Disaster preparedness when you have diabetes

Hurricanes, tornadoes, earthquakes, floods and other natural disasters seem to be in the news a lot. I've been watching the coverage following hurricane Sandy. Among other things, people have been coping with the loss of their homes, a lack of electricity and transportation constraints — including subway shutdowns and long waits in line for gasoline.

If you have a chronic medical condition, including diabetes, you're especially vulnerable during such disasters. Daily routine and regular meals are important for good blood sugar control. The disruption in routine and the stress from the chaotic nature of a disaster can adversely affect your diabetes management and your health. And if you take insulin, you likely need it every day, often multiple times a day, to keep blood sugars in balance. During a disaster, you might not have your usual access to your health care providers, medications, medical supplies or all of these. For these reasons, it's important to be prepared, before a disaster is imminent.

The American Association of Clinical Endocrinologists recommends that you include the following items and information in a disaster preparedness kit that's insulated and waterproof:

• List of all medical conditions and prior surgeries
• Information about your diabetes, including past and present medications, any adverse reactions to medications, and present diabetes complications
• List of your health care providers and their contact information
• Letter from your diabetes health care provider detailing your most recent diabetes regimen (especially for insulin), as well as your most recent lab results
• List of all your medications, your pharmacy and all active prescription information and eligible refills
• 30-day supply of your diabetes and other medications, including insulin if you take insulin, oral diabetes medications and a glucagon emergency kit (if prescribed)
• Glucose tabs or other treatment for low blood glucose
• Blood glucose testing supplies, including lancets, test strips and, preferably, at least two blood glucose testing meters — be sure test strips haven't expired, and keep fresh batteries for the meters
• Cooler and at least four refreezable gel packs for storing insulin (don't use dry ice) — you might also consider including a few extra insulin cooling cases for use during a power outage
• Empty plastic bottles or a sharps container for syringes, needles and lancet disposal

If you use an insulin pump, I'd also recommend keeping extra infusion supplies and batteries in the kit.

In addition, consider keeping these generally recommended supplies on hand in case of a disaster or emergency.

• Emergency radio with fresh batteries
• Flashlight with extra batteries
• Cell phone
• Pencil and pad of paper
• Candles and matches
• Whistle
• First-aid kit
• Female sanitary supplies
• Copy of health insurance cards
• Heavy work or garden gloves
• Important family documents (e.g., titles, birth certificates)
• Two- to four-week supply of water for each person

Things to remember

If coping with a disaster, keep in mind how it might affect your diabetes. Stress, as you know, can lead to high blood sugar. Mealtimes are usually erratic during a disaster, and that can also cause changes in your blood sugar, especially if you take oral medications or insulin. Changes in activity, such as repairing damages or doing cleanup without stopping for a snack, can lower your blood glucose. Or, if your blood glucose is over 250 mg/dL (13.9 mmol/L), excessive exercise or activity can cause your blood glucose to rise even higher.

In addition to keeping an eye on your blood sugar management, always wear protective clothing and sturdy shoes, and check your feet daily for irritation, blisters, sores or infection. Things like contaminated flood water and disaster debris can increase your risk for injury.