Emergency Preparedness for Type 1 Diabetes

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From the wrath of Hurricane Sandy along the eastern seaboard to devastating wildfires in the west, the past two years have shattered previous records for natural disaster destruction in the United States. The hardships and chaos these catastrophes cause are difficult enough. But factor in the added demands of managing type 1 diabetes (T1D), and a bad situation can get much worse. No matter where you live, you should have a plan for taking care of yourself and your diabetes in an emergency situation.

Be Prepared

Kim Kaar lives in southeastern Connecticut with her husband Marko and their three children—Emily, 18, Gabriel, 10, and Alex, 14, who was diagnosed with T1D at eighteen months of age. Just blocks from Long Island Sound in one direction, and the Connecticut River in the other, the Kaar family has ridden out their fair share of storms over the years.

“Possessing a mentality of ‘always be prepared’ has made it fairly easy to keep type 1 diabetes care consistent,” Kim explains. Despite the challenges of two hurricanes and a major blizzard over the past two years, advance planning and a well-stocked diabetes emergency kit has kept Alex’s T1D safely in check through flooding and extended electrical power loss.

But the Kaars may be in the minority. “Even though it is something that I always talk to them about, before Superstorm Sandy hit last year, most of my patients did not have realistic emergency plans in place,” laments New York-based diabetes educator Susan Weiner, RD, MS, CDE.  “People just don’t think it will happen to them…until it happens to them.”

What’s in Your Kit?

“Organization and checklists are key to making it through an emergency,” according to Mrs. Weiner, author of the upcoming book The Complete Diabetes Organizer (Spry Publishing, Fall 2013). “Think through the essentials of your daily diabetes routine and how you would accomplish them in a worst case scenario – with no power, fresh water, transportation, and heating/cooling. That should be the baseline for your emergency plan.”

Your emergency kit should contain at least two weeks’ worth of supplies. Because some items are perishable or have expiration dates, check your kit every month or two. During these checks, rotate all stock that has an expiration date (e.g., insulin, test strips, glucagon kit, prescription and over-the-counter medicines). The rule of thumb should be to put newly purchased products into the kit (those with the longest shelf life remaining) and rotate out older unexpired stock for more immediate use.

Along with diabetes supplies and insulin, it is important to have a print copy of all of your prescriptions. “You can’t rely on pharmacy software in an emergency. You might find yourself having to go to a new pharmacy for months,” relates Kelly Kunik, a diabetes advocate and blogger who has lived with T1D for more than 35 years. Ms. Kunik recently rode out Hurricane Sandy near the South Jersey beachfront community she calls home. It took five months for her storm-damaged local drugstores to reopen; prescriptions were filled at a trailer in the interim.

What else should be in your kit? It will vary by what your individual treatment needs are, but this printable checklist can be used as a general guide.

Once it is packed and ready, keep the kit handy and near a convenient exit in your home. While you should reach for and recheck your kit at the first news of an approaching storm, many disasters strike with little to no warning. Easy access is important.

Testing out your kit in real life conditions can help you be better prepared when an emergency does arise. The Kaar family regularly “road tests” their emergency kit by bringing it along on family vacations. These vacation road tests have helped them transition Alex to multiple daily injections (MDI) at least once: “It came in particularly handy while on a trip in the Caribbean when Alex’s pump did not survive a swim with sea turtles.”

Type 1 Diabetes Unplugged

Long-term power outages are also a fact of life with many natural disasters, which can make food and insulin storage a challenge. And once battery power runs down, communication with the outside world may be cut off.

After being out of power for a week during Hurricane Irene in 2011, the Kaar family invested in a home generator to help alleviate these problems. Ms. Kunik also suggests a simple yet effective gadget: “Buy a universal battery operated charger for less than $50 dollars. It not only lets you recharge your continuous glucose monitor (CGM) as needed, but it also gives you access to the outside world on your phones or iPads.”

Prepare for staying warm in cold climates—and keeping yourself (and your insulin) cool in hot ones. Insulin pouches that cool when immersed in water (e.g., FRIO®) may be a good investment for your diabetes emergency kit. In addition, if you have warning of a storm or snow event, make as much extra ice as possible to keep food cool in case of power outages.

Even though you will need to have back up power and batteries on hand, diabetes management tools such as insulin pumps and CGMs can be helpful in a disaster situation. When activity levels or stress influence blood-glucose levels, these devices can help make it a little easier to adjust insulin for better T1D management. However, make sure you are always prepared for the possibility of a diabetes device failure. Having an extra blood-glucose meter is important, as are MDI supplies in case of insulin pump failure.

Stress and Your Sanity

Stress, and the high blood-glucose levels that often come with it are a natural occurrence when you find yourself in an emergency situation. Ms. Kunik reports testing “like a madwoman” during Hurricane Sandy, which helped her to stay on top of her blood-glucose management. But she also advises others not to be too hard on themselves in an emergency situation. “You’re dealing with a major amount of stress before, during, and after a natural disaster. Don’t criticize yourself if the numbers on the screen are less than stellar. Nobody expects you to have perfect numbers, so you shouldn’t either.”

In some natural disasters, it is not just stress that affects your well-being. Storms can be boring, keeping you cooped up inside for long stretches of inactivity and potential overeating. After the event is over, you may find yourself at the opposite end of the spectrum, overexerting yourself as you try to clean up damaged property. Be aware of these pitfalls and test often.

For kids, being able to maintain a sense of normalcy is important, both for their emotional outlook and for blood-glucose levels. Don’t forget about age-appropriate entertainment. “We set aside games, art materials, and books to reduce boredom and stress levels for when electricity may still not be available,” Mrs. Kaar explains.

But here’s the biggest stress buster: being ready for a natural disaster before it actually happens. From a psychological perspective, thinking about the possibility of a disaster causes fear and anxiety because it represents a loss of control – over surroundings, property, and personal safety and health. But the emotional process of planning ahead helps both children and adults cope with the uncertainties that may occur. And with proper preparation, you can control how you manage your diabetes. Which is another good reason to start, or check up on, your diabetes emergency preparation today.