FUDiabetes

Have T1D, will travel: a trip to the Sahara

travel
unlimited

#1

We just came back from a long driving trip through parts of the Sahara. For obvious reasons, we chose to do it in winter. For safety, we decided to remain in Moroccan territory and in lands controlled by Morocco: we elected not to drive in Algerian or Malian Sahara—maybe another time, when political and religious realities are different? Here is a quick summary of our trip’s impressions, followed by a short description of our diabetes logistics and experiences.

The key to the trip was “The Jeep,” in reality a Toyota Landcruiser, that worked impeccably well everywhere, including in deep sand. It carried a driver, the four of us, a minimal amount of luggage, and a ton of water. Each person had a side window, an important consideration in several respects, including car sickness, in these very bad trails.

In most places, the trail ahead was a thin ribbon of dirt or sand, often clearly marked by past vehicle tracks.

In the valleys, you could see the pass ahead from far away always. It would remain ahead for hours sometimes.

Then, as you came down the other side, the valley or the plain would open up again.

The skies were huge.

On both sides of the ride, the views would keep on passing by. We couldn’t help but stop often just to look, even after many days on the road.

Most of the time, we had hills or mountains close on one side, further on the other.

Other times we would drive through ancient seas and lakes, with nothing in sight but a faraway horizon.

It was always a surprise to see big green showing up in our view, such as an oasis of trees next to a mountain side.

Even more of a surprise would be free water whose surface could be seen. We hardly saw any on the way, except in rare mountain streams.

Wherever there was water, there were traces of men.

But, the rest of the time, there were hardly any. Occasionally, we would see ancient fortified mud-built ksars.

SaharaHighAtlasKsarEDSM2

At other times we would find antique kasbahs along a dry river bed or a pass, sometimes still inhabited. Built of the very mud they stood on, they would be a perfect fit into the earthen landscape.

SaharaB%26WKasbahEDSM2

And, of course, there were the dunes.

They were the reason we got a driver. I was comfortable driving montain trails and rough ground, but I was less sure of how well I would deal with deep sand alone, without a companion car: it turned out that this was the right decision. Our driver was Berber. He spoke Amazigh, a good bit of Arabic, and a mix of English, French and Spanish with us. His family was still nomadic 20 years ago. We got along famously together.

To us, this trip is another proof that you can be UNLIMITED! I know it will remain with me for a long time—the landscapes:

The skies:

And the sands:

(continued)


#2

Logistics

We brought with us one small carry-on, duffle bag or backpack per person. In addition, we had a 2,000 inch3 backpack for diabetes supplies and one tiny sling bag, always in my son’s possession.

For pump and CGM gear, we brought a bit more than twice as many supplies as we expected to use. We also brought a spare iPhone for my son, and we were, of course, carrying 2 follow phones. We did not bring a spare PDM, but we had an extra hand glucose meter. We also had about 20,000mAh of battery banks, that were used extensively, along with several chargers, cables and spares, and many Euro-US adaptor plugs. One accessory that came very handy was a US 10-ft extension cord, because power, when available, was often a single outlet per room: it gave us flexible access and the capacity to plug in many devices without more adaptors.

We brought about three times more insulin than we needed, divided into two thermoses. We also brought twice as much basal insulin as we might use, although we pump, in case we had pump failures. Each thermos had both fast-acting and basal insulin, and 5-6 frozen iceballs. The iceballs turned into thermal moderators in fridges when we actually had access to them (hardly ever).

In Europe we travel with a med kit and about 25 different types of drugs in a small Pelikan case. We took our med kit, but only a small selection of drugs with us (for portability). It was sufficient for everything except for one incident.

We brought 6 lbs of fast candy (Skittles). We normally use milk and a sippy cup for night lows. We had no access to milk most of the trip, so we bought 2 kgs of hard sugar that we took with us, and made bottles of cold sweetened tea that had 5 grams/oz of sugar, which we then dispensed at night with the usual sippy cup. We weighed the liquid to dispense it (33 grams per oz) with a portable digital scale that we brought along. We also carried clementines and bananas for daytime lows, that we purchased on the go. The bananas crushed often and were a pain to use, but the clems were great at 9g/fruit (not that they were always easy to find: we once had to cover 150km to find fruits to buy…).

We carried 6 days of clothes. We had 4-5 layers along. We used all of our layers, even winter jackets we were not sure were needed.

Using a driver was very helpful to logistics, since it allowed us to leave luggage in the car whenever we were walking around. We remained in Berber and Tuareg country all the time on purpose, and felt safe all the time, although we drove a few miles away from where two Western tourists had their throat cut a few days before we were in the neighborhood—I consider it to have been a very unusual event.

Outcomes and incidents

Basal needs remained remarkably stable all the way through. On the other hand, patterns and ratios widely varied. We had a very hard time evaluating meal carbs, and meals were, in general, carbier than we normally eat. We ate only local food. Most meals ended with post-dinner carb peaks due to poor estimation, although, towards the end, we were able to do a better job. Puberty peaks were different from home, and happened at different times. Ratios were widely different, with CR going from a home 1:35 to a road 1:12 (with many changes).

We had a pump site infection that gave us trouble, and required antibiotics. We were very lucky because we were near a small village with a doctor. Our guide helped us a lot there. The nurse did not want to take our boy, but wanted us to ambulance him to a bigger town 6 hours away. Our driver told her that she had to take him by law even though he was a foreigner, and that he would bring on the police if she did not. Finally, out of sheer weariness, she called on the doctor for the boy. We had had a site infection a year ago when we had used Keflex. We discussed suitable antibiotics with the doctor, and she gave us the same type of antibiotic. The office would not let us pay for anything, either care or medicine. I used a pen to mark the infection edge every day, to monitor success, in case it was an MRSA. After 2.5 days of antibiotic use, the infection started waning, and the angry red turned more normal. After 5 days it looked pretty cured, and the treatment was 7 days long, after which nothing remained.

In terms of weather, we never had any dangerous heat (for insulin, or for us). It was cold at night most days. In the deep desert, it ended up being below freezing a couple of nights, in particular when we were camping in tents—but it never was bad enough that we had to sleep with the thermoses. We never had any insulin conservation worries with our regular thermos logistics. A couple of nights, we had access to fridges, but they looked so old that we decided they were more dangerous than leaving the insulin outside in its thermoses.

We had a hard time with dehydration: we had to drink enormous amounts of water, and the cold was deceiving. The first few days, we had bad CGM signals due to dehydration. The later part of the trip was better, but we were never far from losing sensor signal due to dehydration. We probably lost an extra sensor for that reason.

Finally, we hardly had any wifi anywhere we were. We slept in houses, rustic hotels, encampments and guest houses. Many of these places only had generator power, from sunset to about 11pm. There were four of us: my wife and I, my T1D son, and my college son. We ended up dividing sleeping rooms in a different way: my T1D son and I slept in one room, and I used his phone as the CGM alert source. My wife and my other son slept in another space or room. Since we had very little broadband, if at all, we largely did not use our follow apps for the whole trip—but night was the only concern, and we made it work.

We used bottled water all the way through. We avoided raw vegetables. We did not run into any digestive problems during the trip, but, upon coming back to Spain, my wife and I had a very hard 4 days, including significant fever. We were lucky it did not happen earlier in the trip. We still don’t quite know exactly what caused it—but of course we understand that it must have been a food issue, likely bacterial contamination.

In the end, we had rough food and accommodations, and it was just what we wanted. Our logistics worked well. We never ran short of anything. We had no major breakage. we dealt well with all emergencies that developed. We came back with half our supplies left. Except for the site infection we never felt worried. It was a great trip and we hope to go back some time!


#3

The pictures are amazing. That sounds like a wonderful trip!!!


#4

@Michel, I love your narratives and photographs! They are a joy to read and VERY inspirational! We plan to start taking our boys further around the lower 48 while they’re still little. When they get older, my husband has a pretty long (and exotic) list of places he wants to take us all to. :slight_smile: Your posts make that seem much more realistic. Thank you.


#5

I am really glad you like them! We knew we did not want my son to ever feel limited, so we have worked hard at finding solutions. Travel is a big part of our lives, and we feel that the solutions we have worked on for the past 3 years are become more routine to us and to him :slight_smile: He certainly is not fazed at all by any of the adventure travel we do.

When my younger boy was four, we bought a 20-ft travel trailer and a Toyota Highlander, and went camping for 4-5 weeks a year all over the US every year. We ended up camping in 43 states (we missed our 50-state target because my older boy became college-bound then). Of the contiguous 48, we have only missed some of the Southern states and a few county-sized ones in the Northeast :slight_smile: The year my son was diagnosed, our national travel plan was to go camping and hunting in Alaska, but that fell through… We are still planning to go back though!


#6

What an amazing experience. Thanks for sharing, especially the pics!


#7

Fascinating, and what fun! Thanks for sharing.

Do you think the infection was related to sanitation? Especially when sleeping in tents you likely didn’t have access to long, hot showers! I’ve rarely had site infections but one of the worst was while on a canoe trip when I didn’t wash very often (besides swimming in lakes).

Just out of interest, what was the “local food” you mention?


#8

I have wondered about that. The pod was installed several days into the trip, so my son’s skin had been exposed to poor sanitation for a while already. We also were wearing clothes for more than one day, and we did not have daily showers (no access to showers often…). We did sanitize the skin as always, but we did not take enough precautions, I feel: we probably should have more sensitive to the fact that it was a risk. Aftwerwards we started using two swabs of alcohol wipes rather than one.

As a note, btw, in several parts of Europe, sealed alcohol swipes are unavailable. We have resorted to cotton swabs and alcohol bottles in several places. But we took US alcohol swipes with us to the Sahara.

We did not eat any western food. In the morning we ate flat Berber breads with fermented sheep’s cheese, fermented goat’s milk butter, honey, olive oil, olives, and scrambled eggs with local greens and onions. Lunch and dinner we would have Berber soups, Berber “salads” (mostly pickled ingredients and pulses), tajines and couscous. Our street foods mostly involved Berber flat bread pockets (or wraparounds) with sheep or goat meat, caramelized onions and peppers, and sauteed local greens. Olives in many forms with every meal! In the high plateau in the Bled we never had cow meat, but a couple of times in the Atlas we did, always in stews.

I regret to say that French (Freedom?) fries have made their appearance in the desert as a common roadside ingredient :slight_smile:


#9

Hey now. Rhode Island has FIVE counties - not only one.

:stuck_out_tongue:


#10

This sounds like the most amazing experience for everyone in the family. So happy you all got to experience it!!


#11

I am sorry to say that Rhode Island is one of the 5 contiguous where we have not camped :slight_smile:


#12

The pictures are really great.

Nothing to do with D, this would be WAY outside my comfort zone.

But I love looking at your pictures !!!


#13

Yum! But I can see how carb counting would be a serious challenge, especially when you’re always moving on to a new place with someone else’s breads and tajines and mystery meals.


#14

Wow! What a great trip and experience for all of you, and for us, to see and read first hand! Thank you :slight_smile: for sharing!


#15

That is an awesome story and beautiful pictures.

Thank you for sharing


#16

Those pictures! :heart::heart::heart:


#17

It goes without saying that you and your family is truly unlimited during this remote trip. Great job.

Now that the niceties are over, I have a technical question related to your photography. The last picture, i.e. the one with the beautiful blue skies and the orange sand, is that as it came out of the camera, or did you manipulate the saturation and colors?

Very striking photo btw. Would be interested in a JPG when you get the time.


#18

The framing is untouched. From the original pic out of the camera (this one was actually a spur of the moment phone pic) I increased saturation, moved the palette towards reds, and added a tiny bit of contrast. As you can see there is no good way to get a clean white balance, so you have to guess a bit. I tried to recover the emotional feel of the original moment. I can send you the original if you wish!


#19

The saturated version is fine. It looks a little doctored, but that is part the appeal of it as well.

If you wouldn’t mind a slight larger file than the one posted.


#20

Very cool