It’s typhoon season once again.
It can get severe—massive flooding and power outages that last for several days or even weeks in affected areas. This can complicate matters, particularly for those with chronic medical problems like diabetes, high blood pressure, and chronic lung and kidney diseases.
Noted endocrinologist (diabetes specialist) Dr. Marsha Tolentino has written an article on disaster preparedness for diabetic patients in Diabetease, a supplement of the H&L (Health and Lifestyle) magazine.
She recommends that people with chronic medical problems have a disaster kit prepared at home, ready for use in the event of a natural calamity or disastrous event.
The kit should contain a flashlight, a portable radio, instant noodles, a change of clothes, clean water and the person’s maintenance medications.
“These can spell the difference between death and survival while being stranded on your rooftop,” says Dr. Tolentino.
In extreme cases, power outages may last for months. Drugstores may remain closed, and the medicines in stock may have been damaged by the typhoon or flooding. Deliveries of fresh medicines may not be possible for some time.
“This can result in a lot of uncontrolled blood sugar and blood pressure,” Dr. Tolentino warns. “It might be prudent to have at least one month’s supply of medications, if possible.”
The following “essentials” should be included in the diabetes disaster kit:
1) Oral maintenance medications that could last till situation is normalized. “An updated list or your doctor’s latest prescription should be included, and these should be rechecked periodically to make sure all medications are not expired,” Dr. Tolentino advises.
2) For those on insulin, they should prepare a cooler, with ready refreezable cooling gel packs. They should add the gel packs and insulin vials or pens just before they evacuate. They should also have enough alcohol pads, syringes and needles for use. They must include a plastic bottle or container to dispose of their needles, syringes and lancets after use.
For those who are on insulin pumps, insulin administration may have to be reverted back to insulin injections when the insulin pump fails, so they must have clear instructions from their doctors regarding this, especially the dose adjustments.
3) Glucometers for measuring blood sugar levels with enough lancets, test strips and batteries. The blood sugar levels can go up (hyperglycemia), but can also go down (hypoglycemia), especially if the food supply is irregular. The symptoms for hyper and hypoglycemia may be similar, so the only way to find out is to check the blood sugar level.
“Because certain conditions like lack of food supply can predispose a patient to hypoglycemia, having some glucose tablets or hard candy could be lifesaving,” advises Dr. Tolentino.
All these essential items should be in an insulated and waterproof bag.
“More important than having a disaster preparedness kit, diabetic patients must have an emergency plan,” stresses Dr. Tolentino.
Her additional recommendations:
1) Let others know you have diabetes. Make sure relief workers are aware of your diabetes and other complications, especially heart or kidney disease. This will increase the chances that you get the medical attention that you need.
In your wallet, have a waterproof card listing the type of diabetes you have (type 1 or type 2). Type 1 diabetes is insulin-dependent, while type 2 diabetes or adult-onset type may just require oral maintenance medications.
One must also have a list of one’s medical conditions, as well as information on any complications, prior surgeries and allergies. Include your latest medication list and if possible, latest labs.
2) Avoid dehydration. While true for all persons in an emergency situation, diabetics are more prone to dehydration since high blood sugar (hyperglycemia) may be unavoidable. The stress of the situation, erratic meals and skipped medications (especially if on insulin) are all causes of hyperglycemia, which in turn causes excessive urination and dehydration.
Serious medical complications may result if sources of clean water are not available. Diet sodas can substitute for water if supplies are limited. Having water-purifying tablets in your disaster kit can prevent these complications.
3) Be prepared to treat hypoglycemia or low sugar. In most situations, food supply will be limited and meals may not be taken on time. Some medications, like the sulfonylureas or insulin, make you more prone to hypoglycemia. Know the symptoms of low blood sugar (like shaking, cold sweats, and light-headedness, for example). Have something containing sugar at all times, like small hard candies, to bring up your levels until you can eat something more substantial.
If unsure about food supply, it might be prudent to keep your sugars a little on the high side rather than strictly controlling your blood sugar and getting hypoglycemic. This is especially crucial if you have a serious heart condition or are on dialysis.
Remember that increased physical activity and excessive sweating, such as when working nonstop after a disaster to aid in relief, also makes you prone to hypoglycemia. Try not to skip meals and get some rest when you can.
4) Prevent infections. Because of nerve damage or decreased blood supply, diabetics are more prone to foot infections, so inspect your feet for cuts or wounds and have these treated immediately if there is swelling or redness. Wear shoes at all times to protect your feet, especially during storms and floods.
5) Medications. As much as you can, try to take your medications as prescribed by your doctor and stick to your diet plan to avoid hyper and hypoglycemia.
Most people may not have access to their usual medications, and food choices, if available, are usually limited to instant noodles and canned foods in the initial relief period.
Type 1 diabetics are at greater risk than type 2 patients because they are dependent on insulin, and skipping even a dose can push them to a serious complication called diabetic ketoacidosis or DKA. This condition will need immediate hospitalization.
If they run out of insulin stock, Dr. Tolentino advises to take lots of fluid to avoid dehydration. They should also limit the amount of carbohydrates they eat, until such time that they can resume their insulin injections.
Similarly, for those on oral medications, dosage may need to be adjusted if there has been weight loss and if food intake is erratic to avoid hypoglycemia.
Be prepared, because knowing what to do can spell the difference between survival and death. It may not seem that urgent, but one can never tell when it will happen. It’s better to be prepared than be caught flat-footed.