hand, there is no need to arbitrarily bug them.

Make sure that YOU also know how to check their sugar, in case they are too confused to do so themselves.

Have them pack extra testing supplies. Due to the time zones, and the different activity schedules, and the different food, they might need to test more often than they do at home.

Even if they are confused or incoherent, as long as they are conscious enough to swallow, you can help them and can probably resolve the incident by yourself, even before you get any medical assistance. On the other hand, if they are unconscious, they will choke if you try to force food on them.

If they are semi-conscious, try simple, direct instructions: "Listen to me. You are having an insulin reaction. You need sugar. Do you understand me? Open your mouth. Swallow. Good. Open your mouth. Swallow. Good. "

The key is to try to head problems off rather than letting them progress to the state where they need medical intervention. If their parents are letting them go, it indicates that they are stable enough and responsible enough. They should be able to have a good time, and you should too!

In terms of what types of snacks to have on hand, the parents should be able to give you suggestions. If the parents agree, you might want to consider 2 categories: 1) a healthier longer acting snack for a meal replacement, to tide them over between meals, used BEFORE their sugar is low, to avoid problems. 2) a quick acting carb such as glucose tabs or frosting in a tube, to use if their sugar is already low.

One more thing. In the airport, cases with diabetic supplies are often pulled aside for hand screening. If so, it is good manners to inform the screener that there are syringes and lancets...if they get surprised they get scared, and if they get scared they can make trouble.

Are you thinking of using a buddy system? It's probably a good idea if they don't wander off by themselves.

ann_nyc is offline  
Jan 22nd, 2009, 08:40 AM
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What fantastic detailed advice and encouragement from you. I do feel confident working with these two students. As you say, they are mature and parents have faith in them (and me).

The reason I ask for advice from people on this forum is because I know that "book reading knowledge" is so much more valuable when combined with real life experience.

Thanks again to you and everyone who is helping me.

teacherCanada is offline  
Feb 9th, 2009, 08:08 PM
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Thanks again everyone for your suggestions and support. We have had our meeting with parents, the two students, chaperones and a diabetes educator. The evening session went very well. Parents were able to express their concerns and students were able to demonstrate how comfortable they were with their insulin protocols.

I am relieved that the two students can support each other if need be. As chaperones, we will monitor the two of them from a distance. We must remember most of all that these two teenagers are teenagers - and that they want to have a wonderful experience travelling and they want to have fun.

Our departure is in about 23 days and we're pretty much ready to go.

I will try to post upon our return to let those who have responded how everything worked out.

teacherCanada is offline  
Feb 10th, 2009, 04:55 AM
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It sounds as if you are well prepared, and that you have a good chance of ALL having a good time.

After all, they are not invalids. Your idea of monitoring from a distance sounds perfect, especially considering that they are teens. Just make sure you always have extra snack supplies in your own bag, so that there is a backup.
ann_nyc is offline  
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