Emergency Preparedness With Diabetes: Two Rules

Anne L. Peters, MD


December 09, 2019

This transcript has been edited for clarity.

Recently, I've had evacuees in my house—they were evacuated from one of the fires burning in California. It's made me think about how to help my patients prepare for their own evacuations should that happen.

We know that when patients are evacuated quickly, particularly if they are taking insulin, they can have a problem afterward getting insulin and the tools they need to manage their diabetes, which may set them back in their diabetes care for the next year or two. Here in California, policemen were literally knocking on doors and saying, "You need to get out now." You don't have a lot of time when this happens, so I want to make sure that everybody is prepared for disaster.

This is what I've told my patients. I have two basic rules. One is to prepare the absolute minimum amount you need to survive with any kind of diabetes that involves injections, particularly type 1 diabetes. The second is to prepare for a setting in which you might have a little bit more time and be able to carry a little bit more in terms of supplies.

Preparing for Immediate Disaster

For an immediate disaster, the patient needs to have insulin, strips, a meter, a little bit of simple carbohydrate, and a little bit of water at the ready. I tell people to assemble the things they need that would actually keep them alive. So patients on two different kinds of insulin—a short-acting and a long-acting insulin—need to make sure they have an extra couple of pens or an extra couple of vials kept in the refrigerator in a pouch that keeps them cool. There are lunch bags that keep things cool, not frozen. That should be kept in the refrigerator with the basic supplies, because then the patient can just pull it out and go.

In that kit will also be pen needles and/or insulin syringes. I always recommend adding some glucose tablets and easy things to eat, like food bars, and some juice or some water. In addition, there should be a blood glucose monitor to-go, even for people with fancy sensors and things. The battery needs to be out of that monitor, because it can go bad in the refrigerator from condensation. The battery for the meter should be taped outside of the refrigerator so it's ready to be put in with the other supplies. There also needs to be strips, a lancing device, and lancets.

Again, I want people to be prepared if all else fails. A patient whose cell phone dies and who can't look at continuous glucose monitor data, or whose pump needs to be charged but there is no electricity, will need to be able to give long-acting and short-acting insulin and be able to test blood sugar with a meter. That patient will need to be able to treat both low blood sugars with carbohydrates and higher blood sugars with fluid. That would keep somebody alive. That is an important kit to have right there, always ready.

Another important part of this is to make sure that in that kit, there is a physician note indicating how much insulin to take. Patients might forget when they are panicked in an emergency. Or they might be depending on an insulin pump to dose their insulin. So have the exact doses of injected insulin to use written down.

It's also helpful to have a couple of other things in that kit. A list of all current medications is very helpful, and potentially a current copy of the person's health insurance card in case they need to start getting medications at a different pharmacy while they are waiting for the evacuation to end. That is the most basic plan.

Preparing for the Longer Term

The secondary plan is to have a backpack for a lot of other things. Inside the backpack, I would put extra oral medications that the patient might be taking. They can also put in there more information about their healthcare and your healthcare situation, if they need it.

And they can put in more devices. Patients on an insulin pump or an insulin sensor can put sensors and pump supplies in that bag. They can put all the things that they would need for more high-tech care of their diabetes, ready to go.

For anything that requires batteries or electricity (including a cell phone), they can get solar chargers, and I would recommend keeping it in that bag. If they are out of their house and electricity is out or there are no outlets to plug things in, they can use the solar charger to charge their devices. It's important to have that separate bag for doing more things when staying away longer. Obviously, they can put more water, food, glucagon, or anything that might be necessary for ongoing management in the bag.

There are a number of places patients can call during an emergency. A very important group is the Diabetes Disaster Response Coalition. They give you a planning list and information about how to prepare for an emergency. They also will give up-to-date information about where one can get insulin and what to do if there is an emergency. Calling the American Diabetes Association or the JDRF during an emergency can also be helpful because they can connect you with resources.

But the key is to have that basic pack available and ready to go with anything that you might need urgently, no matter what. Then the second, bigger bag is also important so patients can have additional supplies and continue managing their diabetes when they are not at home and may not be able to access what they usually use for management.

It's great to be prepared. I hope nothing bad happens in your community. But if it does, I want patients to be ready to be safe and thrive with their diabetes. Thank you.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts and three books on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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