Almost two years ago, while working as an English teacher in South Korea, I was diagnosed with Type 1 diabetes (read about my initial experiences managing my illness here). After a few months in Australia getting my head around glucose levels and insulin injecting I moved to Cambodia. I have been living in Phnom Penh for just over a year. Below are ten tips for people with diabetes considering relocating to – or travelling in – Southeast Asia.
1) Stock up
Bring enough supplies (and then some) to last until your next trip back home. Glucose meters are available in Cambodia, but the selection is limited. Insulin is expensive and only comes in disposable pens. And while there are plenty of sugary treats on offer in supermarkets and convenience stores, I have had trouble finding simple jellybeans. Customs at Phnom Penh airport is incredibly laidback (the official on staff when I arrived wasn’t interested in even glancing at my year’s worth of insulin) so there is no problem carrying as much medicine as you need. The Cambodian postal system, on the other hand, is very unreliable – getting supplies sent from overseas can be a drawn-out (and sometimes ultimately unsuccessful) ordeal. Your best bet with the post is to have the package sent registered mail to a business (rather than a home address), with the phone number of someone who speaks Khmer included.
2) Back up
In my first three months of living here I had my bag stolen – inside were my glucose meter, Lantus and NovoRapid pens. I had spare pens, but the extra glucose meter I had wasn’t available in Cambodia, and so became useless once I ran out of strips. I was forced to check my sugar levels very sparingly while I waited for a replacement meter to arrive from Australia. There’s a double moral to this story: back up your diabetic supplies, and keep a tight hold of your bag while riding in a tuk-tuk.
3) The Frio Pack
I am eternally grateful for this wonder of technology. Frio Packs require no refrigeration (they are activated with water) and keep insulin at safe temperatures – even in Cambodia, where (in the hot season) the weather can sit at close to forty degrees Celsius for days. I keep one Frio Pack constantly activated for my NovoRapid (which means simply sitting it in a sink full of water every few weeks) in case I’m going out to eat. It’s also good to have a few extra Frio Packs on hand in case of power cuts (which happen fairly frequently during Cambodia’s hot season).
4) Find a doctor you can trust
I try to avoid frequent visits to the doctor, but it’s important to know where to go should something serious happen. When I first arrived in Phnom Penh I visited the International SOS Clinic and chatted to a fantastic doctor and the nursing manager about living with Type 1 diabetes here. It may be a little expensive, but the peace of mind is worth it. I also keep in touch with my wonderful diabetes educator back in Australia, and make sure I get all my checks done every time I’m home (about once a year).
5) Get used to saying: “No thanks, I can’t eat all of that rice right now.”
The management of diabetes is not very well understood in Cambodia (Type 2 is much more common than Type 1, and injecting insulin is particularly rare). Cambodian people are generally very friendly, and love to share food. When I first arrived in Phnom Penh I was still very thin, and many of my co-workers were determined to fatten me up by constantly feeding me! My polite refusals were often met with confusion, and so I did my best to explain the intricacies of living with diabetes – “I can’t have too much sugar, but I can’t have too little, either!” Being able to say ‘diabetic’ in the Cambodian language is also helpful. In Khmer diabetes is dteuk nom baem, which literally translates as ‘sweet pee’!
6) Be aware of the heat
Cambodia is hot. Really hot. Almost all of the time. It’s so consistently sweltering, in fact, that you start to forget how the weather might be affecting your blood sugar. I try to check my levels fairly regularly on really hot days, and drink lots of water. I’m also careful not to over-exercise; I find bike riding, yoga, and swimming are the best ways to stay fit (and stable) in Phnom Penh.
7) Be aware of food
White rice is a staple in Southeast Asia, and it also happens to be really high in carbohydrates. Most Cambodian restaurants only serve white rice with meals, though brown rice is readily available in grocery stores. I try to cook at home as much as possible, and go easy on the rice when I’m eating out. A lot of Cambodian cooking uses palm sugar (this recipe for fish amok – the country’s national dish – calls for a tablespoon of the stuff, however I’m sure that amount is often doubled in restaurants here), and fruit shakes and coffee almost always have sugar added (whether you ask for it or not). The good news is that mango is delicious, cheap, low GI, and everywhere, as are a wide variety of other fresh and healthy fruits and vegetables.
8) Look after your feet
For me, life in Phnom Penh means either wearing sandals or no shoes at all. This may be comfortable and easy (and good for showing off painted toenails), but it makes my feet much more susceptible to cuts. In the rainy season bare feet also inevitably equal wet feet – and flooded city streets are breeding grounds for all types of wonderful bacteria. I always make sure I clean my feet properly (especially after walking through puddles) and cover up any scrapes. A pedicure and foot massage every now and then is nice, too!
9) Be prepared to be unprepared
There is always an element of uncertainty (and adventure) to life in Cambodia, which can make living with diabetes tricky at times. Last week I was caught for two hours in a rainstorm that turned into a flood, resulting in me being an hour late injecting my Lantus for the day. And while travelling across the border from Cambodia to Vietnam during Khmer New Year our bus was stuck in heavy traffic. What should have been a six hour journey became an eighteen hour one, and included sleeping on the bus by the side of the road overnight. Lessons learned: keep insulin handy, and always carry extra snacks!
10) It’s really not that hard
When I first decided to move to Cambodia just a few months after my diagnosis I was a little concerned (my parents were very concerned!) about how I would go. A year on, it’s hard to remember what I was worried about. Perhaps the most important tip is this one: as long as you are careful and organised, living with Type 1 diabetes in Southeast Asia is no problem at all.