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Diabetes Disaster Preparedness

Introduction

A disaster is a sudden occurrence that inflicts widespread destruction, hardship, loss of life, and distress. Natural disasters include hurricanes, floods, earthquakes, frosts, drought, heat waves, fires, mud slides and tornadoes. Human induced disasters include crime, nuclear leaks, oil spills, aircraft crashes, space accidents, railroad accidents, sport disasters, shipwrecks, terrorist attacks, bio-terrorism, and nuclear war.

After Hurricane Hugo in 1989, diabetes educators in South Carolina identified numerous needs among people with diabetes during a disaster. In response to their stirring presentation of the Hugo Model at the 1990 annual meeting of the American Association of Diabetes Educators, the Garden State Association of Diabetes Educators developed guidelines for diabetes care during disaster conditions. The guidelines were divided into two major areas: information for the diabetes educator and information for the person with diabetes. This revised version of the guidelines is designed for the diabetes educator to supplement and not replace a physician's advice.

I hope diabetes educators and the diabetes community will implement and benefit from these guidelines and, as a result, be able to cope more effectively during a natural or human induced disaster. These guidelines can also be implemented in a less severe occurrence as in a prolonged electrical power failure.

"Preparation through education is less costly than learning through tragedy."
Max Mayfield, Director National Hurricane Center, 2004

Patient Information

Modern media have made our world seem small. News about events around the world reaches us in minutes. We learn of hurricanes, floods, earthquakes, volcanic eruptions, industrial accidents and terrorist attacks immediately. TV teaches us that 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. This is the time when you are most likely to be alone. 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.

What is the impact of the disaster?
What does it mean to you?
What actions should you take to be prepared?

First Aid"Be Prepared" List

You should safely store the following medical supplies or have them available:

Make sure you have enough supplies for 2 weeks. Check your supplies at least every 2 - 3 months. Watch for expiration dates.

 

  • FIRST AID MANUAL and KIT
  • A copy of your emergency information and medical list
  • Extra copies of prescriptions
  • Insulin and or pills (include all medications that you take daily including over the counter medications)
  • Syringes
  • Alcohol swabs
  • Cotton balls & tissues
  • Blood sugar meter, lancets, strips and diary
  • Insulin pump supplies (if on insulin pump)
  • Batteries for insuliln pump
  • Urine ketone testing strips
  • Quick acting carbohydrate (for example, glucose tablets, orange juice, etc.)
  • Longer lasting carbohydrate sources (for example, cheese and crackers)
  • Glucagon Emergency Kit (if Type I Diabetes)
  • Empty hard plastic detergent bottle with cap to hold used lancets and syringes
  • Non Prescription drugs: aspirin, non-aspirin pain reliever, anti-diarrhea medication, antacid, syrup of ipecac, laxatives, vitamins

Other supplies:

  • flashlight with extra batteries
  • whistle/noisemaker
  • extra pair of glasses
  • female sanitary supplies
  • heavy work gloves
  • tools
  • food
  • radio with extra batteries
  • extra set of car keys
  • pad/pencil
  • matches / candles
  • soap, toothpaste, hygiene items
  • first aid kit
  • important family documents
  • water
  • clothing and bedding
  • cell phone
  • cash, travelers checks, credit cards
  • medical insurance and Medicare cards
  • copy of homeowners insurance policy
  • Small portable cooler with refreezable gel packs (do not use dry ice for medicines)

Are You Prepared

What would you do if you had to evacuate?

Do you have enough medications with you to last 3 days?
Do you have emergency telephone numbers near your phone?
Do you have a plan to signal the need for help from your home?

How will you communicate with your family if you are separated? With your family, identify two meeting places (one close to home, the second should be away from your neighborhood), in case you cannot return home. Identify emergency escape routes ahead of time. Make sure your car has a full tank of gas.

Grab and Go Bag: Organize a "grab and go" supply bag with essential food, water, medications and supplies for at least 3 days. This bag should be in a designated place and be ready to "grab and go" in case you have to leave your home quickly because of a disaster. You should have a disaster supply kit at work in case you are unable to return home.

Move to a safe shelter. Low lying areas and mobile homes should be evacuated.

Helpful Hints About Insulin, Pens, Syringes

  • Insulin may be stored at room temperature (59° – 86°F) for 28 days.
  • Insulin pens in use can be stored at room temperature according to manufacturers directions.
  • Insulin should not be exposed to excessive light, heat or cold.
  • Regular and Lantus insulins should be clear.
  • NPH, Lente, Ultralente, 75/25, 50/50, and 70/30 insulins should be uniformly cloudy before rotating.
  • Insulin that clumps or sticks to the sides of the bottle should not be used.
  • Although reuse of your insulin syringes is not generally recommended, in life and death situations, you have to alter this policy. Do not share your insulin syringes with other people.
  • If you are using an insulin pump, make sure you have enough supplies for 2 weeks. It is important that you have instructions and supplies for returning to injections from your doctor in case of pump failure or inability to get pump supplies. This includes type/dose/time of insulin administration, 2 vials each of the prescribed insulin and 1 month supply of syringes.

bootThings To Remember

Stress can cause a rise in your blood sugar.

Erratic mealtimes can cause changes in your blood sugar.

Over work to repair damage caused by the disaster (without stopping for snacks) can lower your blood sugar.

Excessive exercise when your blood sugar is over 250mg can cause your blood sugar to go higher.

Wear protective clothing and sturdy shoes to protect you from injury. If you do get a laceration from the debris, you may need a tetanus shot and an antibiotic.

Check your feet daily for any irritation, infection, open sores or blisters. Disaster debris increases your risk for injury. Heat, cold, excessive dampness and the inability to change footwear can lead to infection, especially if your blood sugar is high. Never go without shoes.

shining sunHot Weather Tips

  • Stay indoors in air-conditioned or fan cooled comfort
  • Eat balanced meals.
  • Avoid exercising outside
  • Wear light colored cotton clothing
  • Drink plenty of water regularly even if you do not feel thirsty (water, diet drinks).
  • Limit intake of alcohol.
  • Avoid salt tablets unless prescribed by your physician
  • Seek emergency treatment if you feel:
    Fatigue, weakness, abdominal cramps decreased urination, fever, confusion.

You should wear diabetes identification AT ALL TIMES

can of foodFood Items To Be Stored

  • 1 large unopened box of crackers (saltines)
  • 1 jar peanut butter
  • 1 small box powdered milk (use within 6 mo.)
  • 1 gallon (or more) of water per day per person for at least one week
  • 2, 6-pack cheese and crackers or 1 jar soft cheese
  • 1 pkg. dry unsweetened cereal
  • 6 cans regular soda
  • 6 cans diet soda
  • 6-pack canned orange or apple juice
  • 6-pack Parmalat milk
  • 6 cans "lite" or water packed fruit
  • 1 spoon, fork and knife per person
  • disposable cups
  • 4 packages of glucose tablets or small hard candies for low blood sugar
  • 1 can tuna, salmon, chicken, nuts per person
  • mechanical can opener

Check these supplies every 6 months and replace when necessary. Keep items in airtight plastic bags and put in an easy carry container backpack or duffel bag.

can of foodFood Considerations During A Disaster

  1. Food and water supplies may be limited and/or contaminated. Do not eat food you think may be contaminated. It may be necessary to boil water for 10 minutes before use.
  2. Drink plenty of water.
  3. Maintain your meal plan to the best of your ability. Your plan should include a variety of meat/meat substitutes (i.e., peanut butter, dried beans, eggs), milk/milk products, fruits, vegetables, cereal, and grains.
  4. Limitsugar/sugar-containing foods. These include:
    • Jellies, jams, molasses
    • Honey
    • Syrups (fruits canned in sugar syrup, pancake syrup)
    • Tonic (dietetic tonics with less than one calorie per ounce are allowed)
    • Frosted cake
    • Presweetened or sugar-coated cereals
    • Pie, pastry, Danish pastry, doughnuts
    • Chocolate
    • Custards, pudding, sherbet, ice cream
    • Gelatin
    • Soda
    • Cookies, brownies
  5. Monitor your blood sugar frequently and record in diary.
  6. When reading labels, limitproducts with these sugar-containing ingredients:
    • Sugar
    • Corn syrup
    • Dextrose
    • Sucrose
    • Corn sweeteners
    • Honey
    • Molasses
    • Brown sugar
    • Fruit syrup
  7. Avoid greasy, fried foods.
  8. Try to eat meals and snacks at the same time every day. Avoid periods of hunger and overindulgence. The quantity and frequency of your daily food intake should remain similar depending upon your activity level.
  9. Increase food and water intake during periods of increased exertion or physical activity by either eating between-meal snacks before activity or by eating additional food with meals.
  10. Carry a fast source of sugar with you at all times:
    • 3 glucose tablets
    • 1 small box of raisins
    • 6-7 small hard sugar candies

"Sick Day" Rules During A Disaster

  1. Always take your insulin or pills on time or close to it. Never skip your insulin unless your doctor has told you otherwise. Insulin is still good if there is no refrigeration. A used or unused bottle of insulin may be kept at room temperature (59° - 86°F) for 28 days. Discard unrefrigerated insulin after 28 days.
  2. Keep an extra bottle of each type of insulin you use on hand at all times.
  3. Eat within 15 minutes or no later than ½ hour after taking your insulin (depending on insulin type) or diabetes medicine. Try to eat on time.
  4. Never skip a meal. If you cannot eat solid food because of nausea, vomiting, and/or diarrhea, sip regular Coke, eat hard candies, fruit or regular soft drinks instead of following your usual meal plan.
  5. Most Important:
    • Do not let yourself get dehydrated
    • Drink plenty of liquids
    • In between meal times, sip diet soda
      (This will not replace food, but can help keep you hydrated)
  6. Rest.
  7. Check your blood sugar every 4 hours. Notify your doctor if your blood sugar average is over 240mg or if you are ill for 2 days.
  8. Test your urine for ketones when: (type I)
    • your blood sugar average is over 240mg
    • you are vomiting
    • you have symptoms of high blood sugar (unusual increase in thirst or hunger, quick weight loss, increased urination, fatigue, stomach pain, rapid breathing or fruity breath smell)
  9. Call your doctor if your ketone test is moderate or high and/or if you have symptoms of high blood sugar (as listed in number 8). You may need more than your usual amount of insulin on a sick day. Your doctor can guide you in this.
  10. Call your doctor if you are vomiting, cannot keep down food, liquids or diabetes medication or have persistent diarrhea. Discuss with your doctor ahead of time your use of antiemetics and anti-diarrhea medications.
  11. Call your doctor if your temperature is over 100 degrees, your illness lasts more than 24hrs (type 1), have difficulty breathing, have progressive weakness or change in mental status.
  12. Wear diabetes ID and carry a list of your medicines, doses and times taken.

If you need medical assistance or are out of all medications and food, and cannot reach your doctor, do one of the following immediately:

  • go to the nearest hospital
  • contact the police
  • contact the American Red Cross
  • go to an Emergency Medical Center

Specific Sick Day Supplies:

  • Thermometer
  • Glucagon emergency kit
  • Urine ketone strips (type I)
  • Regular ginger ale (not diet)
  • Regular soda
  • Instant broth, soup
  • 1 box each of sugar-free and regular Jell-O