this post is for diabetics: the logistics of medication, part 1 of 3 (home)

Planning a thru-hike with a chronic condition would be made somewhat easier if you were an oracle.

Were I in possession of a crystal ball, I might know:

• What kind of customs officer might be greeting me at the airport and how helpful they’re feeling
• Whether my insulin is more likely to be lost in the post or damaged on trail
• Which will prove more convenient: injecting, or carrying my pump, consumables and batteries as well as a back up insulin pen
• Exactly when my Libre sensors are going to run out

Since I’m going to have to guess at all of the above, I’ll update you as I go.

Access to medication and supplies in Australia

• CGM Sensors: The NDSS can only authorise 15 months of supplies in a 12 month period — so if you use CGM consistently like I do, then you can access up to three month’s worth of “extra” sensors in advance. I need 7 months, plus a buffer for the ones that fail, to cover my whole trip. For reference, I’ve had 3 randomly fail in 5 months — mine last two weeks, so this is roughly a 30% failure rate.
  
  From what I can gather, I’m just going to have to revert to blood test strips for more than 50% of my trip.
• Pump consumables: It seems that I can buy “up to 6 months’ worth” of pump supplies. This should cover me, as I plan to take them as a back up and use the insulin pen if I can bear it. This is also through the NDSS. I have to ask NDSS to increase the limits on my account a few weeks in advance of leaving so I can pick up my CGMs and supplies in one transaction.
• Pen needles, swabs, finger prickers etc: seems like if I wanted to buy 10,000 of these tomorrow I could walk into a Chemist Warehouse and do it.
• Insulin and glucagon pens: These were easy to get scripts for from my GP, as was the doctor’s letter below.

Insulin pump supplies (the teaspoon is for pushing the insulin up through the reservoir - if you try to pull with the plunger instead of push, a vacuum forms.)

Getting insulin and accoutrements into the US

I attempted to Google the rules regarding the medications you’re allowed to bring into America and, frankly, they don’t have a standard set. The best I can gather — best meaning ‘most conservative’ in this case — is that the FDA dictates no more than three months’ worth of medication.

Essentially, they say they prefer it if you buy the rest of the medication in America while you’re here, but no self-respecting Australian would buy insulin in the United States. Second best scenario for the FDA is that you post out the next round of medication in a package with a doctor’s letter explaining that this is personal use. Also not a great idea for refrigerated meds, expensive and impractical.

So I’m going to take a very generous three-month’s supply. Who is the customs guy to tell me that I don’t need that much insulin?

Travelling with medication

The letter from my doctor states:

• The fact that I have been diagnosed with Type 1 Diabetes
• The medications I’m carrying, listed
• The devices and consumable supplies I’m carrying, listed (e.g. insulin pump, insulin pump tubing, CGM sensors, blood glucose monitor, test strips)

It does not state dosage for any of these medications.

The next instalment will be about my experience at various airports. I’ll be at quite a few in about five weeks! Perth, Kuala Lumpur, Narita, San Francisco and San Diego.