January 11, 2024
Navigating diabetes in a crisis
Natural and human-made disasters can cause widespread and long-lasting impacts on supplies, services and healthcare systems, exceeding local authorities' day-to-day capacity.
By Justine Evans
Unforeseen natural and human-made disasters can cause widespread and long-lasting impacts on supplies, services and healthcare systems, exceeding local authorities’ day-to-day capacity.
Disasters can fall into two categories: natural disasters like floods, earthquakes, fires or infections, or human-made disasters like war and armed conflict. Given the increasing number of major disasters and the high prevalence of diabetes globally, it is inevitable that disasters will negatively impact many people with diabetes. Particularly vulnerable groups include people with type 1 diabetes and diabetes-related complications and pregnant women.
During a disaster, the healthcare system can fragment and pivot. For a person with diabetes, insulin, treatment, and devices such as glucose monitors and supplies can become scarce or inaccessible. Furthermore, medical facilities and access to medical records and information may also be affected. One potential consequence is that a person’s overall health can worsen for up to two years after a disaster, raising the risk of diabetes-related complications. This consequence is due to treatment errors, injuries, infections and psychosocial distress.
In response to a humanitarian crisis, relief workers are central to implementing an action plan to help people impacted. This relief management involves four stages: prevention, preparation, response, and recovery. Prevention and preparation are crucial for a successful response and recovery. Prevention serves to mitigate the cause, impact and consequences of disasters. Preparation involves anticipating a potential loss of shelter, power, communication, clean water and food supplies for individuals and organisations.
People with health conditions, such as diabetes, are also particularly vulnerable during disasters. Despite rising numbers of disasters globally, the number of disaster-related deaths has been falling over the past century. This can likely be attributed to better disaster management, to which preparedness at multiple levels is key,” Diabetes Care and Disasters, IDF Western Pacific Region, 2nd edition 2022.
A fragile network of support services, volunteers, clinical bodies and government agencies exists in disaster situations to ensure the best possible health outcome for people with diabetes. At the core of this network are diabetes associations, people with diabetes, their families and communities.
A major factor to consider when planning evacuations or shelter-in-place situations is that first responders may lack diabetes knowledge or resources. People with type 1 diabetes cannot have their insulin treatment interrupted. However, insulin and diabetes supplies are often not included in emergency shipments.
Non-governmental organisations (NGOs) are central to disaster response. They often focus on different healthcare needs and range in size and influence from small local organisations to large international bodies. Their contributions include volunteer skills like local knowledge and translation and distributing local supplies before aid shipments arrive.
In recent years, NGOs have leveraged social media to provide up-to-the-minute news information on road closures, evacuation routes, designated help areas and shelter locations. Social media also allows them to disseminate multilingual diabetes information, including guidance on treating diabetic ketoacidosis and conversion charts for glucose monitoring systems. Additionally, local pharmacists can connect with responding healthcare professionals to determine which type of insulin to use.
In a power outage, insulin can be stored and retain potency without refrigeration, even in hot settings. When stored at room temperature 15°C- 30°C (59°F-86°F), it can remain usable for up to four weeks. Human insulin can be stored at 25 °C (77 °F) for a maximum of six months and up to 37 °C (98.6 °F) for a maximum of two months. Alternative cooling options include evaporative coolers, polystyrene containers and clay pots. The most important is that insulin is neither left in direct sunlight nor frozen.
It’s perfectly OK to use insulin that has not been refrigerated. It does not lose potency even after many months. If, however, the insulin has been frozen, it loses its potency. To store insulin, there are evaporative coolers and traditional clay pots can be used”, Prof Alicia Jenkins, Clinical endocrinologist and physician researcher (Australia).
Another challenge for people with diabetes during a disaster is not having access to their insulin brand or type. If you have to substitute your brand or type, closely monitor your glucose levels. If you use an insulin pump, refer to the guidance and your pump instructions for suitable insulin substitutes. Once you regain access to your regular insulin, discard any insulin stored at room temperature or exposed to direct sunlight.
Planning is an essential part of emergency preparedness. In addition to having basic emergency supplies, people with diabetes should create a diabetes care kit in an easy-to-carry waterproof bag or storage container in the event of an emergency evacuation. To help assemble a kit, the American Association of Clinical Endocrinology has produced a printable checklist available for download.
Natural and man-made disasters, from floods and pandemics to warfare, can overwhelm local resources and disrupt crucial services. Successful health outcomes for people with diabetes can be achieved when relief workers combine efforts with diabetes associations, people with diabetes, their families and communities.
This manual, produced by the IDF Western Pacific Region, spotlights strategies to mitigate the adverse effects of natural disasters and fosters knowledge exchange to bolster community resilience during a disaster. The second edition draws on insights gleaned from disaster experiences.
This online event covers the importance of preparedness to ensure people living with diabetes have a stable supply of insulin in emergency situations.
Justine Evans is Content Editor at the International Diabetes Federation
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