Disaster Preparedness for Diabetics

Diabetes Disaster Mode

 Here in California, we prepare for different kinds of disasters: earthquakes, floods, Tsunamis’, mudslides, and forest fires. Of course, this doesn’t just apply to California; the Midwest — home of Tornado Alley — was hit hard by deadly storms and twisters this past November. It’s a given for a lot of us that preparing for the worst is the best thing we can do. But ..How does a diabetic prepare for a disaster?
Many people with diabetes and their families really do not consider the consequences of ignoring this challenge. Neither do their health care providers. Most disaster experts recommend prepping for trouble by storing three days of supplies per person. The truth? That’s simply not enough. I recommend keeping at least seven days’ worth of supplies on hand. I’ve been criticized for making such a suggestion because people argue that it’s just too difficult. I disagree.
The truth is, it’s much more difficult to try and survive without enough diabetes supplies if you should run out before a fresh supply arrives. In 2003, two friends and I sailed to Hawaii from California on a 30-foot sailboat. We were sure it would take about four weeks. It took us 24 days to get there. Fortunately, we’d provisioned the boat with plenty of supplies in case the journey took longer. It was a challenge to determine how much food, water, and diabetic supplies to bring, but we did it. Imagine being told that you can go to the grocery store just once to provide your home with everything you’ll need for 6 weeks — but you won’t be able return to the store until that time ends. (Forget about Instacart or other home deliveries!) We accomplished provisioning our boat for a full EIGHT weeks. I know you’ll find it much easier to provide ONE week of supplies in your disaster kit.
Diabetes Disasters 101
Remember, you might be on your own. Do not plan to receive any help. Do not expect your phones to work. So, you need to feel self-reliant. An attitude of fortitude will serve you well. When a disaster strikes, don’t panic. Stress can lower blood sugar. During this time, you do not want your blood sugar to run low. It is better to have your sugar run a bit high. Remember, having higher blood sugar during this time is much safer than having low blood sugar. Your sugar can run 150 md/dL to 250 mg/dL for a while without complications. If your blood sugar goes too low, it can be fatal much faster. Talk to your health care provider about this. You want your diabetes to be least of your concerns during this disaster. Hypoglycemia (low blood sugar) intensifies other traumas, even to the point of worsening your anxiety in a deadly spiral of fear and falling sugar. We want to prevent this.

Often people refer to disaster preparedness packs as “go bags” because you may need to carry your supplies away from your home or other location to safety. It should be portable. When we sailed to Hawaii, we called it a ditch bag. You need to set up three sets of go bags. You do not know where you are going to be when a disaster occurs. For many of us, we’re either going to be at work or at home. You need to have a go bag at each location. It would be ideal to have a third bag at either a relative or close friends. Make sure you rotate the supplies and replace expired items as needed. I have always kept two unopened bottles of insulin in my break room’s refrigerator at work. Keep in mind that hospitals and emergency room may be overwhelmed with patients. Know where your urgent care centers are located around your home and work.
In your disaster bag you should have extra white socks in addition to clothing. If you injure your feet, you need to treat it immediately. Always finish the wound dressing with a pair of clean white socks. Some diabetics who have neuropathy may have numb feet; these diabetics must examine their feet as often as possible during a disaster. With neuropathy, you can injure your feet without knowing it. By time you notice it, the wound has progressed and now you are unable to help others.
  In planning for a disaster just accept that your car is damaged or destroyed. You may have to walk, bike to a FEMA station, ER, or urgent care miles away. This will lower your blood sugar. There may be debris that you will be clearing, carrying people and other physical activity that will also lower your blood sugar. You may have to ration your food. You may be unable to eat your regular meals. You might have to adjust your insulin or other diabetic medication to prevent your blood sugar from dropping too low because you are eating less. Many diabetics experience hypoglycemic unawareness. This is where your blood sugar is dropping but you have no symptoms of the low blood sugar. This can be deadly during a disaster. You are so busy with other issues happening, that you are forgetting to monitor your blood sugar. You will be unable to help others if you are incapacitated with hypoglycemia. As the flight attendants always say, “put your own oxygen mask on yourself before helping others”. Keep your blood sugar in control before helping others. One important item all diabetics should pack is glucagon. There are new glucagon treatments available such as Baqsemi and Gvoke. These drugs do not have to be refrigerated and have a longer shelf life compared to the old glucagon kits I use to have.
Insulin will be good for thirty days at room temperature. Keep out of direct sunlight or extreme heat or cold. I have spoken to representatives from the Red Cross, and they do try to keep insulin stocked in their supplies.
Insulin pumps
If you use an insulin pump, make sure you have a hard copy of all your pump settings, basal rate, I.C. ratio, correction factors, etc. Make sure you have extra batteries for your insulin pump. Medtronic insulin pump requires 1 AA battery. Omnipod insulin pumps require AAA batteries for their older versions of their PDM. Omnipod’s newer version, Omnipod Dash has a rechargeable battery in the PDM. Make sure you have spare charging cables for the PDM.  Tandem Diabetes insulin pump also has a rechargeable battery. Tandem uses a micro-USB data cable that can be used to charge the battery and data transfer from your insulin pump. You will also want to pack extra cables for your insulin pump. If there is no electricity available, you can charge your insulin pump from a battery pack with a USB Micro-B output connector. The Dexcom CGM (Continuous Glucose Monitor) is integrated with the Tandem insulin pump. No additional batteries are needed. If you are not using the CGM with the Tandem pump, you can use it by itself.  The Dexcom receiver has a rechargeable battery built in so you will need to have a source to recharge this battery. If you do not have the Dexcom receiver, The Dexcom CGM can connect to your smart phone with the Dexcom app.
Back up insulin therapy
I work for Tandem Diabetes. Periodically our customers may need their insulin pump replaced for a variety of reasons. These customers may have to go without their pump for 24 – 48 hours. When this happens, we ask the customer do you have backup insulin therapy plan such as insulin syringes, pens, and long-acting insulin such as Lantus. It is shocking how many customers we speak to, do not have a plan. When these customers must go without an insulin pump for 1 day, they start to panic and do not know what to do. It will be even more difficult during a disaster to find insulin pump supplies.
Below is a list of diabetic supplies you go bag might contain.
 • Insulin
 • Syringes
 • Alcohol Pads
• Glucometers
 • Strips
 • Lancets and Lancet devices
• Sharps container or empty plastic bottles with a cap.
 • Insulin pump supplies
• CGM supplies, sensors, etc.
 • Glucagon
• Glucose tablets
 For more information on preparing for disasters, visit the FEMA website at: FEMA Disasters