Diabetes and Survival, Part 4: Treatment
By Dr. Bones
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In the first 3 parts of this series, we discussed the different types of diabetes and strategies (some “outside the box”) for prevention.
In this article, we’ll discuss what your goal should be for your diabetic family or group members as the medic. We’ll also consider strategies for treatment of diabetes in survival scenarios, using conventional drugs (sometimes unconventionally). I found so many natural substances purported to be helpful to treat diabetics, it will have to be its own article (part 5).
First, I have to say that this is an article about what to do in a post-apocalyptic setting. This is not a standard article about treating diabetes in normal times. Consult a qualified medical professional and do not attempt to practice medicine without a license. It is punishable by law.
Finding yourself as the end of the line with regards to control of diabetics in times of trouble will be difficult. You may have learned how to splint a fracture or clean a wound; treating chronic medical illnesses, however, will be quite new even to some medical professionals.
Of course, your goal for diabetics won’t be the same as it is in normal times: Tight control of sugar levels involves aggressively expending items that will be in short supply in times of trouble. In a grid-down situation, your goal should be to balance your available insulin and other supplies with glucose control, especially in type 1 diabetics. This must be done in such a fashion, not necessarily to keep glucose levels normal, but to keep them below that seen in “diabetic ketoacidosis”. This condition occurs as a result of missed Insulin doses and/or chronically under-dosed Insulin, as you would see in a collapse.
I have absolutely no basis for my above statement other than plain logic. Insulin, like most liquid medications, will lose potency relatively quickly after it expires. A power source is needed to maintain insulin pumps, glucometers, and other paraphernalia needed to tightly control blood sugars. What happens when the batteries run out?
If the you-know-what hits the fan, you will find yourself in the unenviable position of making decisions as to how to dispense these precious and limited commodities. Therefore, unless the disaster scenario is a short-term one, you can’t afford to expend supplies as would be necessary for tight diabetic control.
This leaves you with having to accept the possibility that you will have to try to keep your type 1 diabetics at higher glucose levels than you would like. If you’re unable to check blood sugars, as a matter of fact, your only guide will be to keep your diabetics from showing signs of ketoacidosis. Their glucose will not be normal, but you might be able to keep it at levels low enough to avoid emergencies. Even a few months of less than optimal control may be survivable and might give some time for society to re-stabilize.
Diabetic ketoacidosis symptoms may occur at different blood levels in different individuals, so you should be aware of visible signs and symptoms, which often present quickly. These signs and symptoms include:
Excessive hunger and/or thirst
Nausea and vomiting
Weakness or fatigue
Shortness of breath
Fruity-scented breath (also called ketosis)
A strong index of suspicion is required. This means that you have to watch your diabetics closely, especially the type 1 patients, for the above signs and symptoms. In normal times, low sugar reactions (also called hypoglycemia) from too much insulin or physical activity comprise more than 90% of diabetic emergencies. These patients improve rapidly from receiving a small amount of sugar or honey under the tongue. As the insulin runs low, however, high sugar reactions, such as diabetic ketoacidosis, will become more common.
So what would you do with a limited amount of insulin and no ability to get any more? That’s a difficult situation, and no one (as far as I can tell) has ever addressed it. Therefore, the following is purely my opinion and has, again, no basis in scientific study.
One option is to take the insulin as usual until it runs out. This will assure normal control for the time being. The insulin is still potent; you can even continue to check glucose levels if the batteries are still good. This is the simplest (and, certainly, most optimistic) strategy. Hopefully, society will restabilize in time for insulin manufacture to restart. If it doesn’t, rapid deterioration of your diabetic patients may occur once your insulin runs out.
Another option is to “ration” insulin. Your goal would be to give just enough to prevent ketoacidosis. If you were able to measure blood glucose levels, you would shoot for a value of close to 200 (much higher than normal). This is a grim strategy, because you will be decreasing your patient’s lifespan even if it works.
Other issues with “rationing” in a power-down setting would be the inability to refrigerate insulin. At room temperature, potency would drop quickly despite having sufficient quantities. Insulin adjustments will be difficult to make. There are no studies that evaluate what the effect of withholding part of an insulin dose would be. The same goes for using expired insulin.
By the way, insulin that is clear when new should not become cloudy, change color, or accumulate debris in the bottom of the bottle. These are signs that it has degraded.
An additional strategy for diabetics, especially type 1, would be to regulate diet severely and subsist on a diet almost entirely comprised of protein and fats. The key is to restrict caloric intake: Give barely enough to maintain normal weight. This is unhealthy in the long run, but frequent, small, high-protein meals may keep glucose levels below ketoacidosis levels for a time.
As an aside: Careful attention to dental hygiene is important in diabetics, who have increased sugar levels in their saliva and a decreased ability to fight infection. Ill-fitting dentures are likely to cause mouth sores that won’t heal.
As type 2 Diabetes is most often seen in older, heavier, and less active individuals, weight control and limitation of the amounts of dietary carbohydrates (which the body turns into sugars) is important. Regular exercise will also decrease blood sugar levels, thus improving glucose control.
Interestingly, dietary restriction and increased physical activity is exactly what the type 2 diabetic will experience if the grid fails. I suspect that a number of type 2’s will not find their condition worsened in a survival scenario, especially if they started off overweight. If they eat small, frequent meals and stay active, they may even improve. Here’s where careful attention to appropriate food storage for diabetics will help. Plan for a balanced diet high in fiber, low in saturated fats. and (of course) low in concentrated sugars.
The most popular medication used for treatment of type 2 diabetes is called Metformin. It works in various ways, including increasing the cells’ sensitivity to insulin. In tablet form, it is a good candidate for long-term medical storage. Other oral medications for type 2 include sulfonylureas, glitinides, glitazones, and others. Metformin and sulfonylureas may have a synergistic effect: That is, they may have more effect on glucose when used together than alone.
Be careful to watch your type 2 diabetics on Metformin as they lose weight during the struggle for survival; they could easily become hypoglycemic. if so, you may have to adjust the dosage downward. Dosages of medications vary according to several factors, such as weight, age, severity of condition, etc.
There are a few studies that indicate that Metformin may help with type 1 diabetes. This occurs if the person is overweight and their body has some resistance to insulin. These patients will, however, be in the minority and still require insulin.
Remember, any diabetic for whom you will be responsible should be evaluated now by a physician. This will make sure that they are well controlled at present. The better the diabetic control before a disaster, the less organ damage has occurred and the higher the chance for survival.
In Part 5, the concluding part of this series, we will discuss the various natural alternatives for the control of blood sugar.
Some additional reading on this topic:
http://www.ncbi.nlm.nih.gov/pubmed/17199734: metformin and type 1 diabetes
Joe Alton, M.D. aka Dr. Bones