Tips for First Responders
There are a number of questions regarding how to provide help to people with diabetes in emergency situations such as a hurricane. Here are the most important issues to look for if someone has diabetes:
Watch Out for Low Blood Glucose (hypoglycemia)
People with diabetes can develop hypoglycemia
(blood glucose has dropped too low) if they take certain medications, particularly insulin and also medications called sulfonylureas. For those at risk for hypoglycemia, you should have ready access to something containing sugar (glucose tablets, fruit juice or hard candy) to treat hypoglycemia if it occurs.
Symptoms of hypoglycemia include:
• Irritability, stubbornness, or combativeness
• Chills and cold sweats
• Fast heartbeat
• Light-headedness or dizziness
• Lack of coordination
• Passing out
Due to serious concerns regarding hypoglycemia and the unusual circumstances faced in the aftermath of hurricanes – particularly if someone is not able to monitor their blood glucose level because they do not having access to a blood glucose meter – it may be best to not strive to keep blood glucose levels as close to normal as possible (as we generally advise) but to allow glucose levels to be somewhat higher. It is important to consider that the requirements for the various medications used to treat diabetes may be very different for someone in a situation such as a hurricane due to significant changes in diet, availability of water, physical activity levels and stress.
Getting enough fluid to meet the body’s needs is especially important for people with diabetes. Their hydration needs may be even higher in an emergency if power outages lead to high temperatures because air conditioning isn’t working or if they are needing to physically exert themselves more than usual.
Dehydration is an even bigger risk if their blood glucose levels rise too high (hyperglycemia) because of a shortage of medication. During hyperglycemia, the body needs even more fluids than usual to help it flush excess glucose from the body through urination. Plain water is ideal, or other sugar-free fluids.
People with type 1 diabetes are at greatest risk because they are completely dependent on injected insulin. These patients usually take insulin a number of times per day. If insulin is not available, the consumption of carbohydrates should be reduced as much as possible.
If a person with type 1 diabetes does not have any access to insulin, the most important priority should be to maintain adequate intake of fluids to avoid dehydration (as discussed above) and avoiding intake of carbohydrates (sugar and starches). As soon as insulin becomes available, these individuals need to return to their usual insulin regimen, keeping in mind that their requirements for insulin may be quite different at this particular time. If the individual’s usual type and brand of insulin is not available, using a different type or brand of insulin as directed by medical personnel is generally safe.
For a person with type 2 diabetes, who may or may not be on insulin, not receiving their medications on a regular basis presents fewer problems than in the person with type 1 diabetes but should be restarted as soon as possible. Again, avoiding hyperglycemia, which can lead to dehydration, is a priority.
As medications become available, they should be restarted cautiously, keeping in mind that a person’s needs for a particular medication and dosage may have changed if significant weight loss has occurred or a person has gone without adequate intake of food for a significant period of time.
In emergency situations, pharmacies may be dispense medication without a prescription.
Another area of concern is the prevention of infectious disease, particularly foot infections. People with diabetes are at higher risk of developing infections of the feet due to nerve and blood vessel damage, so it is very important that they do their best to avoid walking through contaminated water or injuring their feet. Feet should be inspected visually on a regular basis to look for any cuts, sores or blisters so proper care can be obtained as quickly as possible. Should any of the usual signs of infection (swelling, redness, and/or discharge from a wound) be seen, immediate medical help should be obtained.