Managing Type 2 Diabetes After Moving to Peru

Diabetes control has a habit of drifting during an international move, and it rarely drifts for medical reasons. It drifts because the prescription ran out, the pharmacy did not stock the brand, the routine that held the diet together dissolved, and the doctor who knew the history is in another hemisphere.

None of that is a failure of self-discipline. It is a predictable consequence of moving, and it is largely preventable if you deal with it in the first few weeks rather than the first few months.

First: the numbers do transfer

HbA1c is reported as a percentage in Peru — the NGSP/DCCT standard, the same as in the US. If you are arriving from the UK or much of Europe, where results come in mmol/mol, use the HbA1c converter so you are comparing like with like. An HbA1c of 53 mmol/mol is 7.0%.

Blood glucose is reported in mg/dL, again as in the US. If you are used to mmol/L, multiply by 18. A fasting glucose of 5.5 mmol/L is 99 mg/dL; 7.0 mmol/L is 126 mg/dL, the diagnostic threshold.

Getting fluent in the local units quickly matters more than it sounds. Guessing at the meaning of your own glucose readings for three months is its own source of drift.

Medication: what's available and what to check

Most of what you are likely to be taking is available in Peru.

Metformin — widely available, inexpensive, multiple generics, including extended-release.

Insulins — the common basal and rapid-acting analogues are available. Specific brands and pen devices vary, so check availability of your particular device before your supply runs low, not after.

GLP-1 receptor agonists — semaglutide, tirzepatide, dulaglutide and liraglutide are available. Cost is the main constraint, and it is worth discussing openly. If you are buying these here, read this on avoiding counterfeit product first.

SGLT2 inhibitors — empagliflozin and dapagliflozin are available.

Two practical points. Peruvian prescriptions are written by active ingredient as well as brand, so bring the boxes or photographs of them — the active ingredient is what transfers, not the trade name. And a foreign prescription cannot be dispensed in Peru, so you need a local one. That is a straightforward consultation, but it is not instantaneous, so start it before you are down to your last week.

If you use a continuous glucose monitor or a pump, check sensor and consumable availability specifically. This is the supply issue most likely to catch you out, and it is much easier to plan for in advance than to solve urgently.

What changes about food

Peruvian food is genuinely excellent, and some of its staples deserve advance thought if you are managing glucose.

The carbohydrate load of a traditional lunch is often higher than what arriving patients are used to — rice and potato commonly appear on the same plate, which is normal here and not a mistake by the kitchen. Chifa and many criollo dishes are rice-centred. Fruit juices are excellent and frequently very large.

None of this means avoiding Peruvian food, which would be both miserable and unnecessary. It means knowing that a standard menú lunch may carry more carbohydrate than your usual meal, and adjusting either the plate or the medication accordingly. There are also real advantages here: outstanding fish and ceviche, an enormous variety of vegetables and legumes, and quinoa as an everyday staple rather than a health-shop novelty.

Altitude, if you're travelling

If you are heading to Cusco, Puno or Huaraz, altitude affects glucose management in ways worth knowing.

Acute altitude exposure tends to raise blood glucose initially, through the stress-hormone response, and physical activity at altitude can then produce lower readings than the same activity at sea level. Glucose meters and CGM sensors can also read less accurately at high altitude.

More importantly, the early symptoms of altitude sickness — nausea, headache, fatigue, confusion — overlap almost exactly with hypoglycaemia. If you take insulin or a sulfonylurea, this is a genuinely risky ambiguity. Test rather than assume, and carry fast-acting glucose that you can reach without unpacking anything.

If you are planning altitude travel, raise it at your appointment beforehand. It is a short conversation that prevents a bad situation.

What to bring to your first appointment

• Your most recent HbA1c, and older ones if you have them
• Two weeks of glucose readings or your CGM data — this tells me more than any single lab value
• All current medication, boxes or photos, with doses
• Your most recent complication screening: eyes, kidney function, feet
• Any cardiology or nephrology reports

With that, the first consultation can produce a valid Peruvian prescription and a working plan rather than just a request for more tests.

Don't wait until the prescription runs out

The single most useful thing you can do is book while you still have four to six weeks of medication left. It removes urgency from the appointment, leaves room for baseline labs, and means any change of brand or formulation can be made deliberately rather than because the pharmacy shelf was empty.

If you are already out, say so explicitly when you book — it changes how we schedule you. Full details of how diabetes follow-up works here are on the diabetes care page.