Travel in India with type 1 diabetes – the homestay adventure

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 12 in the series about that trip and its planning and how type 1 diabetes played a part.
This post is all about our biggest worry and adventure, two nights staying with a local family in a small village near Orchha.

An adventure awaits

We departed Gwalior by car and headed toward our destination, Orchha, which is a very small town on the River Betwa.
Our accomodation for the next two nights was to be in two of the homestays run by Friends of Orchha. Jane and Amy staying with one family, Emilia and me with another.

What’s a homestay?

A homestay is where a family opens up part of its house to paying guests, to give them a little income and to provide the guests with a completely different experience to staying in a hotel.
To read more about ‘our’ homestay take a look at either the Friends of Orchha website or our many homestay articles on Monsoon Meandering blog.
Homestays usually have rooms for only two people and whilst Friends of Orchha said we could all fit in one I decided that I’d rather split us up and share income between two different families. The cost per room for two people was only Rs500 (£7) per night, so having two rooms only cost Rs1000 (£14) per night, an absolute bargain.

The worries and the reality

You are staying in someone else’s home, one without running water and possibly without electricity too – our places did have one electrical socket each but who needed electricity?
You will be eating food prepared by them in what looks initially to be unhygenic surroundings – we couldn’t have been more wrong about hygenic, they kept their homes as immaculate as possible, the food couldn’t have been fresher, nor the plates/trays shinier.
You’ve got used to hotels with tiled or marble floors, here’s it’s earth – so your feet got a little dusty, then you washed them, simple.
There’s no shower, just a bucket of cold water – there were wet-style rooms specifically for your bucket bath and how environmentally friendly it felt to do it that way.
There’s no flushing toilet, it’s a composting Indian style toilet – Jane’s place did have a flushing WC, but what a waste of water it seemed in the end.
How will we communicate? We don’t speak Hindi, they speak only a couple of words of English – it’s funny how easy it is to adapt and we had a brilliant time without speaking, just playing and laughing all the time.

So what was it like?

Here’s a video featuring one of the homestays run by our host Malti. The room you see is the only room they have for the family, to live in, to eat in, to sleep in. It’s rather humbling to see how happy they are. Our host Malti is cooking us a wonderful breakfast of pakoras and bananas.
httpv://www.youtube.com/watch?v=pplpDsSP6ws

Amy’s diabetes management

One area of concern for us was just how we would manage Amy’s diabetes in a place without the hygiene standards we’ve become used to.
Would Amy eat anything?
What it be so awful Amy’s stress levels played havoc with her blood glucose levels?
Could we keep the insulin cool enough?
The simple answer is that managing the diabetes was no more trouble than an easy few days in England.
This was probably one of Amy’s most rewarding experiences and she instantly became part of the community as soon as we arrived, playing games she didn’t understand with village boys she’d never met and couldn’t talk to.
Amy didn’t eat loads of food in the homestay but we made up for that buy letting her have a bigger lunch whilst out sightseeing. Her levels were good, probably partially as a result of being so happy.

A luxury experience in budget surroundings

On the whole the experience was fantastic, I really couldn’t have hoped for more. Seeing how happy the villagers were with next to nothing, compared to us westerners who have everything yet are often not happy with it. We all had such fun with the villagers and Amy’s diabetes management went very well.

Here’s a short video of the lane outside one of the homestays with Amy playing with the kids and later playing ‘teacher’ with them.
httpv://www.youtube.com/watch?v=8L-9KBGnIl4

A couple of anecdotes

Frog for dinner madame?

Dinner on the second night was at Jane’s homestay and we sat outside whilst the host, Kusum, cooked us dinner over the wood fired stove. We sat on the floor and were handed our meals and watched the lightning in the distance fork in the sky.
Emilia’s plate was hot, she put it on the floor, taking a piece of roti and dipping it in the food.
They I saw it, the small frog. It jumped on her plate just as she was about to take another piece of roti.
“Emilia, wow, did you see that lightning” gave me just enough time to remote the frog from her plate and she was none the wiser.

Don’t scream in the shower

The wet-room where Emilia and I had to shower was just outside of our room, which was hot inside. I went outside to do a little blogging on my netbook whilst Emilia prepared herself for her first ever bucket bath, with cold water.
Shortly after going into the shower room some neighbourhood kids saw my laptop and came over to stare in awe at the pictures I showed them of England and other places they asked about.
I waited for Emilia’s first scream when the cold water hit and I hoped she had heard the kids outside before she came out.
Luckily she’d heard what was going on and got fully dressed in the shower room and only came out when they’d left.
Unluckily for her the kids stayed with me for about 20 minutes.

Next up – summary of problems

Travel in India with type 1 diabetes – Amy’s first few food days

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 11 in the series about that trip and its planning and how type 1 diabetes played a part.
This post is all about Amy’s first few days.

Honeymoon and counting carbohydrates

Amy had only been diagnosed 7 months before we travelled and was still definitely in her ‘honeymoon’ period. Just for the record that word ‘honeymoon’ should not be used for type 1 diabetes, it’s not fun like the real thing, although in a similar vein it can feel like your life has been <insert-your-favourite-past-tense-procreation-word-here>.
At this stage we were not carbohydrate counting and her insulin doses were based around a rough estimate of the size of the meal and whether it was heavy or light on the carbohydrates. Our carbohydrate counting training was scheduled for a month after we returned, but how I wish we’d known about it beforehand.

Breakfast is for wimps

I mentioned in the paragraph ‘A word about flight times’ (flying, medical letters & adjusting basal) that we took a day time flight to India, landing just before midnight (Indian time, 7pm BST, 6pm GMT), how well that worked and that our body clocks didn’t adjust for days. For this reason meal times were all over the place in the first three days and we were generally never awake early enough to have breakfast until day four.

A madly active first few days, no time for hypos

We only had three days in Delhi and we had a lot to do: food at Karim’s (video); a meal as honourary Food Enthusiasts of Delhi; Sunday lunch with my friend Madhu; Sunday dinner with my friend Gautam and his family.
Food times were all over the place, but we’d eaten so much that Amy didn’t have many hypos as the insulin we gave her was probably lower than it should have been.

Day 4: “I don’t like Indian food anymore”

These weren’t the words we wanted to hear but that’s what Amy declared on day 4.
Both kids have always been excellent at eating Indian food, from the moment we introduced “International Food Sunday” to replace the typical roast, although we never got much past “this week let’s try Indian” as they liked it, so many Sundays afterwards featured a Sunday Curry.
Amy had been fine eating Indian food virtually every day during the 3.5 week trip in 2009 bar the odd pasta day. But within 4 days it was all over. We’ve got a problem.

Injecting in not-so-posh restaurants

As a family we rarely eat out so haven’t faced any problems with injecting within the restaurant or having to take Amy somewhere away from the tables, so India brought us a new experience. How would it go we wondered, would she be self conscious, would it put her off if people stared?
For the first few days we’d only eaten a couple of times in restaurants and they had been relatively medium-budget places with nice dividers between the tables, or lovely washrooms. We hadn’t yet tried doing injections somewhere crowded, or just a room full of tables.
On day 4 we had gone to Amritsar to celebrate Jane and my wedding anniversary and I was determined to go to a really out of the way, almost locals only, restaurant named Kesar da Dhaba.
Kesar da Dhaba looks like a UK cafe with its plain uncovered wooden tables, its metal beakers and thali trays for food. There’s no knives or forks here given out by default, you need to request them. We requested 3 lots, I decided to go local.
Amy didn’t eat much, it was a bit too authentic for her liking but she wasn’t daunted by anything, bravely trying the different dishes but only really eating the Shahi Paneer and Aloo Gobi and multiple roti/naans.
When it came to do the injection everything went very well, doing it at the table without anyone really caring at all. We’d forgotten that India until recently was the diabetes capital of the World – now second to China – so everyone had seen it all before.
I believe going somewhere like Kesar da Dhaba really helped us realise that in general there would be no problems coping with injections during our trip.

Hypo, hypo, hypo and forgetting advice

Amy started having a few hypos over the new few days and it took us a few meals to realise why: we were giving pre-meal injections based on what she thought she’d eat but often she ended up only eating part of it, due to her new found dislike of Indian food.
We’d forgotten the advice that injecting after the meal was probably a better idea as when eating Indian food at home Amy had eaten everything put in front of her.
It didn’t take long to remember the advice and changing to post-meal injections seemed to settle the hypos somewhat.

Discovering the food issues

We tried to work out why Amy had suddenly formed a dislike of Indian food as this was likely to make the rest of the trip quite tricky.
A few months prior to the trip Emilia had decided to go vegetarian, something I applauded after doing it myself for a few years. I was also wary of eating meat after wondering whether it may have been the cause of my 2009 downfall.
Due to these two facts we’d so far predominately eaten vegetarian and specifically our dish of choice had been the sublime Shahi Paneer, unless of course you’ve just decided you dislike Paneer. That was it, she hated paneer, but didn’t really know this herself until she’d eaten it over several consecutive days, something that never happened at home when we had paneer.
It was really worth spending the time trying to discover where the problem lie as it made the rest of the trip easier.

Next up – The homestay adventure

Travel in India with type 1 diabetes – food glorious food

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 10 in the series about that trip and its planning and how type 1 diabetes played a part.
This post isn’t really related to diabetes per se but hopefully contains a tip or two for you.

India – a food lover’s paradise

One of the great things about going to India on holiday surely has to be the food. Everyday you get to eat a different variety of Britain’s National Dish, although ironically you won’t find Chicken Tikka Masala anywhere in India apart from 100% foreigner focused hotels. As a note I’d suggest that if you ever come across a restaurant selling Chicken Tikka Masala run a mile and look for somewhere a little more authentic, listed at www.foodora.ca/chain/ci5qh/banh-mi-boys, as an option.

Once bitten, twice shy

If you’ve read my blog from our first trip with the kids in 2009 you’ll know that I was a very poorly chap (That’s The Last Time I Joke About Dysentry!). Going back in 2011 I was naturally quite worried of what lay ahead and even more worried that rather than get hit myself with Delhi Belly that Amy might get poorly, resulting in high blood-glucose levels, ketones and worse DKA (diabetic ketoacidosis).

Delhi Belly is avoidable

Many people will avoid going to India after hearing a horror story from their long-lost-Uncle’s-best-friend’s-cousin – i.e. someone they’ve never met – and how that person got really ill. Well, I could give you stories like that from people that have stayed in the UK too.
‘Delhi Belly’ is avoidable if you eat wisely and trust your instincts so don’t think that any trip to India will end up with you getting very ill.
Listed below are a few of the things I live by when abroad but do bear in mind there’s no scientific facts behind any of it, it’s just my opinion.

Simple rules to stay healthy

It’s not the food that makes you unwell

In my experience it’s not the food which makes you – read me – ill, it’s the way it’s cooked, or actually the way it’s prepared.
I’ve eaten all manner of things during my travels – Brain Curry being the oddest – and never suffered when I’ve known the food has been cooked from fresh.

Trust your gut reaction

I can pinpoint my 2009 illness to the hotel we stayed at in Jaipur. When I took one look at the restaurant I decided I didn’t like the look of it but laziness got the better of me so that’s where we ate that night. The food tasted so good, I ate so much and although felt poorly the next day we still returned to the same restaurant the next night. I knew that place didn’t “feel” good and from here on in I will always trust my initial thoughts about a restaurant. (see the last rule too.)

If it’s still sizzling it’ll probably be okay

After 90% of my wedding party were poorly in Thailand back in 1994 I’ve always lived by the simple food rule that in foreign climes I’ll only eat something that’s pretty much still boiling/sizzling. This has served me well throughout Turkey, Thailand, India and Nepal, whilst seeing those ‘I’ll-just-eat-this-salad-because-I-recognise-the-food’ types getting very ill instead… see the next rule.

Don’t eat it if it’s cold and washed in water

My wedding guests and I all got ill after eating during a buffet cruise down the Chao Phraya river in Bangkok. We were very, very ill and after working out who ate what we realised it was the rice dish. Since then I’ve pretty much avoided rice whilst abroad, but I shouldn’t have, not if it had just been cooked and was hot…see the next rule. People I met in Turkey were eating salad because they recognised it and didn’t recognise all that ‘foreign rubbish’ – I know, I know, why go abroad!? – but their salad was cold and washed in water not up to UK standard, so these people just got worse and worse each day. If they stuck to eating a nice flame-grilled shish kebab as we did they would have (probably) been fine.

Don’t avoid the rice

I’ve avoid rice for so long whilst abroad but all for the wrong reason: what made us ill in 1994 wasn’t the rice, it was the fact that it had been cooked, cooled naturally and reheated a little, all in humid climate and on board a probably not-so-clean boat. In 2009 after being so ill the only thing I could eat afterwards for days was plain boiled rice. How ironic that the thing I’d avoided for so long made me well again.

The look of a restaurant isn’t everything

Whilst taking a 5 hour drive in India we pulled up at a Dhaba – Indian roadside cafe – which basically has a roof but no (or not many) walls. There was an air-conditioned restaurant next door but wanting to get the full Indian experience we entered the Dhaba. We chose a table at the back and when pulling the chair out the World’s fly-population evacuated and my heart dropped for a second. I’m not the sort of person to be put off by a fly, or two, or a thousand.
“Right, we’ll still eat here but only choose something deep-friend”.
We ordered a couple of plates of pakoras (deep fried mixed vegetables) and some finger-chips (or French Fries to you and me). We could see into the kitchen from where we sat and I could see that it was all being freshly prepared for us.
It worked, our pakoras tasted great, no-one even had a hint of being unwell and we’ve used the “deep-fried” maxim occasionally ever since.

Next up – Amy’s first few food days

Travel in India with type 1 diabetes – insulin availability and pricing

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 9 in the series about that trip and its planning and how type 1 diabetes played a part.

This post is not borne from experience but from information some of my good friends in India have provided me, following questions asked via the #DOC (Twitter diabetes online community). I’d like to thank my friends Gautam, Madhu and Yogesh for their help in getting me the information for this article.

NOTE: If you’re interested in diabetes supplies other than insulin take a look at this post: buying diabetes supplies in India

Insulin availability

A quick straw poll of some UK Twitter users gave me a list of the most frequently used fast and slow acting insulins: (all sources courtesy of my friend Gautam.)
Fast-acting – Novarapid – is available, including flex pens. source
Fast-acting – Humalog – is available. source
Slow-acting – Lantus – is available. source
Slow-acting – Levemir – flex-pens are available, can’t confirm about cartridges. source

IMPORTANT UPDATE: Since posting this article last night my friend Gretchen, who is insulin dependant and travelling in India at the moment, has said that she could not find Humalog anywhere in Puri or Kolkata (Calcutta), even though getting it in those places is not meant to be a problem. Bear in mind that whilst Puri is tiny and only has a population of 200,000, Kolkata is a major city with a population of 5 million. Both are on the west coast so perhaps Humalog is not readily available there?

Insulin – example pricing

Using the sources listed under ‘Insulin availability’ above as of now – 6th January 2013 – the following prices apply. The rates are very good at the moment, I’ve seen rates 25% lower.
The current rate of exchange rates for Indian Rupees (Rs) are: £1 = Rs88, 1 Euro = Rs72, US$1 = Rs55 (source)

Speed Name Type Rupees £ Euro US$
Fast Novorapid 1 x 3ml Flexpen 555 6.31 7.71 10.09
Fast Novorapid 5 x 3ml pen cartridges 2211 25.13 30.71 40.20
Fast Novorapid 1 x 10ml vial – for pump 1450 16.48 20.14 26.36
Fast Humalog 1 x 3ml pen cartridge 408 4.64 5.67 7.42
Fast Humalog 5 x 3ml pen cartridge 2040 23.18 28.33 37.09
Fast Humalog 1 x 10ml vial – for pump* 410* 4.66 5.69 7.45
Slow Lantus (Optiset) 1 x 3ml pen cartridge 763 8.67 10.60 13.87
Slow Levemir 1 x 3ml Flexpen 988 11.23 13.72 17.96

* surely this can’t be the correct price but it’s the only one I could find; it’s more likely to be similar to the Novorapid 10ml vial of Rs1450 (£16.48, 20.14 Euro, US$26.36)

Next up – food glorious food

Travel in India with type 1 diabetes – buying diabetes supplies in India

In late July 2011, exactly 7 months after Amy was diagnosed with type 1 diabetes, we backpacked around India for four weeks, in a trip we called Monsoon Meandering.

This is post 8 in the series about that trip and its planning and how type 1 diabetes played a part.

This post is not borne from experience but from information some of my good friends in India have provided me, following questions asked via the #DOC (Twitter diabetes online community). I’d like to thank my friends Gautam, Madhu and Yogesh for their help in getting me the information for this article.
 

Do I take everything or just enough?

The answer to this will always come down to personal preference and the length of travel time. Personally, I’d rather always take enough – in fact, more than enough – supplies for the whole journey as I don’t want to spend time looking for supplies instead of enjoying the holiday. If we got the chance to travel for many months obviously things would be different.

Quick note for people from the UK: we’re very lucky in the UK to get virtually everything for free* from our superb National Health Service, so it may not be immediately apparent that many countries’ residents do not. So you will have to pay for anything you run out of, or replace after loss.
 

Can I get what I need in India?

Probably; almost certainly if you’re on multiple daily injections, as opposed to a pump. It is possible to buy supplies either off-the-shelf or via prescription from these leading brands: Novo-Nordisk, Eli Lilly, Accu-chek, BD (needles/swabs), Johnson & Johnson, Abbott, Freestyle, Bayer and Sanofi. Although these companies sell certain products please don’t rely on them selling everything you currently use. See the HealthKart links further down this post to view information about what may be available.
 

Buying without a prescription

India does have a Doctor prescription system but many things that are only available under prescription in the UK (for example) can be purchased off-the-shelf without the need for a prescription. Other things that should require a prescription can sometimes be bought without a prescription just by talking to a pharmacist who’s willing to sell it, but of course I’d not recommend trying to break the rules. 😮
It seems most things other than insulin and insulin-pens can be bought without prescription.
My friend Yogesh from Delhi told me “Most of the chemists will give you medicine without a prescription, heck half of them act as doctors as well and plenty of people just ask them what medicine to take for ailment, rather than going to the doctor.”.
 

Getting a prescription

My friend Madhu from Hyderabad sums it up well: “Not hard to get doctors prescription or medicine here in India. One way to do it is to get a letter from your GP saying what medicines one takes and more than anything to know what is the composition of the medicines. Any reputable doctor here would do a quick check and give a local prescription. Any mid size hotel here has a doctor who is their house doctor. If not one can go to the major chain hospitals like Apollo which are reputable”.
 

HealthKart.com and some example pricing

Take a look at HealthKart.com to see what types of things are available online, which should give a rough indication what is available offline too. Often online purchases in India are more expensive than in real shops and although HealthKart breaks this rule it’s not much use if you haven’t got a permanent address in India. So this is just for info only: http://www.healthkart.com/diabetes
(meters, test strips, needles and syringes).

* obviously it’s not ‘free’ as I pay my taxes to fund it but you know what I mean.

Next up – insulin availability and pricing