Diabetics in Disasters, by Meir L.

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(Disclaimer: I am not a doctor and I do not have anything to do with the medical field. This is strictly my personal experiences, and the following does not constitute medical advice.)
 
Introduction
As an 18 year old type 1 diabetic, I am a very active person. I enjoy hiking, biking, climbing, etc. Two years ago, in September of 2011, I started going to the bathroom a lot, drinking like crazy,  becoming very fatigued, and feeling poorly much of the time. Since I am related to multiple Type 1 diabetics, I knew the signs of a developing diabetic, and I was kind of waiting for this to happen. Two days after I started showing the signs, I called my father and I told him my fears. That weekend I went to the hospital and I was diagnosed with Type 1 diabetes.

The month that I was diagnosed, many people asked me if this was “annoying” or “life changing.” Since I am related to so many diabetics (more than 5), I was exposed to diabetes since I was born, and therefore it really was not such a big deal. The only things I was really upset about was food, hiking, and the army. I really eat a lot of food and I enjoy eating. I love backpacking and hiking and I was afraid that since I became diabetic, I would not be able to do these activities. The reality is that this is not true, and if a person is responsible, it is very safe, providing that you monitor your blood sugar. Additionally, I was upset because I always envisioned joining an elite nit in the army, and because I became diabetic, they would not let me in. But I soon found out that diabetics can lead a completely normal life, and I have been doing hikes, bike rides and many adventures.

Since 1 in 16 people in America have diabetes, I think this post can help many people out. In this post I will use my adventure and day to day experiences to try to help diabetics (and diabetic’s relatives) understand how to prepare for a survival situation and general everyday life events.

Insulin

A. Understanding diabetes and insulin

Any diabetic can tell you that insulin is the most important supply for living with diabetes. In a normal person’s body, the pancreas performs many functions, one of which is the production of insulin. In a diabetic person’s body, the body’s immune system recognizes the insulin producing cells as a foreign microbe, and it targets them like your immune system would target a foreign bacteria. Therefore, a diabetic person’s body does not produce insulin, and he needs to provide it for himself.

B. Different Types of insulin

There are two types of insulin that I use: Long term (I use Lantus), and short term (I alternate between Humalog and Novolog – same thing). The insulin that the doctor prescribes come in 2 sizes: vials and pens. I like using vials because vials require syringes, and syringes are completely manual. Therefore there is no room for error that pumps and automatic injections have. I have a friend who was on the pump, and every few days he had to get something reconnected, parts replaced, and batteries changed. In my opinion, the less tech is involved, the less room for error there is. Insulin pens can be good for mobile, on the go situation. The biggest problem about insulin (which I will get back to), is that it can spoil due to hot weather (80-90F). If a vial spoils, it is a loss of 1000 units. If a pen spoils, it is a loss of 300 units. So with pens there is less risk. Though pens are manual also, to some degree they are automatic, and you are not completely in control of the injecting process. Many a time I will not be sure if the insulin went into me or not. So pens and vials are basically equal, and until a short time ago, I mostly used vials.

I am not going to talk about insulin pumps, since in a TEOTWAWKI situation pumps are incredibly non practical (batteries, supplies, potential for infections, etc.).

C. Ideas for stockpiling insulin           

A few months ago I realized something important. When the doctor sends in a prescription for insulin, they ask you if you want vials or pens. Then they send in to the pharmacy to give you how ever many units you need a month. The minimum amount of insulin that comes in a vial is 1000, and the minimum amount of units that come in a pen is 5 pens of 300 units each, which comes out to 1500 units. I realized that I use approximately 500-700 units a month, and if I request pens, they will give me 1,500 units a month instead of 1,000. I also think it cost the same amount of money in the co-pay. Because of this, I have over 5000 units of insulin (and counting) in my refrigerator, and every single month I add my surplus of 700-1,000 units. If you get more than 1,500 units a month, request pens, and they will give you 3,000.
Additionally, you can ask your doctor to increase your monthly prescription, although I am not so sure how legal that is.

D. Keeping insulin at a good temperature
For exact temperatures and brands, here http://www.isletsofhope.com/diabetes/care/tips_insulin_chart_1.html, although I do not trust the shelf life they prescribe, since insulin actually lasts longer in my experience.

I. High temperatures
The biggest problem with insulin is refrigeration. Insulin should be stored at 36 to 46 F. The higher temperature it is stored at, the faster it will go bad. If you store sealed insulin at the recommended temperature, it can last until the specified date that is on the container, usually 3 years. Hopefully before three years, the survival situation will pass by and you can resume your supply. If you store opened insulin at the prescribed temperature, it can last more than 3 months. If you store it at room temperature, it will last approx. 1-2 months. Before going on a 3 day summer hike in Vermont, I found a great solution. There is something called Frio packs. It is some technology that if you place the container into water, it can keep the pack cold for more than two days. I also realized that based on this, you can probably store insulin in cold water (in a Ziploc bag), and as long as you change it every day, you can probably make the insulin last a long time. I have heard a good strategy is to leave it in the tank of your toilet.  If this does not work, hopefully you have a generator, and you can power a small fridge with it. Additionally, you can buy a solar powered fridge, although I am not so sure how reliable they are.

These are the different methods that diabetics can store their insulin:
1- Frio packs
2- Storage in cold water (tank of toilet)
3- Solar powered fridge
4- Propane powered fridge
5- Generator
6- 12v fridge that can be plugged into a car
7- Root cellar
8- Bury in the ground (similar to root cellar)
9- Zeer Pots (Evaporative coolers, using clay pots and sand.
10- Any other alternative energy source

II. Low Temperatures
I have written about storing insulin at high temperatures, and I will now go to storing insulin at low temperatures. Apparently (never experienced this), if you store insulin lower than 36F, it will freeze and become unusable. About 3 weeks ago I did a 3 day winter hike in the White Mountains in New Hampshire. At times, the temperature dipped below 0F.  The best way to store insulin in cold temperatures is with body heat. Put the insulin in your pocket, and it will stay warm as long as you stay alive. If for whatever reason you can’t do this, you can keep the insulin in a warm room, though it is not so reliable. If you have farm animals, you can keep it by them, since a cow can generate more body heat than a human. If you have a privy, you can keep it next to the place where the excrement is kept since it can also generate a lot of heat. In the same vein, you can store it by animal dung which is the same as a human’s.

Testing Strips and Glucometer

Different machines
When I first became diabetic, the doctor gave me a OneTouch glucometer. I love gadgets, and I immediately set out looking for different glucometers. I checked out the Bayer USB, the freestyle lite, etc. I realized that the fancier the machine is, the less reliable it is. Take for example the One Touch mini and the new, advanced OneTouch Verio. Forgetting about cost (the Verio is 1.5 times the price for testing strips), the Mini’s batteries can last months, while the Verio’s battery is rechargeable, and therefore it lasts less than a week (I am being generous). The Verio has a cool color screen, gold testing strips, and it is a sleek white color. The Mini is small, compact, and reliable. It gives correct readings, has a long battery, and is not fancy at all. You are better off getting a cheaper, reliable, long lasting battery glucometer than a cool fancy one. In a survival situation, you might not have electricity to recharge your glucometer, while batteries are mostly reliable and long lasting. Maybe as a precaution you should keep one rechargeable glucometer in case of a battery problem. Since for some reason hospitals always give you an OneTouch glucometer when you are first diagnosed, it is worth it to always have one of those, since many people will have the same one and you can barter or share testing strips.
It is very important that you have more than one glucometer. I can’t say how many times I got a suspect wrong reading from one glucometer, compared it to a different glucometer which would give me a different reading, and take a third glucometer to see which one wins.

Cold Weather
When you are in cold weather, sometimes your glucometer will give you an error message (less than 32F). When I went on this winter hike, this happened to me a few times. If it is not a momentary concern, you can put it by you armpit (or somewhere warm on your body), and it will take a few minutes to work. If it is important for that moment, you can breathe on it, and it will warm up fast.

Expiration date
As far as I know, there is no expiration date on a glucometer, while there is an expiration date on testing strips. I think that the expiration date for the testing strips is bogus. My cousin has used testing strips past their expiration dates, and the readings are correct. It is most probably a company ploy to get you to buy more testing strips. If the machine gives you trouble, move the date on the machine back to accommodate the date on the testing strips.

Extra batteries
This is pretty obvious, but you need to have many batteries stocked up. As I said before, all or most of your glucometers should be battery powered.

Stockpiling
As with insulin, you should always keep a very big stock of testing strips. Ask your doctor to write a prescription for 10 tests a day. This should give a nice amount of extra testing strips a month.

Syringes
This can be a very touchy subject, but when it comes to survival, you don’t have a choice. Reuse, reuse, reuse. Even now, when everything is normal (Thank G-d), I disinfect and reuse syringes because I am thrifty. I think the reason why it is so controversial to reuse syringes is because drug addicts share syringes. Sharing syringes can be a problem since it can spread diseases. If you use a syringe that only you have used, I don’t think it should be a risk. I personally use a syringe around 5-10 times before I throw it out (only because it becomes to blunt). But I know someone who uses a syringe for a really long time before he throws it out. I think he might use it for a month or longer. He still as the same prescription from 2005. This is an extreme, but it shows how you can reuse syringes without a problem.

Ketones

Definition (via ADA)
“Ketone is a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. Ketones in the urine are a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy.”

Symptoms

  • Your blood glucose is more than 300 mg/dl
  • You feel nauseated, are vomiting, or have abdominal pain
  • You are sick (for example, with a cold or flu)
  • You feel tired all the time
  • You are thirsty or have a very dry mouth
  • Your skin is flushed
  • You have a hard time breathing Your breath smells “fruity”
  • You feel confused or “in a fog”

How to Test
You can get a ketone test form your local pharmacy. This can be prescribed and is usually covered by health insurance. Depending on the brand there are different instructions. Some glucometers come with a blood ketone test. Novo Nordisk Max comes is one of those.

Results
Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours.
Moderate or large amounts are a danger sign. They upset the chemical balance of your blood and can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control. At this point you are in danger zone. If no doctor is around, take the necessary steps to bring your blood sugar under control (insulin).
Drink a lot of water to flush out the ketones.

Adjusting your insulin dosage
I don’t want to advise people on this, since it is used in everyday life, and I have no medical credentials to give advice. Here is a good link that works with me: http://www.diabetesincontrol.com/images/issues/2011/Jan/adjusting_your_insulin_dose.pdf

Alternative insulin
I have researched alternatives to getting insulin from the pharmacy, and I found that there is no formula for making a “chemical” insulin readily available, although I really hope somebody gets one out there. What I did find was a primitive way to get ready made insulin from an animal. During WWII, a Jewish couple who fled to Shanghai from Czechoslovakia worked out a process for extracting insulin from Buffalo pancreas. The woman, Eva Saxl, became diabetic and though they knew nothing about insulin beforehand they worked out the process based on a medical text “Beckman’s Internal Medicine”. They were generously given access to a chemistry lab. Eva eventually tried the insulin and then began distributing it to other diabetics; by the end of the war she had supplied insulin to over 400 people. It was at least four years that they used that method.

Animal insulin formula (via a comment at TSLRF, I can’t vouch for his post, but there is no reason to not believe him)
“Extracting insulin from very fresh sheep or pig pancreases is fairly easy, if you have the required equipment, consumable supplies, and knowledge. I recall doing it in (I think) high school science labs – but we didn’t actually use it. It is somewhat time consuming, as well.
One US patent for extraction is number 2779706; another is 2637680.
One key concept is that the very fresh pancreas needs to be kept very cold during most of the processing…if you don’t have water ice to keep the process in an ice bath, you won’t get good insulin. On the other hand, it has to be water ice – if the pancreas freezes the tissue is too damaged to use.”
For the exact formula go to http://www.survivalistboards.com/showthread.php?t=33479

Problems with this method
a) You have to sacrifice an animal for the process, which you might need for other things (meat, fur etc.)
b) The insulin is not as good as what people are now used to (all of which is made by bacteria genetically modified to make pure human insulin)
c) Animal insulin isn’t the same as human insulin, varying by 1-5 amino acids depending on the source animal. Even with real (made) human insulin, diabetics have problems, they had more problems with animal insulin. It was used decades ago but they stopped for a reason.
d) Using sheep or cows as sources can theoretically lead to spread of prion diseases (mad cow disease, scrappy, new variant Creutzfeldt-Jakob disease).
e) Bioanalysis so you know how much insulin you need (which will vary with each batch) is difficult to do and probably not realistically possible in an austere setting. Get a stronger than expected dose of insulin and you can die quickly, get a weaker than expected and you can still die, just not quickly.

Conserving and stretching your supply
If you need to conserve your supplies there are many ways to do it. In terms of testing strips, you can just test less per day. As I explained before, syringes can be reused. In terms of insulin, there are a few ways to conserve your insulin supply.

Exercise- Doing exercise can bring down blood sugar. I find that the more you sweat, the faster it comes down.
Eating less carbs- This is an obvious choice. As long as you keep this within reason, you can limit your carb intake, thus needing less insulin.
Give the long term less often- This is for a real survival situation. You don’t want to starve your body of insulin, but if you really need to, you can give the long term less often. The doctor told me the official time that the Lantus will last is 18 hours. Everyone waits 24 hours. There have been times when I was first diagnosed, and I wasn’t so good with remembering, I would by mistake give at 30 hours or more. Even now, when I give by bedtime, sometimes my bedtime is later than others. I have done this with no ill effect. Ask your doctor before doing this, as I am not a scientist.

Have a diabetic pack ready

Always be prepared. Besides your regular stock, have a package of an ample supply of diabetes supplies that you might need at moment’s notice. Here is what you should have in this pack:

  • Two glucometers
  • Many, many test strips
  • Insulin- long and short acting
  • Sugar, high carb foods. Also pack complex carbs
  • Lancets with extra needle pricks
  • Syringes (pen or regular)
  • Ketone test
  • Glucagon
  • Some kind of insulating cooler for insulin (I recommend Frio)

For the companion: The difference between lows and highs (and what to do about it)
There is some confusion of non- diabetics when it comes to the difference between a high and low blood sugar. Whenever I give myself insulin in front of my little brother, he always complains, “Meir has low numbers!”

High blood sugar
(otherwise known as Hyperglycemia) is when a person’s blood sugar is too high, and he needs insulin in order to lower it. Stress, carbs, and sleep can all cause one’s blood sugar to rise. Besides the long terms effects, if one’s blood sugar is too high, he can go into a coma. A high blood sugar is over 150, and it becomes short term dangerous when it goes past 400-500.

Low blood sugar
(otherwise known as Hypoglycemia) is when a person’s blood sugar is lower than 75-80. This can happen because one gives himself too much insulin, is too active with no food, and is not eating carbs. In order to raise it, one needs to eat sugar and carbs. If one’s blood sugar goes to low, he can become unresponsive or unconscious. In order to get one out of this, he needs to be injected with glucagon. I am not sure what the deal with trusting expiration dates on the glucagon pens are, and I am also not sure how to extend the life of one.

Getting insulin when you don’t have
I know that a zombie apocalypse will probably not happen, but I enjoy watching The Walking Dead. When the group needed to go to the animal hospital to get meds, it got me thinking that they also probably have insulin. One of my relatives has a bunch of cats, and one of them is diabetic. Every day she injects it with insulin. I looked online, and insulin made for humans have been used for animals. So it makes sense that it goes the other way around. I think you may have to adjust the dosage though.

You can barter for insulin. When someone is completely dependent on insulin, you need to have viable barter items if the need arises.
In an absolute worst case depopulation scenario, you could possibly scavenge in abandoned hospitals. I think empty nursing homes would have more, since there are more older people who are diabetic.

Recent Innovations
These are different innovations that can make a TEOTWAWKI situation easier.

Artificial Pancreas —This new system ties together existing technologies so that type 1 diabetics are freed from constantly monitoring their blood sugar levels. Instead, a computer handles it by combining an insulin pump worn outside the body, with an implanted continuous glucose monitor (CGM). Special software allows the two to talk and automatically regulate the person’s blood sugar. Not only does this make management easier, but it also helps avoid the sugar level highs and lows that can lead to complications.

Inhaled Insulin—Taking the place of injections, this [“dry insulin”] lets type 2 diabetics breathe in their insulin. Not only is it a more desirable delivery method, but it’s also faster-acting and has less of a risk of low blood sugar levels. While previous attempts at inhaled insulin have failed, this drug is showing fewer potential risks. (Via AgingResearch.org)

A new [variety of] insulin does not require refrigeration.

Conclusion
I am not going to tell you how if SHTF you probably won’t survive. That is your calculations to make. Just understand that most survival situations usually won’t last long. With proper care, you can live out most TEOTWAWKI situations. Even if it is a non-recoverable TEOTWAWKI, you still have the option of getting insulin from animals.

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