Traveling Southeast Asia with Type 1 Diabetes

17/03/2017

Emily and I are visiting an amazing amusement park called Southeast Asia, and as soon as we landed here, we stepped onto the biggest and baddest ride there is, the roller glucoaster.

My blood sugars…

We have been climbing over vertigo inducing hills of carby rice and noodles, plummeting down the steep drops of insulin, dizzy from the loop-de-loops of unknown and new foods, but still elated, giddy, and loving every second of it! Traveling has truly been a roller coaster of emotions, experiences, and glucoses, but among the many blood sugar peaks and valleys have been many successes. These past 2 months in Thailand, Cambodia, and Vietnam has required A LOT of adaptation, not only culturally, but also glucosely (totally a word). We want to share with you what we have learned during this time, solutions that we have found, and ways that we have adapted to keep my glucoses so perfect, that even non diabetics are jealous.

As we leave Thailand, Cambodia, and Vietnam, we are sad to say goodbye to some of the amazing things the Land of Smiles is known for: incredibly friendly, humble, and outgoing people

scenery that is a beautiful mixture of sea and mountains

and food that is amazing… and SPICYYYYYYYYY. (Emily very quickly learned the Thai word for no spice-mao Pet). Along with that amazing food has come one of the most challenging aspects of this beautiful place. Harder than trying to communicate via charades, or how to convey “no fish balls” in our noodles soup, has been learning to stay off the roller glucoaster. This food is mostly carbs, carbs, and you guessed it, more carbs!

All the hills with lots of thrills.

It is good to note that through all the adjustments, my numbers have never been at a dangerous level, and I have been in control the entire time, there have just been more swings than normal.

Back at home, carbs were something I ate to treat low blood sugars, or eaten sparingly in complex foods like beans or high fiber fruit. This allowed me to be proactive and take less insulin (because insulin is expensive and I had to save money to travel the world (just kidding, that’s not the actual reason)) resulting in less chance for blood sugar swings to happen. This is why managing diabetes in Southeast Asia has been challenging because carbohydrates are not only a food group, but a way of life. Carbs are as abundant as oxygen here, and people consume them in pretty much the same amount. Plates of fried rice and noodles are always the cheapest options and are very common and delicious street foods that are indicative to these cultures. It is possible to get dishes of only meat, fish, or vegetables, and many of the most delicious coconut based soups are carb free, but rice is served with every plate that is not already filled with noodles.

A delicious bowl of noodles and chicken bathing in coconut cream-Khao Soi from Chiang Mai, Thailand.

I have been doing my best to avoid these simple carbs, but it’s hard to avoid them when one of the signature dishes of the country is a giant plate of noodles. You can’t not eat pad Thai when in Thailand, it has the country right in the name!

I don’t let diabetes define what I eat and still enjoy the food that is authentic and traditional. Learning more about the cooking techniques, researching the carbohydrates of new foods, and using portion control haw allowed me to stay off the roller glucoaster and enjoy the sights and people of Thailand, Camodia, and Vietnam even more!

Carb Counting New Foods in Foreign Lands

One of the best parts about traveling to new lands is trying new, exciting, and sometimes weird food.

Like fermented duck eggs!

or dragonfruit

The exciting mystery of asking,

“what exactly am I eating?”

is inevitably followed by the question,

“how many carbs is this?”

 It has been difficult carb counting when we’re not totally sure what it is that we’re eating, and educating ourselves more in depth on the cooking styles and ingredients of these cultures has been very helpful to understanding the carbs.

When in Thailand we took a Thai cooking class, which was not only one of our favorite activities, but also helped us know how many carbs were in the food we were eating.

Thai food is known for a delicious combination of 4 flavors: salty, spicy, sour, and sweet. In order to obtain the sweetness, we learned that most Thai dishes have a tablespoon or more of sugar, which can greatly affect blood sugar and is important to know.

The best way to truly know what is going in to your food is to watch it being prepared, and at local street restaurants and food stalls there is no concept of a kitchen. The best way to eat authentic and cheap is at these roadside establishments, and you are right next to the person preparing your food, and can easily watch them work.

It is not only mesmerizing to watch ingredients swirling in a giant wok over an open flame, but gives you a first hand look at what is going in to food. Some chefs only put 1 teaspoon of sugar in their dishes, while others use 2. This can really matter when calculating how much insulin to give, and can be the difference between spiking after a meal or stabilizing. The cooks usually speak enough English to communicate, and have been open to answering our excited questions about their cooking and ingredients they use. This is not only helpful for carb counting, but makes for great human interaction and opens up conversation with locals.

Some foods have been completely new and have us wild eyed and guessing at the carbohydrates.  As diabetics, we are walking nutritional databases for hundreds of foods, and especially when traveling, we have to add to that database. Dragon fruit was like a carbohydrate unicorn, delicious and beautiful, yet completely unknown to us and was something we had to research.

Som Tam is one our favorite Thai foods, and we ate it almost every day. It is a salad made from shredded green, unripe papaya.

We already know the carb amounts of ripe papaya, but were unsure of the much less sweet, unripe variety. (We found that 1 serving is usually about 2 cups, and when counted as 15 grams of carbs did not result in any blood sugar swings.) Websites like nutritiondata.self.com are very helpful for learning the carbs of new foods to add to your mental database. After uncovering the mystery of what is going into the food, you can research the unknown ingredients to find out exactly the carb amount.

We think that trying completely new foods is one of the best parts about traveling, but does not have to be a scary thing due to not knowing how to count carbohydrates. Asking locals, taking cooking classes, and using online databases are great ways to carb count correctly, and keep the blood sugar in check while learning more about your food.

Preventing blood sugar spikes

As diabetics, we have all had those moments where we have done everything perfectly: carb counted correctly, taken insulin right before eating, and possibly even went above and beyond by measuring out portions. We feel on top of the world, confident, a total diabetic superstar. When all of a sudden, 5 minutes after eating we find that we are sky rocketing, WHAT?!

And of course we feel like this…

It’s true, you definitely are a diabetic superstar and are probably carb counting correctly, but sometimes the timing of giving insulin can be just as important as the amount. We have found this to be so true in such a carb heavy country where the majority of the meal is rice or noodles. Carbohydrates are digested very quickly, and can raise the blood sugar even before insulin can start working. Insulin may be “rapid acting”, but it doesn’t truly start working for 15 minutes, and peaks within 30 to 90 minutes. Here is the link to a study that tested the time effectiveness of different types of insulin.

To prevent a spike from happening, we have been following the 15 rule. This is giving enough insulin for 15 grams of carbs, 15 minutes before we start eating. This allows the insulin to start working at the same time the carbs are digested to prevent a blood sugar spike! As soon as I knew what we were going to eat, I gave myself insulin, and I simply bolused accordingly for more carbohydrates. Then I enjoy a nice even blood sugar even with a carb heavy meal!

Besides bolusing with impeccable timing, another great way to prevent blood sugar spikes is by adding fat or protein before the meal. Fat and protein take much longer to digest, and slow down food breaking down in your stomach, including carbohydrates. By eating fat or protein before sitting down to a big plate of carby pad thai, pho, or bahn mi goodness, like this one (picture of pad thai), the carbohydrates break down into the blood stream slower, giving insulin a chance to prevent blood sugar from rising. We often keep a bag of peanuts (high in fat) with us at all times. This is to not only to prevent hangriness between meals, but also to eat a handful before sitting down to what is most likely a high amount of carbs. This combined with bolusing early has led to many days of stabilized blood sugars.

Portion Control

As any diabetic knows, portion control and measuring food are the best ways to know exactly how many carbs you are eating and how much insulin to give, and traveling is no exception. In an ideal world, everywhere would serve exactly 60 grams of rice or noodles. We found that usually most restaurants do serve about one cup of rice or noodles with the meal, but this is not always the case, and you don’t want to trust your blood sugar to an assumption. Being diabetic for 18 years and a registered dietitian has helped me to know an amount of food just by looking at it, but I still always use visuals.

If you have a hand-

you have a measuring cup.

I use this visual in my head all the time to measure food. I know that if my plate of rice looks as big as my closed fist, then I have one cup of rice which is 60 grams of carbs, and bolus accordingly.

If you really want to be exact with measuring when you travel, these sea to summit cups fold up, making them very light and easy to pack.

There are measuring marks on the inside of the cup so you never again have to guess how many carbs of rice you are eating. You can find a link to buy those here.

Traveling opens up the chance to learn new cultures and different perspectives, but also learn much about ourselves. There have been many ups and downs, but we have been learning much about my diabetic management and how I can adapt to different and sometimes challenging circumstances. Changing a few of my diabetic habits and asking questions have been just a few ways that I have been living leashless from diabetes, and making our dreams happen with great blood sugars!

And you can do the same! Please don’t hesitate to contact us via email at Livingleashless@gmail.com or through our Facebook page, we would love to connect and chat with you to help make your travel dreams possible.

Happy travels and steady blood sugars!

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