Lifesaving Delivery

I’ve been living with Type 1 Diabetes since I was a kid. I barely notice it any more and take many-times-daily blood glucose monitoring and insulin delivery as a totally normal part of my daily routine. Like brushing my teeth or putting in my contacts. All that came to an abrupt halt when my “Personal Diabetes Manager” (PDM) decided it had enough of this salty life and refused to power on properly. And so began our adventures in figuring out how to ship a very expensive replacement medical device to a small Caribbean island as quickly as possible.

What’s a PDM you ask? Great question!

Type 1 diabetics do not produce any insulin, the hormone that enables the body’s cells to utilize the glucose floating around in your bloodstream. Instead, they inject insulin according to what they’ve eaten, how much physical activity they’re doing (exercise requires energy), and how much glucose is already in their bloodstream. It’s all a big balancing act with the goal of keeping blood glucose levels within the normal, non-diabetic, range. In my case, insulin injections went by the wayside several years ago when I made the decision to start using an insulin pump. The pump is a device that you carry with you and continuously supplies insulin through a tube which is inserted just under the skin.

Most recently, I upgraded to the OmniPod system which involves attaching a small “pod” to your skin which carries a reservoir of insulin and delivers it much the same way as the pump. This system is much, much better than the pump given our lifestyle because (a) there’s no tubing to get caught on anything (b) unlike the pump, the pods are waterproof and (c) there’s no carrying around a large, pager-like device on your belt all the time like it’s 1995. Other than the cost (this shit is expensive!), the one caveat is the pod is controlled by a separate device (enter the PDM) which tells it how much insulin to deliver and when (I’m simplifying here, but close enough for this post).

Hence, one of my biggest fears since we moved to the boat has been is losing or somehow damaging my PDM making my whole insulin delivery system useless. Because of the cost, it just wasn’t practical for us to carry a spare. Instead, we decided to carry a bunch of old-school insulin syringes so in the event a mishap I could always revert to the olden days when I used to deliver injections several times per day. Well that’s exactly what ended up happening.

A pod on my arm and my PDM. They’re only held close together for the picture, normally they can be several feet apart and still work together just fine.

Old-school syringes, swabs, and vials. Not ideal.

Ok enough background information. Here’s the story.

So as previously mentioned I woke up one morning and, prior to eating breakfast, attempted to trigger a bolus of insulin using my PDM only to see a dreaded “Error, Please contact customer support” message. With a sinking feeling in my stomach, I immediately started googling to try and figure out a way to reset the device and hopefully clear the error, but no dice. Needless to say, I also quickly contacted the Omnipod customer support team and luckily they agreed to replace my PDM right away; however, nothing is every quite that easy as, after some back and forth with their distributor and shipping agency, it came to light that they could offer same day replacement service but…only within North America; they couldn’t ship the replacement device to the Caribbean at all! While the customer support agents were very courteous and helpful, it was frustrating to learn we’d have to figure out how to ship the device to a location in Dominica ourselves. On top of that, of course the PDM failed on a Saturday morning and all the shipping company offices in Dominica are closed on the weekend so we had to wait until Monday to start sorting things out.

So I was forced to go to my plan B of pulling the syringes out of the med kit and drawing up and giving injections before every meal and again before bed. Going back to that way of living for a number of days was a real eye-opener as to how much more convenient my life has become without the need to carry around syringes, a vial of insulin, and alcohol swabs, not to mention the sideways looks you sometimes get if someone notices you giving an insulin shot in a restaurant (or in our case, beach bar).

When Monday morning rolled around, we went to work researching how the international shipping aspect could be handled. Turns out FedEx has an office in Roseau, the capital of Dominica, so we decided to ship the PDM there and ask that it be held there for pick-up. Given the importance, we didn’t want to risk any additional delays in coordinating a courier from Roseau, on the southern part of the island, up to Portsmouth on the northern part of the island where Matriarch was anchored. With that decided, I contacted Omnipod again to confirm the plan and ask that they ship the replacement PDM to my parent’s house so my parents could put it in a FedEx shipment to us. The PDM arrived on my parents doorstep less than 2 hours after I hung up the phone with Omnipod to confirm the plan! Talk about a quick turnaround. If we were living anywhere in North America it would have been problem solved in the same day! Thankfully my parents are very supportive so they drove the package to London, Ontario, a 45 minute drive and the closest location to them where FedEx shipments leave by air. So by Monday at 6pm the PDM was on its way to us in Dominica with an expected arrival of Wednesday.

With the PDM now on it’s way to us, the next challenge was to figure out how we were going to get down to Roseau to pick it up! One of the local guides told us the island of Dominica looks like a crumpled up piece of paper. There are no straight roads and there are a lot of steep slopes to negotiate going between any two point. As a result, the 20 miles or so as the crow flies between Portsmouth and Roseau takes an hour or more by car. Originally we planned to take a “bus”, which are really privately owned vans that stop and pick people up, but ended up deciding to rent a car with another family and make it a day trip since we needed to do some shopping in Roseau anyway. And thank heavens we did, because what we expected to be a simple stop at the FedEx office to pick up a package turned into a multi-stop tour of Roseau and cargo port!

The first step was finding the FedEx office itself which was no small feat given there were 2 cruise ships in port and the city of Roseau was jammed with tourists, tour guides, taxies, and all other manner of craziness that comes with 8000 people jumping off 2 cruise ships for a few hours of exploring the island. I should note here that this day was March 11…before COVID shut downs, curfews and restrictions thank goodness! Once we found the office and filled out some paperwork, we were directed to visit the cargo port to get our package. The cargo port happens to be exactly where the cruise ships dock and it’s definitely not a walk from downtown where the office is. So we jumped back in the car and made our way down to the port where the security person informed us we needed to visit the Port Authority office before we could enter. So we parked the car and walked over the Port Authority to complete some more paperwork and pay some fees before being allowed inside the port complex itself to get the package. After being informed of there “one package one person” policy, Megan waited behind while I went through the security checkpoint and found the right location within the port’s cargo yard. I spoke with a custom’s officer who went and retrieved our package from the warehouse where it had arrived. Then he proceeded to make me open everything up, I assume to verify I was telling the truth about the contents and wasn’t trying to smuggle anything (good thing I wasn’t!). Then he directed me to a different office at the other end of the port compound to pay the import duty. Oh and he kept the package until I came back with the receipt showing I paid. So off I went again to the other side of the port to find the payment location. Thankfully the import duty wasn’t too costly, I assume because the PDM is a medical device that was being replaced under warranty. Then it was back to the warehouse to collect the package and voila!

Here I am, somewhere inside the port compound with package in hand! Wish I had more pictures, but for some reason (sarcasm) the authorities don’t love you taking photos in there…

Sooooo happy to have my replacement PDM in hand! I wasn’t sorry to put those syringes back in the med kit (hopefully) not to be needed again.

We celebrated in the parking lot with a lunch of jerk fish and jerk chicken from one of the food places right beside the port. I was soooo relieved to start up the new PDM and get a new pod working so I could ditch the whole syringe, vial, injection routine! The whole process took the better part of 4 hours from the time we left Portsmouth, but we still a good chunk of the afternoon left which we put to good use with a visit to the big hardware and grocery store just outside of Roseau.

Wow, I’m thankful we have good people in our lives!

I am thankful we have people around us that are so helpful and supportive. It would not have been so easy to fix this problem without my parents who dropped everything to get the package to us fast; without the Bliss crew (Harry and Darlynne) to drive us and stay with the kids while Megan and I negotiated the system. Taking the bus would have been a cluster. Total cluster-f&*k. And while I didn’t want to ever have to test my back-up plan for insulin delivery it is good to know it worked ok. My blood sugar was fairly stable during that time (more than I thought it would have been) and while using syringes really is not something I want to go back to, it’s now a failsafe system that we know works. Of course, injecting insulin on a passage with a 5m swell might be a different game but let’s hope that doesn’t ever happen :S