Tips for Relocating With Diabetes
Take some steps to make your move a little bit easier, whether you’re relocating to a home across town, across the country, or around the globe. Here, people who have made the big move share their tips and tricks for managing diabetes when they change from one address to another.
Before the Move
No matter the distance you’re moving, it’s smart to plan as much as you can as far in advance as you’re able, says George Grunberger, MD, FACP, FACE, president of the American Association of Clinical Endocrinologists. Grunberger suggests reaching out to your diabetes care team early in the moving process so that they can help you devise a strategy for staying healthy.
Find a Doctor
Lining up a new care team in the place you’ll call home is a crucial first step, Grunberger says. This is particularly true if you see an endocrinologist because there are fewer of these specialists than other types of providers. Your health should be the No. 1 item on your moving to-do list. Your current health care providers can help you build a new team whose roster includes an endocrinologist and/or primary care doctor, dietitian, certified diabetes educator, and more. ]
Grunberger, with his ties to other endocrinologists, has made connections for his patients. “I know a lot of people professionally,” he says. “You wind up steering people into the practices you know, so hopefully they will be getting the level of care they are used to.” Your current providers may have professional contacts or belong to membership groups, which they can tap to help you find the best care.
Finding a primary care physician is essential to staying healthy in your new home. Christine Mealey, RN, MSN, CDE, CEN, says that even if you don’t stick with the first provider you pick, getting that jack-of-all-medical-trades lined up needs to be done early. Many providers book far in advance, and transferring medical records can add extra time to the wait. “The process of sending medical records can take 30 to 60 days in some cases, so planning ahead is vital,” Mealey says. “In my rural area, primary care providers will not schedule an appointment prior to receiving your medical records.”
When you’re gearing up for a move, look into your health insurance situation. If you will have insurance, find out what it will cover. And if you won’t have insurance, Mealey suggests looking to community health centers. They typically provide primary care regardless of patients’ ability to pay. You can find a community health center in your new area through the National Association of Community Health Centers’ website.
Arrange for School Care
Parents of kids with diabetes also need to plan for school-based care. Crystal Crismond Woodward, director of the American Diabetes Association’s Safe at School program, says parents should work with their child’s new school as early as possible to ensure assistance for diabetes management there. Moving to a new state? Familiarize yourself with state laws relevant to school diabetes management and protocols.
When reaching out to your child’s new school, let the principal and school nurse know your child’s enrollment date. Collect forms, such as a Diabetes Medical Management Plan (DMMP), which will need to be completed by your child’s diabetes provider ahead of time. Make sure that school staff has been trained to provide diabetes care before your child steps into the classroom.
Your child also will need a 504 plan, which uses information from the DMMP to document the school’s responsibilities regarding care. Inform the school’s 504 coordinator that you are seeking accommodations for your child. “Ideally, an in-person meeting with the school should occur prior to your child’s first day to review plans and to meet school staff who will be responsible for your child’s diabetes care,” Crismond Woodward says. (For more on 504 plans and DMMP forms, see “Back-to-School Checklist”.)
Preplanning can reduce your stress and may help you keep your blood glucose levels in better control. For Chris Snider, 31, and Dayle Kern, 34, of Atlanta, practice makes perfect. Both have type 1 diabetes and made cross-country moves separately when they were dating and more recently together as a married couple.
When they moved from San Francisco late last year for Kern’s new job in health communications, Kern and Snider tried to solidify everything—from making appointments with their new diabetes care team to planning the layout of their new apartment—in the weeks and months leading up to their cross-country drive. Snider describes their method of moving as “doing as much planning as possible and trying to eliminate as many variables as possible,” in order to avoid blood glucose spikes and drops.
You may not always have the luxury of time and planning to get everything in place, and you may need to lean on your loved ones to get through. Matthew Weed, PhD, MPA, MA, MPhil, 45, recently made the move from New Haven, Connecticut, to Davis, California.
Having type 1 diabetes since he was just 1 year old and being totally blind, Weed depends on a crew of friends, volunteers, and allies to help him manage his diabetes and get around.
A nursing student at Yale University who aided Weed during his employment there was one of several people who helped him move to California. Weed also paid a nurse practitioner to travel with him to check his blood glucose and administer insulin as he adjusted to his new surroundings.
On the Move
During their recent cross-country move, Kern and Snider stockpiled diabetes supplies in their cars as they followed one another on the road. They packed snacks with and without carbs, extra insulin pump infusion sets, blood glucose meters and test strips, continuous glucose monitor (CGM) sensors, and insulin, stored in a Frio Insulin Cooling Case. Snider had used a mini refrigerator that plugged into his car’s cigarette lighter before, but found he preferred the Frio’s portability.
For the drive, Kern and Snider set their CGMs’ low glucose alerts to sound at higher levels than they normally would. “I probably ran a little higher while driving, especially through Texas and Oklahoma,” Kern says. “It’s a straight shot, so I can get into a zone.” That makes it easy to miss symptoms of hypoglycemia. Even if you’re sticking to a strict schedule, make time to treat lows. If your blood glucose plummets while you’re driving, pull over, treat, and only drive again once your blood glucose is in a safe range.
Phyllisa Deroze, 37, PhD, MA, of Abu Dhabi, United Arab Emirates, has lived in multiple countries and visited more than a dozen others. When flying to her new homes, Deroze, a U.S. Fulbright scholar who has type 2 diabetes, stays true to the medication schedule she set in her last home’s time zone, just until she gets settled. “I keep my watch on the time zone that I’ve left,” she says of her current metformin schedule. She did the same for insulin when she used it in the past. “I stay on the regimen for two days before I flip to the current time zone.”
Deroze notes that diabetic meals on international flights are served before other meals—helpful for avoiding mid-flight hypoglycemia. Her approach is similar to what Grunberger suggests for his patients: Ignore the clock in the place where you’re traveling, at least at first.
Grunberger suggests that people who are in the process of moving increase their blood glucose testing, as new foods, roadside dining, and sleep deprivation can all wreak havoc on the body. Having sources of fast-acting carb, such as tablets or gels, on hand also will help in cases of low blood glucose.
After the Move
Once you get to your new location, you’ll want to make it feel like home. Part of that is making sure you are comfortable with the diabetes care team you’ve set up. Grunberger says that people who have been living with diabetes for a long time and who have taken an active role in leading their care team can often tell “within the first minute, the first question” whether their new doctor is a good match.
Bea Sparks, 40, of Niles, Illinois, was diagnosed with type 2 diabetes in 2001 but had been seeing an endocrinologist for thyroid issues before that. When she moved from her native Colombia to Canada in 2000, her first endocrinologist had “no empathy,” she says. “Moving to a country with a completely different health system not only requires you to follow instructions on how to access services but also [requires] mental preparation when meeting new doctors who belong to a completely different culture.”
Learning the lay of the land in a new culture can also toy with your blood glucose levels. New foods, new medications, even different measurements for blood glucose and medication can make management tricky. Deroze says she likes to be prepared for emergencies when she lands in a new place. “I learned how to say ‘I have diabetes’ and things like ‘I need juice,’ ” she says. If you don’t speak the language of your new home, write down key phrases so you can always communicate your needs. A medical alert bracelet, with information in the language of your new home, can be helpful as well.
Deroze also says that a new health care system may offer surprising and favorable results. In the UAE, her diabetes care is better and cheaper than it was in the United States. She makes same-day appointments with an endocrinologist and gets a full workup in the same office. When she lived in the United States, a surprise trip to the endocrinologist with bloodwork and medication could cost more than $250.
“I can’t tell you how many times in America I had to make a decision between my insulin and gas in the car or my endo visit or food for a week,” she says. “I had spent so many months using my credit cards to cover strips and other diabetes-related expenses, and here I was a million miles away from home, and the same care—or better—and the same medications were costing me only $13.”
No matter where your move takes you, a new home is a prime opportunity to set a “new normal,” says Snider. Since moving to Atlanta, he and Kern have found a gym, started an exercise routine, and are preparing the week’s meals together.
And if you’re still not sure about the health care providers near your new home? Grunberger suggests tapping the diabetes online community, which spans the globe on social media and on message boards—including the American Diabetes Association’s, at community.diabetes.org. They’re ready to offer guidance and support so you can feel at home in no time.
New Home, New friends
A diabetes support group in your new home can help you feel settled and supported, and members might also have recommendations for health care providers, fitness opportunities, and more. Find your local American Diabetes Association office, then click the link for support groups to find one in your area (or give your local office a call). If you can’t find one that works for you, try one of the Defeat Diabetes Foundation support groups.
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