“I realised during a couple of difficult weeks where I’d felt rough, thirsty, and generally unwell for a while. It was only when I noticed a constant thirst and lack of energy – plus weight loss – that I knew something wasn’t quite right. For some reason I don’t remember being too shaken by the news. My family were quite upset, but I can’t recall it bothering me as much as it probably should have. My family still worry about it far more than I do.”
Meet Loui Holmes, a British native now residing in sunny Saigon, among the innumerate foreigners living in the great southern city of Vietnam – however, Holmes differs from the majority of expats that fill the streets of Saigon in that he is a Type 1 diabetic. “I was diagnosed with Type 1 diabetes when I was 22, which came as a shock as no one else in my family had the condition. I knew very few people with Type 1, and so I found social media to be very helpful – especially twitter.”
We all know someone who seems to be constantly hitting the proverbial road, travelling about the world as though life were one long unbroken Instragram story, intent on telling the internet that they’re just #LivingMyBestLife, stating that they feel #Blessed while the rest of us are slumped in degrading office chairs with a disappointing Tesco meal deal sandwich feeling #FuckingMiserable.
While for most of us, this seemingly interminable gallivanting about remains an unobtainable aspiration due to financial reasons, work commitments and a plethora of other responsibilities that seem to anchor us in a mass grave, most of us don’t have to deal with the potentially damning healthcare implications that travelling the world can bring. Hailing from the UK, where a much besieged NHS generally covers most ailments, Holmes was anxious to see more of the world, but wondered how his newly diagnosed Type 1 diabetes would affect those ambitions.
Around 10% of the UK lives with Type 1 diabetes, making it a fairly common, but still serious condition that lasts a lifetime. No-one is sure what causes it, but it prevents the human body from producing the hormone insulin, which is needed to pass glucose from the bloodstream into the cells of the body and fuel them. This, in turn, means that what and when you eat and drink becomes of critical importance to your survival – which makes life on the road that much more dangerous. Diabetes, both Type 1 and Type 2, can be fatal if not managed possibly and even minor issues can lead to long-term complications, none of which are good.
“For all the faults that the UK has, the health system is not one of them. I was very aware that when leaving the UK I’d have limited access to vital healthcare that is so readily available. My healthcare team was excellent when I gave them the news that I’d be leaving for an indefinite amount of time, and they helped me to secure enough supplies to last me a good few months, some of which I still have now. I wasn’t overly worried about finding supplies, as I figured that insulin must be needed everywhere; my main worry was health check-ups and what to do if I ran into a major problem. This actually happened earlier this year when I suffered DKA in India and was hospitalised for a week; I contacted my UK healthcare team and they gave some advice to the Indian doctors based on my earlier blood tests.”
For those unaware of DKA – Diabetic ketoacidosis – is a serious, life-threatening complication that arises from the body running out of insulin, so ketone acids begin to break down fat as fuel. Along with the usual symptoms of vomiting, nausea and a lack of energy, comes confusion, the need to pee and – apparently – fruity scented breath.
While Holmes is, in his own words, a slow traveller, he’s spent months in numerous countries such as India, Nepal, China and Singapore before settling on Vietnam as a temporary base of operations. “I was passing through Vietnam on the way to somewhere else when a friend I was visiting persuaded me to stay in Saigon for a while. Through the food, the landscape and the locals, the country grew on me very quickly and I’ve not felt the need to move on since. Vietnam is also a great base for travelling further through Asia as it’s quite central really, and flights to other countries from here aren’t too expensive. I can’t imagine that I’ll be in Saigon forever, but certainly for the foreseeable future.”
With Vietnam consistently voted as one of the top foodie destinations in the world, for Holmes and the other 371 million diabetics worldwide, it’s still a viable option to visit, but special care and attention needs to be applied. “I try to eat as fresh as possible when eating Vietnamese food, and I’m wary of some of the street food as sometimes it isn’t the cleanest, but I’ve never had any problems with it and have actually only been ill when eating western food here. In terms of diabetes, there isn’t too much you can do with the food, but with drinks it’s always worth asking about the content. In some drinks, like cà phê sữa đá, the sugar is unavoidable really, but when having a smoothie or juice drink, you can ask for no sugar, which isn’t a problem for the vendor as they make them fresh anyway.”
“The reason I mention sugar a lot isn’t because it’s the main cause of diabetes, but because if you are already diabetic, even a couple of teaspoons of sugar in your drink can play havoc with blood sugar levels. That, mixed with the hot weather and humidity, can lead to problems quite quickly.”
One of the key purposes to Holmes’ blog, Type 1 Traveller, is to provide a resource base for diabetics who want to travel and allows him to share his advice, experiences and tips for living with diabetes while still travelling out of his comfort zone. “One of the exciting things about travelling is the food and yet this is one worry that a lot of diabetics have about travelling. If you’re going to worry too much about the local food in countries, you’re going to miss half of the experience, so I just say try everything regardless! However, if you are living here it becomes much easier to pick and choose certain foods as you know what they contain.”
Vietnam’s diabetes epidemic is mostly silent, with the World Health Organisation reporting that almost 50% of those living with diabetes here are unaware of their condition, killing an estimated 53,458 in 2015 alone. These numbers are only set to rise as last year, roughly 5 million Vietnamese people were diagnosed with diabetes – approximately 5.4% of the population – with the rate of diabetes having doubled over the past ten years. For Holmes, the problem here is a ticking time bomb.
“I’ve read that that the government is trying to tackle the rise of diabetes as Vietnam is one of the fastest growing countries in terms of the condition, but I can’t really see much happening. Although there’s no known prevention of type 1, there is for type 2, yet sugar is put in a lot of food here, and the drinks, especially tea and coffee, are loaded with it; having to actually ask for no sugar when ordering a drink is ridiculous. Now, sugar isn’t the cause of diabetes, but lots of sugar mixed with lack of exercise (which is also a problem here) and a diet high in fried foods really doesn’t help. I honestly think that things will get worse before they get better, but you could say that about most countries really.”
Contrasted with a lot of countries, Vietnam doesn’t stack up too bad, not even featuring in the top 20 countries where the diseases is most prevalent, but behind the statistics, the personal experiences of Holmes are what he hopes to highlight in his blog.
“I think that diabetics in some countries have it far easier than in others. Some countries seem to have a good understanding of diabetes and the healthcare isn’t bad. In India for example, most people knew what I was doing when injecting in public, whereas in Nepal people often thought I was injecting something else and I’d get stared at a lot. I think, in Vietnam, diabetes is widely ignored, even though supplies are quite easy to come by. Also, the general pay of the majority of Vietnamese isn’t too great, and so paying for insulin is something that perhaps a lot of people have to save up for. Of course back in the UK, most treatment and supplies are free, and so if you’re diabetic there really isn’t a lot to complain about, though a lot of people still do find things to moan about.”
Has living with Type 1 diabetes stopped Holmes in his world-wandering ambition?
“One of my high points was trekking for two weeks through the Annapurna region of Nepal. The scenery is unbelievably beautiful, and seeing how mountain people live their lives really opens your eyes to how little we actually need. The air up there is clean and the water fresh; everything is just pure and unspoiled! The low point was earlier this year in Darjeeling. I’d returned to India to visit friends and got a bit ill because of something I drank, this then led to Diabetic ketoacidosis (DKA), which landed me in hospital for a week. I was looked after well, but being in an Indian hospital is something I’d rather not have to go through again…”
For more information on travelling with diabetes, check out Holmes’ blog, Type 1 Traveller.