Tuesday, 21 October 2014

Managing Diabetes in Disasters

Modern technologies has made alarms and information made reach faster to all. We learn of hurricanes, floods, earthquakes, industrial accidents and terrorist attacks immediately. We have seen on televisions how any disaster brings chaos to people and their environments. As a person with diabetes, your daily routine involves schedules and planning. An emergency can seriously affect your health. It may be difficult to cope with a disaster when it occurs. You and your family should plan and prepare beforehand even if the event is loss of electricity for a few hours. The first 72 hours following a disaster are the most critical for families. For this reason, it is essential for you and your family to have a disaster plan and kit which should provide for all your family’s basic needs during these first hours.

In our earlier blog we tried to cover the general problems a diabetic person may face in natural disasters and a few tips on how to manage your diabetes even in such circumstances. The recent calamities like floods in Jammu and Kashmir and then the severe cyclone Hudhud that hit Vizag had a large catastrophic effect on everyone trapped in those situations. We have introduced our Diabetes Helpline number where you can call and discuss with our doctors on any doubts or clarifications on effectively managing diabetes in natural disasters.

In the current blog we are trying to expand on problems which a known diabetic person may experience. We received queries like what if in such a critical condition the patient finds to have no insulin or any other anti-diabetic drug or there is unavailability or less quantity of medication to them, then how they can maintain their blood sugar levels and other such problems.

During natural tragedies, crises and other unavoidable threats, people with diabetes face particular challenges to their health care.
  • First and foremost, if you are a refugee seeking assistance by rescue forces in an emergency situation, it is of major importance to categorize yourself as a person with diabetes and any related conditions, so that you can obtain appropriate healthcare.
  • It is also important to prevent dehydration by drinking enough fluids, which can be difficult when drinking water is in short supply.
  • Additionally, it will be very helpful to keep some food item thing containing sugar with you at all times, in case you develop hypoglycemia (low blood glucose).
  • Further, to prevent infections, which people with diabetes are more susceptible to, pay careful attention to the health of your feet, and get medical treatment for any wounds at the earliest.

Preparing Yourself Before & During the Disaster

Modern day technologies help us to predict and get information in advance for the disasters like cyclone, and hurricane or even in case of floods, with latest communication devices we can get to know if the water is increasing in our area making it flooded. Utilizing these information, get yourself prepared before disasters strike you:

Insulin Storage and Maintaining its Effectiveness

Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. According to the product labels from all the major insulin manufacturers, it is recommended that insulin be stored in a refrigerator. During and immediately after a disaster, patients in the affected area may not have access to refrigeration hence the user should ensure to keep their insulin be available with them in right stock and then should try to store them as cool as possible. Unopened and properly stored insulin in this manner, it may preserve the effectiveness of medicine until the expiration date on the package. However, an insulin product that has been changed for the purpose of dilution or has been removed from the manufacturer’s original container its shelf life reduces considerably and hence should be discarded within two weeks. 

As it is generally suggested try avoiding direct heat and direct sunlight as well as freezing if placed on ice. The insulin is kept away from direct heat and out of direct sunlight. To a large extent, insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes.  This can result in loss of blood glucose control over time.  Under emergency conditions, you might still need to use insulin that has been stored even at higher temperatures. You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin.  Remember not to use insulin that has been frozen.  When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. Additionally, insulin contained in the infusion set of a pump device like reservoir, tubing, catheters should be discarded after 48 hours.

Switching between Insulin Products in an Emergency

Although a physician’s close medical supervision is an important aspect along with monitoring of blood glucose levels when switching insulin products. However, if medical supervision is not possible under emergency conditions, the following recommendations may be considered: 
  • Make sure to closely monitor your blood glucose and seek medical attention as soon as possible
  • One brand of regular insulin can be substituted for another brand of regular insulin and same for rapid-acting insulin on a unit-per-unit basis in emergency conditions
  • Regular insulins should be injected approximately 30 minutes before the start of each meal. Whereas, rapid-acting insulins begin working much speedily than regular insulin and hence are to be injected 15 minutes before the start of each meal to avoid dangerously low blood glucose levels 
  • One intermediate-acting insulin product may be substituted for another intermediate-acting insulin product on a unit-per-unit basis in emergency conditions. Likewise, these intermediate insulins may also be substituted for long-acting insulins on a total unit-per-day basis, in an emergency condition. 
  • Prominently, when switching from a once a day long-acting insulin to an intermediate-acting insulin; the dose of the once a day long-acting insulin should be cut in half and given as two injections of intermediate acting insulin, one in the morning with breakfast and one in the evening with dinner to avoid dangerously low blood glucose levels 
  • When switching from an intermediate-acting to a once a day long-acting insulin, add up the total amount of intermediate-acting insulin units for one day, and give it as a single long-acting insulin dose once a day 
  • Patients should check and be aware of the instructions for use of the pump device to see if available insulins are compatible with their devices 
  • Patients using insulin pumps who must switch to injected insulin may substitute intermediate or long-acting insulin for the total “basal” dose infused over 24-hours on a unit-per-unit basis in emergency conditions.

Blood Glucose Meters and Hurricane Disasters
Heat and humidity can damage blood glucose meters and test strips. If you use a blood glucose meter, check the meter and test strip package insert for information on use during unusual heat and humidity.

Diabetes Preparedness List

Safely store following to prepare yourself in disasters: 
  • Extra copies of medical prescription
  • Insulin/ Insulin pumps or injections including any counter medicines
  • Alcohol swabs
  • Cotton balls and tissues
  • Blood sugar level meter
  • Strips for your meter
  • Glucose/ Glucose tablets/ Orange juice etc. which can provide quick carbohydrate
  • Longer lasting carbohydrate sources like cheese and crackers
  • Container with cap to dispose used syringes

Quick Health Advice
  • Wash your hands to avoid illness or infection especially when testing your blood glucose or treating a wound
  • Keep safe drinking water after disaster as a diabetic you may need more fluids
  • Keep a first aid kit for emergency wound care and foot care
  • Being sick and raise your blood sugar levels hence avoid catching cold/ flu 

Call us for any further query on how to effectively manage diabetes and prepare yourself in such natural disasters.

Best regards,
Dr. MS Singhal
Singhal Diabetic Clinic, Haridwar

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