Recent Diabetes Diagnosis-cruise travel tips?

[Gatordad815]

Hi all! Our family of four enjoys cruise vacations and young daughter was very recently diagnosed with Type 1 diabetes. She also has Celiac disease, so we are already accustomed to closely managing her meals, and Royal Caribbean has been excellent at accommodating gluten free meals, but this adds a whole new dimension to our planning.

 

Can anyone give advice/tips on managing diabetes on a cruise? I already know to contact special needs and to have extra supplies just in case, but what else should we know to help manage on a cruise?

 

I’m specifically curious to learn how people reliably calculate carbs to keep insulin dosing correct? I’m assuming we will be guesstimating using an app, but is there any more reliable way to get accurate carb information from the kitchen? 
 

Can anyone comment of Adventure Ocean? I’m assuming we will just check her blood glucose when we drop her off to be sure it’s not going low, but is there anything else we should know? Any tips on shore excursions/exploring ports? 

 

Any other tips/advice? Thanks in advance for any input-this is still pretty new and daunting to us!

[j1d1]

Hello fellow Gator Dad.  We have both Celiac and DM1 in the family as well although not in the same child.  First I would recommend checking in with either her Endocrinologist or Diabetic Nurse for any advice.  My advice will be general and not specific to RC as most of our cruises have been on other lines, but thus far I haven't found much in the way of differences between the lines in this regard.  Also please remember that any advice I give is not specific to your daughter as I can only give our experience.  In other words this is NOT specific medical advice.  Any advice is somewhat dependent on what technology you are using to manage her DM (i.e. shots vs pump, finger sticks vs CGM) and the age/independence of the child.  A cruise is definitely a situation where a pump and CGM come in very handy.  If she is not using a CGM, I would recommend that you contact her Endocrine and insist on starting one.  They are a complete game changer.  One downside is that you need to purchase the internet package for at least two devices if you want to monitor the CGM while separated.  You'll also need a way to communicate which can be something like iMessage or WhatsApp if using the internet package on two phones or the cruise line specific texting.  Note that I have found the cruise line texting apps to be very hit or miss in how well they function and don't trust them.  We use iMessage which works fine as long as all phones are Apple and you have the internet package on both.  I like iMessage because I can see if message was delivered and read.  My understanding is the WhatsApp is a good alternative if not all phones are Apple, but I have never used it.  Also consider different types of pumps.  We use Omnipod which is nice because they can be kept on even in pools, waterslides, and the ocean.  One thing to consider though is the adhesive for pumps/pods and GGMs.  They tend to not work as well after exposure to sweat, chlorine water, salt water, and being more active.  Backup adhesive/overlays can be very helpful.

 

My primary advice is that you have to adjust expectations for the time on the cruise.  It will be VERY challenging to start.  Especially with a recent diagnosis.  Our first goal is to avoid low blood sugar.  This can be very challenging as a child may be much more active than usual on a cruise.  Reducing your basal shot or pump basal rate can be helpful, but that is going to be very specific to the child.  Secondary goal is to prevent highs, but my tolerance of highs is adjusted up a good bit during the time on the cruise.  You will not be perfect.  There is no way around this.  Do the best you can.  Prevent lows and major highs.  Do your best not to let DM ruin her (and your) vacation.  Having set reasonable expectations for both her and you can make this more manageable.  Remember that it will get easier.  CGM goes a long way here as the alternative is a lot of finger sticks.  It is very important that she stay hydrated.  Have hydration plans for ports and shore excursions.

 

Our diabetic child tends to eat the same things repeatedly.  I have been doing this long enough that I don't necessarily need to carb count because they don't stray far from the usual.  Adjustments using a pump are also helpful if I miss on estimated insulin needs.  The cruise lines don't generally have carb counts available unfortunately.  You are welcome to ask, but don't be surprised if you don't get an answer.  Use apps to estimate.  Consider goals above regarding lows and highs when dosing.  This will require trial and error unfortunately.  It is hard to give specifics here.

 

Our child never really took to Kids Clubs.  I think that was partially due to diabetes.  The staff want to be helpful but are very limited in what they can do.  If you are lucky, one of the staff members has experience with DM1.  This is an area where the independence and age of your child make a big difference.  The ability to monitor blood sugar and communicate can also make a big difference.  I don't have much else to add as our child hasn't spent much time in the Kids Clubs.

 

When packing, have backups for your backups.  That's for everything.  Insulin, pump supplies, CGM supplies, glucose monitor, test strips, preferred sugar/glucose source for lows, etc.  Whatever it is, assume that you can not easily replace if lost or broken.  Try to keep insulin cold without freezing if at all possible.  You will leave insulin in a hotel or stateroom refrigerator at least once.  You will end up with a good sized bag just for DM supplies.  Give yourself extra time to get through security at both airports and ports.  Technically DM technology should not go through x-ray machines although some will tell you that no damage is caused.  We still avoid the x-ray machine and request that child not go through the scanner when wearing DM tech.

 

TL;DR. Try not to get overwhelmed.  It does get better although it will remain a challenge.  Avoid lows.  Learn from mistakes.  Triple pack everything.  Give yourself extra time for everything.  If not using a CGM, insist on starting one.  Remember you are on vacation.

[leaveitallbehind]

It may be difficult to get the carb information you are looking for from the ship - a lot of meals and variables at play with carb related ingredients.  However, it certainly can't hurt to ask special services - or the maitre d - to see if any of that information can be provided.  You can also ask to see if there is any low carb meals that can be offered as a dietary request. 

 

Failing all that, a nutritionist associated with her recent diagnosis can certainly provide a guide to carbs that can give you at least a general overview as to foods to include v what to avoid so that you can better manage selections and help you balance carb and protein intake. They will also provide target ranges of carb intake with each meal and snacks. I would talk with them in detail prior to the cruise for their input.

 

It actually can be relatively easy to calculate a rough carb and protein total just by understanding the different food types and and consumed quantities associated with total carbs absorbed.  It does take some time and familiarity with what is good v bad to get used to, but it eventually will become a lifestyle-type of program.  Once armed with this information, on board, buffet offerings may be an option in assisting with this if not easily done through special needs and the MDR. 

 

Diabetes is a complex and tricky illness to manage, but it certainly, over time and with experience, can be successfully accomplished.  Type 1 is certainly different than Type2, and IMO is more complex to navigate.  But I'm certain that you will be able to learn to deal successfully with this and be able to cruise with confidence.

Edited May 15, 2022 by leaveitallbehind

[BirdTravels]

I am diabetic and it is impossible to get a accurate carb count. Get into a routine of carb lite foods. You can request diabetic foods, but for me, that more trouble than it’s worth. Order the standard dinner and keep the mashed potatoes for yourself (leaving the yummy protein and veg on the plate). And remember that NSA food are not always carb lite. They are lighter, but contain sugars from the natural ingredients. 

[orville99]

DW has Hashimoto's/Hypothyroid disease and can't eat anything with gluten or soy. The WJ has always been her best option for her diet, because they have a wide variety of gluten free/soy free options available. On Harmony (at least) she has been able to get the chef to make her Thai rice noodles and they will walk around the entire venue with her to point out everything that meets her dietary requirements. Not sure if any of this helps your daughter, but at least there are options available other than rolling the dice in the MDR.

[HxFx]

Hello, another fellow Gator. DH has T1D. He was fairly late onset so it hasn't been that long since he was a newby. The CGM is a good idea but those can be inaccurate on occasion. Is your daughter still in the "honeymoon" phase where insulin will be sporadically produced by the pancreas? I recommend manual testing more often then normal to supplement the CGM.

 

Counting carbs can be difficult, especially while you are not familiar with her reactions. Sometimes high protein that takes longer to digest can require more insulin than anticipated. For DH, black coffee sets off his blood sugar as well (fairly common). Don't know if anything with caffeine would do that but something to look out for. I agree she should generally try to avoid carbs.

 

The extra supplies are definitely a must but the ship should have extras as well as this is very common (to include T2D who are insulin dependent). You may want to limit excursions that will take you far from the ship until you know your daughter's reactions. Always have candy or glucose tabs with you. DH gets cold sweats/clammy when he is getting low. 

 

Hopefully this hasn't discouraged you. DH manages it well and we've had great trips!

[Jasukkie]

Please speak with your daughter's MD about whether a land based vacation may be more suitable for a newly diagnosed type 1 diabetic. Medical care onboard is being stretched very thin by Covid.

[rudeney]

Sorry to hear that @Gatordad815.  I have no diabetic problems, but I try to follow a low-glycemic diet.  I lost over 60lbs and that included cruising.  I often lost weight when cruising because I have choices.  I can pick and choose good proteins and low-glycemic vegetables at the buffet and in the MDR.  I think the biggest challenge you may face is your daughter not understanding why she can't eat all the "pretty" food.  I hope you have a good cruise!

[Gatordad815]

Thanks to all for the helpful insight! It’s reassuring to read the perspectives of others who have managed this. I’m feeling like we are getting the hang of this, but definitely want to learn everything I possibly can to be sure we are managing this as best we can. Thanks again.

[Itchy&Scratchy]

16 hours ago, Gatordad815 said:

Thanks to all for the helpful insight! It’s reassuring to read the perspectives of others who have managed this. I’m feeling like we are getting the hang of this, but definitely want to learn everything I possibly can to be sure we are managing this as best we can. Thanks again.

imho, you need to learn to manage it at home first, and then apply the same techniques on the cruise.

 

My dad has non-insulin dependent T2 so it doesn't apply in this situation, but a friend of ours has a very well managed T1 since she is in her late 70s. She eats regular food in moderation and sticks to no sugar added desserts. She cruises A LOT. Once you and your DD get a hang of the situation, you will be fine as well.

 

A friend of our's DD is college aged now, but she was dx in childhood. It was very difficult to manage until they finally got a pump for her.

[lakemurraykid]

I was so happy when I saw this thread.  I am on the Allure in October and am Type 2.  Food really gets the best of me and I admit it.  I get so confused on the carbs.  I know I can't have potatoes, rice or white bread.  I was on a cruise this past November on another cruise line and when I made my reservation I noted that I was diabetic.  I was told to talk with the maîtres'd and I did.  But when I went to the DR, I had to tell the server.  She then went and talked with the chef and he had no clue.  After about 45 minutes I got dinner.  This happened twice.  After that I went to the buffet for everything.  The selections were considerably greater and I was able to pick what I knew I could eat.  I ate all of my meals at the buffet from there on.  I haven't told RCCL yet about my situation, and I wonder if it will be handled any better than my last cruise.  I'm not on insulin but do have to take two different meds daily.  If you have any suggestions, I would love to hear them.

[rudeney]

@lakemurraykid Although I am not diabetic, I try to eat a low-glycemic diet for general health reasons and I have done this for over 20 years now.  The trick to weight loss on a low-G diet is to put your body into ketosis, which is where your blood sugar drops so low, it must begin to burn stored fat.  I don't believe that is what a diabetic person should do unless directed by a doctor, but it is for otherwise healthy people trying to lose weight.  You might want to grab a copy of the book Sugar Busters, which explains a lot about body chemistry and why low-G diets work for weight loss and can make living with diabetes easier.  

 

I would suggest getting familiar with the glycemic index of foods and avoid anything over 60 (for ketosis, you generally must avoid anything over 50).  Dairy and meats (without sauces or gravies) and most vegetables are fine.  Just remember not to eat "pig food", which is potatoes, corn and carrots.  Bread and pasta is generally no-go except for very small portions of true whole grain breads or pasta  (not "made with whole grain wheat" but "100% whole grain wheat").  Don't worry about fats.  Generally speaking, consumed fat not only won't make you fat, it can actually lower blood sugar levels.  Besides that, most low-fat version of normally fatty foods will use corn syrup and other high-glycemic ingredients as a substitute. 

 

Besides the self-control challenges, eating out can be difficult because you won't usually have access to the true ingredient list.  What I do is order meats without the sauces.  No pasta, bread, potatoes or rice.  I choose sides like green vegetables, peas, etc. that prepared without sauces or topping, except butter or oil.  You are right - the buffet works better because you can select exactly what you want and see the food before choosing it.  

 

Having said that, I do get cravings for sweets, bread, etc.  When I do, I select a sugar-free dessert option, but if it comes with a cake or crust, I don't eat that as it will made from refines wheat.  Sugar-free ice cream is a good choice if available.  Puddings are not good as they contain a lot of starch (high-G).  For bread cravings, I will choose the grainiest looking piece and eat very little.  I have  found that some Italian restaurants do offer a whole-grain pasta option.  I think I found this once on a cruise ship.  Oh, and beer is the worst high-G "food" you can consume.  It's 105 on the index!  

[KB Cruisin]

I am T2 and gluten free.  Rccl is a very good line for food issues. One issue I had was that the no sugar added desserts often spiked me. I ended up with a uti after several nights (vicious cycle).  I will say medical was excellent for that. I will know next time to pass on those.  

[death_star]

I am T1 so have dealt with this for a good long while. The best you can do is find something a bit similar to what you're eating in an app and go with that. Some portion sizes are a good bit smaller than what they might be in a land based restaurant. As some others have said the best you can do is try to minimize long crazy highs while not getting very low. 

 

Stock up the room with lots and lots of snacks. When something is going on you don't have time to wait for room service. Always keep fast acting glucose both with her and yourself. I have had many experiences after walking all over creation that I suddenly find myself <50. That being said account also for the extra activity. 

 

Get a glucagon emergency kit and take it with you anywhere off ship you all might go. Also bring flying if your flying and keep it really accessible. 

 

Lots and lots of supplies and alternative means of delivering insulin if there is a pump involved (a cracked pump and swimming at CocoCay do not mix). Also put most of this stuff in the carry on. You don't want to risk the one suitcase that they lose is the one with all of it in it. 

 

Have not had anything less than a great experience with onboard medical. 

 

 

[JeffT237]

On 5/15/2022 at 5:33 AM, Gatordad815 said:

Hi all! Our family of four enjoys cruise vacations and young daughter was very recently diagnosed with Type 1 diabetes

 

On 5/15/2022 at 5:33 AM, Gatordad815 said:

Can anyone give advice/tips on managing diabetes on a cruise?

 

My wife was diagnosed with Type 1 diabetes about 30 years ago at the age of 23.  I know it can seem overwhelming with a new diagnosis however with a good medical team and support group it is completely manageable.  Travel can be challenging.  My best advise to you is trust your daughters medical team.  A good PMD, nutritionist and endocrinologist is a must. They can guide you with the day to day, as well as get you ready for travel.  My wife has always been active and we've travelled a lot and I'm sure your daughter will have the same experience as well.  My best advice to you and you'll learn this, don't let this get in the way of experiencing life and travel.  You just have to take extra precautions and planning.

 

Some things that have worked for us not for just travel but for everyday life is an insulin pump combined with a continuous glucose monitor.  She has found more consistent blood sugar levels with the pump than when she was injecting insulin.  She has also been using the newer insulin nasal spray as well.  The continuous glucose monitor (CGM) is great, not only for her not having to poke her finger for a blood sample, but for myself to see her glucose level in real time and get alerts when it drops or rises too high.  WiFi on the ship is needed for myself to see it, her CGM can work via bluetooth to her iPhone.  It sounds like you have concerns when you guys are separated on the ship, the CGM is a great tool for that. The CGM and pump are both water resistant although the CGM loses it's ability to connect via bluetooth when in the water.  @death_star had some great advice as well.  I always carry Glucagon which now comes in a nasal spray for emergency use, and stocking up on snacks in your cabin is a must.

 

When flying just give yourself additional time at the airport.  You will be carrying more supplies than most passengers and TSA can be tricky.  It really depends on the agent.  Some times with all of my wife's supplies, snacks, meds, devices and juice boxes they send her to a secondary search and look at everything, sometimes she says she's T1 and they wave her through.  Very unpredictable.  Embarkation has never been an issue.  My wife has made a few connections with fellow T1 cruisers on this board, I'd encourage you to seek the advice of other T1 travelers, they usually have great advice.  If there's a way to direct message me, feel free she'd love to talk to you or your daughter if you're interested as she's done before.

 

Happy traveling!