Two Letters Re: Insulin for Diabetics in Event of TEOTWAWKI

Dear Jim,
I’m a family physician and my wife has had Type 1 (insulin-dependant) diabetes mellitus since age 9.
There’s an inhaled insulin (“Exubera,” manufactured by Pfizer) that offers some promise for long-term storage, as it’s a powder. It was released last winter, so there isn’t much clinical experience with it yet. Problems such as irregular absorption and possible lung injury are still under investigation.
Oral insulin therapy may also suffer from irregular absorption and will likely have the same shelf-life issues as injectable insulins.
The only practical long-term solution for the insulin-dependant diabetic is to extract injectable insulin from livestock. The process is no longer used and recreating it would require a reasonably well-stocked and functioning lab. (Here’s a thumbnail sketch covering the discovery of insulin and some of the issues involved.)
I’m researching ways by which the process might be made more practical under adverse circumstances.
After insulin, the most important thing that a Type 1 diabetic would require is the ability to monitor blood sugars. Glucometer strips are readily available, but fairly expensive. Under deep-freeze storage conditions, they should last well beyond their expected life, but will inevitably expire. Urine test strips are likewise available and more convenient, but much less accurate than blood glucose measurement. Strips will also retain their viability when kept very cold.
A last resort that might prove useful is a very old standby, though not for the squeamish. Before laboratory blood and urine testing became available, a simple means of detecting abnormal blood sugar in urine was to taste it. (If it tasted sweet, the patient was deemed to be diabetic.) Obviously, I don’t recommend this as a matter of routine, but in a dire situation, the information may prove useful. Kind Regards, – Moriarty


Saw today’s board regarding insulin alternatives. As a Internal Medicine Specialist, Intensivist, and Disaster Medicine Specialist, I treat many diabetics. Currently, Type 2, or Adult onset diabetes is the most common in the U.S. and rising steadily. It is usually treated with oral medications, and then insulin once [the patient has] maxed on oral medications. Weight loss, exercise, and diet modification can decrease and possibly eliminate dependency on meds early in the course of the disease. However, Type 1, or juvenile diabetics are dependent on insulin from a young age and cannot survive without insulin, regardless of diet etc, without developing Diabetic Ketoacidosis Acidosis, a potentially fatal condition.

Exubera is the latest formulation of insulin that is a dry powder, that is then inhaled. ( It is set for release this month, in fact the [Pfizer company] rep just stopped by last week. Other oral insulins are in phase 3 trials but are not yet on the U.S. market. The price on these is still unknown, but will be significantly higher than standard subcutaneous injections. It cannot be used by asthmatics or those with severe lung disease. As a dry powder it should have a significant shelf life. I’ll keep you posted on its progress and price as it comes available. I’d be happy to go into more detail on diabetes, treatment, and options if needed. And as always, would happy to help with any medical questions or issues. – MD in MO.