Thinking of taking a cruise ship vacation but worried about managing your diabetes while on board?
Today, we're happy to hand the mic over to our team member Rachel Kerstetter, who you may remember is a fellow T1 PWD in Ohio who blogs at Probably Rachel and works with us on social media using her initials, RK. As it happens, Rachel and her husband recently set out on a tropical Caribbean cruise, the latest of several they've taken over the years -- which may make her the DOC's "resident cruise expert." We asked her to please share her top tips about blood sugar management while enjoying the pleasures of a cruise on the open seas.
On Cruising with T1D, by Rachel Kerstetter
My husband and I took a seven-night, Western Caribbean cruise in late February on the Oasis of the Seas. This happened to be my sixth cruise ever, the third since being diagnosed with type 1 back in 2011.
Overall, my diabetes fared well throughout this recent cruise. I only had one persistent low and one stubborn high on pod change day. But in preparing for the cruise, I noticed that a lot of people have questions about cruising with diabetes.
So, here’s how I would respond to each of those based on all my cruises with diabetes through the years.
How do you handle supplies? What's the backup plan in case you run out of something critical?
The first rule of traveling with type 1 is to bring extra supplies. I manage my diabetes with an OmniPod tubeless insulin pump and Dexcom CGM. I travel a lot for work and a little for play and my rule of thumb is:
Double it… plus One.
I would have two, maybe three pod changes during my trip so I brought seven pods. Three of them were decorated for cruising. I didn’t anticipate changing my Dexcom sensor, but I brought two new ones just in case. I also packed: 100 test trips on top of my partial vial, my back-up meter, extra lancets with an extra lancing device, lots of alcohol wipes, a new tub of glucose tabs, batteries for all my stuff, 8 inches of Flexifix tape, syringes, pen needles and my emergency back-up Lantus. All packed in a neatly labeled zip-top bag in my carry on.
Always, always, ALWAYS pack medications in your carry on, NEVER check it! I did however pack my scissors for the tape in my checked baggage, to avoid issues with TSA. I placed my insulins in a small insulated lunch bag with a frozen solid ice pack. The thing about traveling by air with cooled medications, is that the ice pack needs to be frozen solid at the checkpoint.
As an insulin pumper, my back-up plan is switching to MDI (multiple daily injections) if my pump fails, so everything I need for both therapies stayed with me in my backpack.
Is Port security like airport security when it comes to diabetes supplies?
Yes, port security is a lot like airport security in that you should keep all diabetes supplies in your carry on. Your bags will all be X-rayed like at the airport so if you use an insulin pump, make sure you know your pump manufacturer’s recommendations. It is a little less chaotic and strict than the airport however. You walk through a metal detector and you can bring sealed liquids through. That’s the U.S. part of the ports at least. Port security in each country is a little different so it all depends; one of the biggest concerns for the Caribbean ports is drug smuggling, so there may be closer inspections of supplies. I highly recommend carrying a doctor's letter and wearing a medical identification bracelet.
How do you keep insulin cool on board and in the tropical climates?
The ice pack while traveling is good, I use the kind that comes with my insulin and stays frozen for 48 hours. In advance of my trip, I placed a medical request with the cruise line for a sharps container and a fridge. There’s usually a small fridge in each cabin for a minibar that works, but I request a medical fridge just in case.
I don’t typically take insulin off the ship with me because it's never more than a 20-minute walk back to the boat in port, but the cooler and ice pack would come along if I chose to do a longer shore excursion.
Do you notify any authorities on the boat that you have diabetes?
It’s not required to disclose diabetes to the cruise line, however I do in order to make sure that I’m covered. By notify, I mean that I list it on my passenger profile form, that everyone's required to fill out. Beyond that, I don’t really report it to anyone.
Is there some kind of medical center on board in case you need it?
Yes, cruise ships have medical facilities and doctors on board, and it’s reasonable to go there for minor issues that arise when on board. For bigger medical emergencies they will make arrangements to send patients to the hospital. In fact, on my cruise they did evacuate one patient to the hospital on a helicopter. The Oasis of the Seas had three doctors working in the medical facility and several nurses when I was on board so I didn’t worry about not being able to get help in the middle of the ocean.
How do you keep up with exercise while on board?
This can be as easy or as challenging as you make it. There are ample opportunities to be active on the ship, and just going to and from the places and activities we were interested in took me up to more than 10,000 steps a day, according to my FitBit.
Also, the long elevator waits made the stairs a faster and more active option for moving between decks. Cruise ship fitness facilities vary; the ships that I’ve been on have had excellent gyms and offered fitness classes. The Oasis offered yoga, daily stretching, water aerobics, spinning and other classes. They also had sports facilities where you could play basketball, soccer, ping pong, rock climb and more. There is also a running track, and roughly two-and-a-half laps around the perimeter of deck 5 equaled a mile.
With all of the running around, I usually have trouble with plummeting blood sugar, especially when I’m guesstimating carbs. So I usually increase my lower limit on Dexcom alarms so I get a low warning at 85 rather than at 70 to give me time to get to some food.
Cruises are notorious for endless buffets… How do you approach the huge amounts of food?
There are endless jokes on every cruise I’ve been on about the vast amounts of food. In the past nine years that I’ve been cruising, the food situation has continued to improve. But it’s easy to eat very poorly, so it takes a little self-control. I was able to find low-carb options and plenty of fruits and vegetables on our trip. And water was always available, as was coffee and tea. But so were sugary tropical drinks, sweet lemonade and a ton of dessert.
We enjoyed fresh eggs most days for breakfast with my favorite roasted tomatoes and a bowl of fruit. Lunch was a variety of things, but almost always accompanied by salad. Dinner was always a served meal for us in either the dining room or a specialty restaurant. The served meals are usually very good portion sizes. Dessert was an option with every meal but they were typically smaller servings and there was a variety of sugar-free and no-sugar-added options for cookies and ice cream. In general, I’d rather have three bites of anything chocolate than a sugar-free lemon cookie, but my husband was a fan. So aside from shifting my schedule a little, food was fairly easy.
Do you ever get seasick, and if so, how does that play with blood sugar levels?
I was amazed the first time I cruised that I didn’t get seasick. I tend to get car sick, so much so that riding in the back seat of a car is a bad idea for me. But the boat rocking doesn’t make me ill. However, it throws off your equilibrium. We had some rough seas cruising in the winter and I would sometimes feel light-headed or off-balance… sometimes those are symptoms of falling blood sugar for me so I was often checking my Dexcom or with my meter to find out if it was the motion or my blood sugar.
Some people do deal with severe seasickness and have found help in things like Motioneaze or seasickness wristbands. They did give out something for seasickness at the medical facility that seems to help cruisers who suffer from motion sickness. Feeling queasy can make eating unappealing, so keeping an eye on BG levels is a good idea.
Can you share any funny/ quirky/ memorable experiences related to D-care on a cruise ship?
Cruising with diabetes is always an adventure and it definitely has its entertaining moments. Wearing my pod on my arm brings a lot of questions. One night at dinner, I was wearing a sleeveless top with my tropical pod on my arm and the waiter asked what it was, I answered that it was my insulin pump. The lady at the table next to us leaned over and said, “Our son has type 1, he was diagnosed two years ago.” We started talking and came to find out that he was diagnosed at age 22, just like me. Our stories were pretty similar, except his doctors didn’t diagnose him with a pregnancy test!
On another occasion, we were enjoying drinks at one of the bars (drink responsibly friends!) and an older gentleman asked, “Is that thing for treating motion sickness?” I chuckled and explained it was my insulin pump. “Wow! That’s amazing. I know a guy who had one but it was wired to him. Technology can do so much. So you can drink with that thing on?”
On day two of our most recent cruise, I was on the second deck of the Solarium which overlooked the deck below and I spotted a woman with a Dexcom sensor on her arm. She was too far away to talk to and I knew I couldn’t catch up with her, so I was on Dexcom watch the rest of the cruise -- but I never saw her again.
There were definitely plenty of other little special moments sailing the high seas with my diabetes. Cruising can be an extremely fun vacation, and with advanced preparation and a good attitude, managing diabetes on a cruise can be smooth sailing.
Thanks for sharing, Rachel! Definitely sounds like you had a blast, and glad to know we have you to turn to if we ever have any more Cruise Qs.
So let's hear it, DOC Friends: Any additional inquiries or waterfront cruise tips/ tricks/ tales of your own to share?