Living on a Remote Island with T1D


Explorer at heart

I’ve loved to travel since I can remember, so when I was diagnosed with type 1 diabetes at age 17, I started to worry that it would end my days of exploration. Those first few weeks of management felt scary and unpredictable, but only made me more determined to take control of my health and pursue a life of adventure that I’ve always wanted. I took my first major trip only a few months after I was diagnosed: my family and I went on a safari in Kenya. We camped out in the middle of the National Park with no medical resources near. I over-prepared for that trip like no other—I had backups for my backups. After successfully managing my diabetes on that trip, I felt confident in pursuing more travel, and on my own! In my second year of college, I decided to spend a semester studying abroad in the Gold Coast of Australia. I conquered and enjoyed my time there! Many small trips followed and I felt confident traveling and managing diabetes but my next major travel dream was not so easy…

I decided I was going to spend a year teaching on a remote island. Through a wonderful program, I found the opportunity to teach on the island of American Samoa. This island is so small that you can drive across the entire thing in just a couple of hours. It has small grocery stores, one movie theater and a few Chinese or fast food restaurants. It is also so remote that the nearest major land mass is a close tie between New Zealand and Hawaii and even those are both a six-hour flight away! Before I got too excited, I had to be logical about how I was going to live there with diabetes.

Island living

The island had minimal medical care and—I was told—did not carry insulin or diabetes supplies. Step one was to clear this crazy idea with my doctor. I had to make a year commitment to the program, meaning I wasn’t going to be able to come home for checkups or blood work with my endocrinologist. I can’t say he was thrilled but we worked out a system in which he could view my numbers via the internet. He filled out a ton of paper work and then, it was a go. Step two was to find out a way to get my insulin! Since I was told the island did not carry insulin, I decided to have it shipped to me. Hawaii was not an option due to high insurance rates when shipping from the mainland, so we had to do more digging. Finally, we discovered a company called Express Ships and I was able to have my insulin put in a freezer box and shipped in a cargo ship or plane once a month. Step three was to pack ALL my supplies. I was allowed to bring two suitcases and I filled an entire one up with needles, glucose tabs, lancets, backup batteries, meters—EVERYTHING! For a whole year! And then was I ready to go.

The island was absolutely beautiful! Postcard perfect, yet still very underdeveloped. The hospital was crawling with critters, with doors wide open and a wonderfully friendly staff, yet they had very little little knowledge of type 1 diabetes (T1D). I was nervous at first, I felt very alone. I managed to adopt a healthy routine amidst the unhealthy lifestyle that many islanders lived. My students would walk into class eating frosting out of a can for breakfast! The two or three restaurants on the island only offered fast food and there was very minimal education for health and fitness. With such few resources, I had to take it upon myself to stay on track. I found vegetables I liked among the interesting new selection that was offered and stayed away from the endless supply of junk food. I swam and hiked for exercise and enjoyed the beauty of the island by foot as often as I could.

Best laid plans

So my insulin shipments were going as planned, coming in every other week by a cargo ship or flight. I felt pretty comfortable with that system until something scary happened. With little internet connection, we had only short notice before a massive hurricane struck. The power went out, the water was shut off and school was cancelled. About four days in, I got towards the end of my last insulin pen and I was scared. The island was in rough shape but the hospital stayed open. I called them and asked if I could pick up my insulin hoping it had arrived around before the hurricane. They told me that the flight carrying medications had been cancelled. They didn’t seem concerned until my sense of urgency was translated.

Eventually, I was informed of a backup supply of insulin vials on the island for military use and if I was really in need, I could have access to those. They made it seem like it was top secret. Not wanting to take them up on the sketchy insulin vial offer (which looking back, I’m sure would have been fine), I decided to stretch my small amount of insulin out and live on a super low-carb diet until the damage was cleaned up and the flight could arrive. Our avocado tree in the yard had littered avocados all over the ground, so I ate those, nuts and granola bars for the next two days until the flight was able to come in. Once I received word that my insulin was on the island, I was so relieved, but the experience really scared me straight. From then on, I was over-prepared. I always had backup boxes and even brought extra supplies to school. Although this was an extreme circumstance, the lesson anyone can learn is that you never really know what’s going to happen. Always stay prepared, even over-prepared, with your diabetes.

That said, get out there and travel because NOTHING can hold us back!

WRITTEN BY Abby Crawford, POSTED 04/16/19, UPDATED 11/08/22

Abby talks more about her exciting life on her blog: She loves exploring the world and has spent years living abroad. She's been living with diabetes for over eight years now and although she sometimes struggles, she never stops traveling and trying to inspire others to do so. Check out her adventures on Instagram: @diabetestravelchick.