It is the nature of most humans to resent having to be dependent on anyone or anything. One of the basic tenets of the survivalist is self-sufficiency. Surviving with diabetes when disaster hits close to home is a real challenge, but not an impossible one if you prepare properly.
For the average person who is reasonably well prepared, the survival situation provides a challenge, a welcome break from routine. Overlooking an item when storing emergency supplies can mean only inconvenience. For people surviving with diabetes and other certain medical problems, an item forgotten can result in certain death.
Diabetes is just such a problem. Several years ago, an earthquake shattered large areas of Argentina. Medical authorities were pleading with the drug companies to get them insulin. They were even begging for the precious drug to be parachuted into some areas.
It is obvious then that any survivalist group that has diabetics or “borderline” diabetics as members must plan and make provision for an interruption of life-sustaining medication. If you happen to have a diabetic in your family, it will be a common struggle, and surviving with diabetes will be possible only if everyone knows what to do.
Surviving with diabetes – The facts
At present, it is estimated that more than thirty million people are surviving with diabetes in the United States. These are people who have diabetes and must take specific actions to control it. When saying “diabetes” we are referring to a disorder known technically as “diabetes mellitus.”
Diabetes is a term used to describe an inadequate supply of effective insulin in the blood. Insulin is a hormone produced by the pancreas. Insulin is necessary for the transport, storage, and utilization of glucose (sugar) by the body. All cells in the body need glucose to function.
Glucose is essentially the “fuel” the cells “burn.”
Glucose is provided by the metabolism of carbohydrates. When there is no intake of carbohydrates, the liver releases a form of glucose which it had previously stored (glycogen). In a normal person the pancreas is stimulated to release insulin to enable the glucose to pass through the cell membranes for use.
In a person surviving with diabetes, either the pancreas does not produce any insulin or the insulin it produces is chemically inactive. As a result, the glucose cannot pass through the cell membrane and remains in the blood.
This tends to shift the body’s fluid balance so that water leaves the cells and enters the bloodstream, often dehydrating the patient. As the blood passes through the kidneys, this excess water and glucose is removed from the blood and subsequently excreted from the body in urine.
It is this mechanism that produces some of the classic signs and symptoms of diabetes: frequent urination, glycosuria (glucose in the urine), and virtually unquenchable thirst (resulting from the body’s attempt to replenish intracellular fluid lost during dehydration).
Additionally, since the cells are not getting an adequate supply of fuel for energy production, the patient fatigues easily. Healing of minor wounds, particularly of the extremities, is greatly delayed. This frequently results in infections.
There is a greater incidence of atherosclerosis (hardening of the arteries) in diabetics. When the vessels supplying the extremities are affected, the supply of oxygen to their tissues is drastically reduced. Thus, gangrene is a common complication of diabetes, which ultimately requires the affected extremity to be amputated.
While the actual cause of diabetes is uncertain, it is felt to be partially hereditary, and it is known that physical and/or emotional stress can precipitate the disease in those individuals who are predisposed to it.
The emotional and physiological changes brought on by pregnancy, for example, have been known to trigger diabetes in a previously healthy patient. Obviously, the stress and dietary changes that would be inherent in a true survival situation might be all that’s required for diabetes to be manifested.
Whether in a post-disaster survival situation or just attempting daily survival in today’s world, it is very important for people surviving with diabetes to wear a Medic Alert bracelet or medallion.
This little piece of inexpensive jewelry can mean the difference between the rapid identification of an emergency condition or mistaking it for alcohol intoxication. In other words, the difference between life and death when surviving with diabetes can be an item showing people you are a diabetic.
Hypoglycemia, or insulin shock, is a condition that suddenly develops as a result of an abnormally low serum (blood) glucose level. This can be caused by the administration of too much insulin or the intake of insufficient quantities of carbohydrates.
The patient, often found unconscious or “out of his head,” is usually drooling. He will be very weak if movement is attempted at all. People will often believe that the patient may suffer from a heat disorder.
His breathing will range from shallow to normal depth and rate (normal respiratory rate is 16 to 20 breaths per minute). The patient will usually be pale with cool, moist skin. Blood pressure will usually be normal, as will be the pulse.
As more and more brain cells are deprived of glucose, seizure activity will occur. If emergency treatment is withheld or delayed for very long, death can occur. Fortunately, you do not have to be a physician to provide life-saving emergency care.
First Aid when Surviving with Diabetes
If the patient is conscious, provide him with a glass of fruit juice with a spoon of sugar stirred into it and assist him in drinking it.
If the patient is unconscious, open his mouth and place about a teaspoon of sugar (1 packet) under his tongue.
NEVER attempt to give liquids to an unconscious patient. If someone with the capability and medication is present. 50 percent dextrose in water (D50) should be administered intravenously. Fifty percent dextrose should NEVER be administered by any route other than intravenously. The intramuscular injection will only result in irritation and damage to the muscle tissue.
Another emergency medication for insulin shock is Glucagon. The advantage of this is it can be administered intramuscularly or intravenously. The disadvantage of Glucagon is that it works by mobilizing glycogen stored in the liver and converting it to glucose.
If there is an inadequate supply of glycogen stored in the liver, it simply will not work. If the patient is only suffering a hypoglycemic episode, the reaction to the sugar will occur within minutes. The patient will become alert, fully conscious and unaware of what has transpired. The effect is quite dramatic. If, after 5 to 10 minutes the patient’s condition has not improved, the administration of sugar (or D50) can be repeated.
Hyperglycemia, or diabetic coma, occurs over a period of days. It is caused by an inadequate supply of insulin to utilize the carbohydrates the patient has ingested.
The patient will look sick. He will be extremely thirsty. He will have no appetite and may complain of abdominal pain. He may be vomiting. His skin will appear flushed and will usually be dry.
He will be breathing deeply and more rapidly than normal. His pulse will be weak and rapid, and his blood pressure will be lower than normal.
The patient’s breath will have a distinctive, sickeningly sweet, fruity odor to it. This odor most closely resembles the smell of unscented nail polish remover. Acetone, a ketone, is usually the active ingredient in nail polish remover. As the concentration of glucose in the blood increases, ketones are produced. A small amount of these ketones is eliminated through the lungs and results in the “acetone breath.”
Left untreated, the condition can deteriorate, and the patient lapse into coma followed by death. Immediate emergency treatment consists of administering insulin intravenously or intramuscularly. The saline solution must be administered intravenously in order to rehydrate the body.
The first liter of saline should be administered over a period of 20 to 60 minutes. Subsequent replacement therapy should be titrated according to the patient’s condition.
One or a combination of treatment regimens are followed to control diabetes. A direct correlation has been established between diabetes and obesity. Frequently obese patients with diabetes are put on a prescribed diet aimed at reducing their weight to an acceptable level.
Once the excess weight is lost, diabetes disappears. These patients may be considered as borderline diabetics but will probably need to do little more than control their weight to remain asymptomatic.
When determining an effective course of treatment for a diabetic patient, a physician will often have the patient keep very accurate records of his dietary intake as well as glucose levels in the blood at different times of the day for a week or so.
After reviewing the resultant data, the physician then decides which mode of treatment will be most effective for the individual. Control can sometimes be maintained by closely monitoring and adjusting carbohydrate intake to adjust the serum glucose to within normal limits.
If diet alone fails, some patients can control their diabetes through the use of diet and oral medications. When this fails, insulin must be given daily by injection. The most effective way to control serum glucose is to monitor dietary intake and inject appropriate amounts of insulin several times throughout the day.
Since this is impractical for most people, the insulin is usually administered subcutaneously (just under the skin) in the morning or evening, and a strict diet followed throughout the day.
Diabetics have exchange charts that allow for flexibility in what they eat and still provide strict compliance with the prescribed total intake of carbohydrates. The diabetic emergencies de-scribed earlier usually result from a deviation from the prescribed routine.
The control plan is based on the body’s needs, given a certain level of exercise and stress, as well as diet. When these factors are altered, problems arise The survival situation can drastically alter all the factors a control plan is based upon.
Since it is imperative for the diabetic to follow a plan diet, exercise, and medication in his daily routine, it follows that plans should be devised for controlling his serum glucose levels should a situation arise which confronts him with increased stress, decreased diet, altered levels of exercise and the elimination of an external source of medication.
The first step for the diabetic to take in planning for an interrupted supply of insulin is consultation with his physician. The physician should be able to prescribe a dosing schedule designed to meet the various levels of carbohydrate intake from the specific foods the patient is storing, given varying levels of activity and stress.
Testing is ordinarily a part of the diabetic’s daily routine. At the same time, each day the diabetic tests his urine for its glucose level using a plastic strip with chemicals impregnated on one end. The chemicals turn different colors to correspond to different levels of glucose. A color comparison chart is supplied with each bottle of test strips. More accurate determinations can be made by testing a small sample of the blood directly. That strips are available for this purpose.
Alternatively, the patient can use one of the electronic instruments presently being marketed for making very accurate serum glucose determinations in the home.
Stockpiling when surviving with diabetes
For surviving with diabetes, ample supplies for whatever testing method(s) will be used should be stockpiled. Bear in mind, a much closer watch on serum glucose levels will be required in the survival situation than ordinarily is needed.
This is due to the wide variance in energy outlay, demands of stress, and difficulty in maintaining a constant carbohydrate intake.
Inquiries to drug companies revealed the existence of a crystalline form of insulin that is diluted prior to injection and is used for research purposes. This at first sounded promising, until it was learned that the shelf life of this material is only one year — when refrigerated.
Therefore, those diabetics who depend on insulin should stockpile the drug. By coordinating with your pharmacist, you should be able to procure the freshest insulin available. If necessary, calls to several pharmacies can be made to locate the insulin with the longest shelf life available.
Insulin can be stored, at room temperature, for up to two years. By noting the expiration date on a particular bottle of insulin and buying only medication with a reasonably long shelf life, up to a two-year’s supply could be stockpiled.
The patient would need to rotate his stock, using the oldest insulin first and replacing it with the medication having a two-year shelf life. Thus he would constantly be using medication he had stockpiled.
Hypodermic needles, of course, should also be stockpiled. The same principle should be applied to oral medications. Medications and carbohydrate sources to deal with diabetic emergencies should be stored as well.
These should include hard candy, sugar, Insta Glucose (an oral glucose preparation supplied in unit dose plastic squeeze tubes), and dextrose 50 percent in water (D50) for IV injection.
Surviving with Diabetes and Wound Care
Due to decreased circulation in the extremities, diabetics must pay very close attention to wound care and care of their feet to prevent injury.
In addition to medical supplies, several pairs of comfortable shoes should be placed with the survival kit. Appropriate topical antibiotics should be available, as well as dressing and bandaging materials to prevent and treat wound infection.
For survival communities or groups, the individual(s) charged with the group’s medical responsibilities should be made aware of any diabetics or borderline diabetics in the group.
The medic should ensure that the group has an adequate supply of test materials and medications to handle diabetic problems or at least hypoglycemic emergencies.
If the diabetic used the same approach in dealing with his medical supplies as he does with any other necessity, the survival situation would be no different for him than it is for an individual without that particular disorder.
Surviving with diabetes when SHTF can be a drag if you didn’t plan for it properly. Besides the minimal knowledge required on how diabetes affects your body and what it may lead to, you will also need to stockpile the proper supplies to outlast the crisis.
Surviving with diabetes might not be a single person job and everyone close to you, needs to understand what you are dealing with, how they can help, but most importantly, what to do when things get a turn for the worst. You don’t have to be an EMT to provide proper assitance to people surviving with diabetees.
This article has been written by James H. Redford MD for Prepper’s Will.
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