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Type 1 diabetic travelers to Japan, be prepared

by Mykel Greene

Contributing Writer

Although traveling to Japan with Type 1 diabetes, or tōnyō-byō, can be tough, it really doesn’t have to be. Proper preparation can make the whole experience as easy as pie, meaning you spend less time worrying over how to take care of yourself and more of it experiencing the wonders of the country. Over the course of the past four months, here’s what I’ve learned about navigating Japan as a Type 1 diabetic.

Before you go

First and foremost, see your doctor prior to your trip and get in contact with one in Japan that speaks a language you do. Consulting your doctor for a full check-up before a large trip is always a good idea, but it is especially important for those of us who have chronic illnesses that might become more difficult to manage overseas. Since the time difference between home and Japan may make communication impractical, it’s best to have a doctor here in Japan who is familiar with your history of treatment.

It is also important to note the country’s laws on importing prescription medication and medical supplies. Japan only allows you to bring a month’s worth of supplies. If you intend to stay in Japan for longer, you will have to apply for a yakkan shōmei. This document tells customs that you have been approved to bring the amount of supplies listed on the certificate. To be approved for the yakkan shōmei, you must send your individual prescriptions, doctor’s notes and forms to one of three health ministry offices, depending on which airport you are flying into. You can apply for this certificate by mail or email, though I would recommend email considering the sensitive nature of the documents. I must warn you: This process will be a pain in the neck.

Gear up with tech

Consider assistive technology for managing your diabetes, such as a continuous glucose monitor (CGM). As the name suggests, a CGM is a device that measures your blood glucose levels in your interstitial fluid, at most every five minutes.

Though it is relatively new and may not be offered nationwide, in Japan they provide a similar device called a continuous glucose monitoring system (CGMS). Like with an insulin pump, the CGM/CGMS is partially inserted under the skin with a transmitter that sits on top.

The transmitter is a Bluetooth device that interprets the sensor information and sends it to a receiving device, which can be your smartphone or a separate piece of hardware that comes with the CGM. The CGM notifies you when your blood sugar is rising or falling at a faster rate than normal, or is stable but too high or low. With all the stresses and strains of long-distance travel, it’s easy to forget to keep an eye on what’s going on inside your body. I certainly did, so having my phone beeping and buzzing every five minutes to tell me that something was wrong was a godsend.

For those of you who would be more comfortable just using testing strips, please bear in mind that it might be difficult to find the strips that you use with your meter in Japan. While Japan does have familiar brands like Accu-Chek, FreeStyle and OneTouch, depending on what is covered by the national health insurance program, clinics and pharmacies might not stock the strips that you need. If they do, they might be too expensive. Therefore, make sure you fill out the yakkan shōmei to ensure you will have the supplies you need to monitor your diabetes.

Know your enemy

Try to memorize standard food measurements. For example, a cup of cooked white rice will invariably be 45 carbohydrates (in terms of grams). Unless fried with a bread coating, meat and fish will usually be less than 3 carbohydrates. Vegetables only exceed 5 carbohydrates when sugar and/or fat is added during cooking.

Memorizing basic meal components like these will help prevent the panic attacks that can arise from not understanding nutrition labels here in Japan. I cannot even count how many “nutrition labels” I’ve seen that are split between two locations on the package. One will tell you important details like the carbohydrate count, sugar content and serving size. If you are traveling from the U.S., you should acquaint yourself with metric units such as milliliters and grams, because the rest of the world doesn’t use fluid ounces or ounces.

On the second label you will find information such as the ingredients and size of the entire package. Of course, all of this is in Japanese, but fear not: As long as you can recognize the kanji for carbohydrates (炭水化物, tansui kabutsu) and sugar (or “sugariness,” 糖質, tōshitsu), you will be in good shape.

There will be times when you won’t find carbohydrates on the labels at all. When this happens, it can be helpful to know how to convert kilocalories into carbohydrates. A quick way to do this is to take the number of kilocalories listed on the package and divide it by 4. For example, if the bread you’re eating contains 133 kcal, you would divide 133 by four, giving you about 33 grams of carbohydrates.

However, I know from experience that remembering portion sizes can be difficult. Luckily, just like the saying goes, there is an app for everything. One I would recommend is Figwee, which comes in a free and paid version for desktop and mobile devices.

Figwee has a pictionary of thousands of foods with the corresponding calculations of portion sizes. You can adjust the sliding scale until what you see on a virtual plate appears to match the amount you ate. For dishes Figwee doesn’t recognize, like oyakodon (chicken and egg rice bowl), you will have to build the dish yourself by separately estimating how much white rice, egg and fried or smoked chicken was used and doing a few calculations.

Know yourself

Be aware of how certain carbohydrates affect you. Generally speaking, white rice, bread and pasta are foods that linger in your system longer than, say, french fries or tempura. Sometimes, the nutrition labels will tell you whether there is fructose in what you’re eating. Since fructose is absorbed much faster in your system, it is good to know if it’s present in your food. If you know katakana, one of Japan’s three writing systems, you will be able to find fructose (フルクトース) easily.

Knowing how long it takes your body to process particular foods is key to making sure you don’t give yourself an improper amount of insulin. In my first month here, my blood sugar was all over the place. I was eating more white rice than I had before, but I didn’t expect Japanese white rice to stay in my system for so long, causing my blood sugar to skyrocket.

Also, beware sauces and dressings. While these condiments might not contain much sugar at home, in Japan they are loaded with it, which can cause hyperglycemia if you’re not careful. I surely wasn’t. This might not be true for all diabetics, but it is definitely something to look out for.

Consider a support network

Last, it is good to have a strong support system when you are home, but this is even more important when you go on any adventure across the ocean.

You could consider joining an online forum, a local group or a regional chapter of a national organization such as The Japan Diabetes Society, for example. Knowing you have a support network of knowledgeable folk at hand can give you some peace of mind amid the chaos of culture shock and routine readjustment. These JDS chapters bring together people who are affected by diabetes and provide educational activities that can make living in or visiting Japan with Type 1 diabetes at least a little less daunting.

For more on The Japan Diabetes Society’s regional chapters, visit www.jds.or.jp/modules/en/index.php?content_id=10. For details about the yakkan shōmei, visit the Ministry of Health, Labor and Welfare’s website at bit.ly/mhlwdiabetes. Send all your questions and comments to lifelines@japantimes.co.jp.