Diabetes Emergency Plan: Are You Ready?

By DaVita Dietitian, Marisol Avila, RD, CDE

Natural disasters such as hurricanes, blizzards, earthquakes, wildfires and floods can suddenly interrupt life as we know it. If you have diabetes and are on dialysis, missing dialysis treatments for a few days due to an emergency can further complicate matters.

If you have an action plan in place for an emergency, you have a greater probability of surviving a major disaster and reducing fear and anxiety. The following tips can help you cope with an emergency and improve your chances of survival when you have diabetes.

Emergency kit

Your emergency kit needs to be portable. Obtain a sturdy, lightweight bag or backpack with wheels to store your diabetes emergency supplies. Keep a smaller pack in your kit to store important papers, medication and some food in case you are not able to take the whole kit with you.

Place the emergency kit in a closet near your bedroom, at the entrance door of your house or in the garage. Stock it with:

  • A pair of sturdy shoes
  • A flashlight with fresh batteries
  • An ABC fire extinguisher
  • A whistle
  • A radio and batteries
  • A light blanket
  • Glucose gel or small amounts of juice and hard candy
  • Protein bars
  • An extra pair of glasses
  • A cell phone with extra batteries
  • Personal hygiene items
  • An extra set of keys
  • Local maps
  • A walking aid, if needed
  • Diabetes supplies (see below)
  • Small first aid kit

Include a list of important phone numbers such as for your dialysis center, your pharmacy, your physician, your local ESRD network (1-800-MEDICARE), the DaVita Guest Services hotline (1-800-244-0680), any emergency contacts, as well as a copy of your insurance card and a detailed medical history.

Medications

Keep a current list of all your medications and obtain a week supply to store in your emergency kit. Be sure to rotate them out before they expire. Maintain an extra copy of your medication list stored online, for example, as a Google document, for easy access in case the hard copy is lost or destroyed.

Monitor blood sugars

Blood sugar levels have the potential of fluctuating a great deal during an emergency due to stress, missed and delayed meals or changes in your normal activity level. For example, during disaster cleanup efforts, increased activity can lead to hypoglycemia. On the other hand, excessive intake of sugar or starchy foods, injury, infection and stress can result in high blood glucose.

Monitoring your blood glucose frequently is extremely important when you have diabetes. Your emergency kit should include:

  • Alcohol wipes, soap and sanitizers (to disinfect before checking blood glucose levels)
  • A glucose monitor with plenty of testing strips
  • Blood glucose log and pen
  • Lancing device and lancets
  • Sharps container or puncture resistant container such as an empty plastic detergent bottle with a cap (to safely dispose of any needles)

Treating low blood sugars (below 70 mg/dl)

If your blood sugar is less than 70 mg/dl, follow the rule of 15:

  1. Take 15 grams of carbohydrate, such as 4 ounces of apple, grape or any low-potassium juice; or 3-4 glucose tablets or one tube of glucose gel; or 6-7 small hard candies or 1 tablespoon of regular sugar, jelly or honey.
  2. Retest blood glucose after 15 minutes.
  3. If blood sugar is still less than 70 mg/dl, eat another 15-gram portion of carbohydrate.
  4. Next, eat a snack that contains some protein such as a protein bar or half of a sandwich.

Keeping insulin safe

Extreme temperatures can destroy insulin and test strips so keep them away from heat and check the expiration dates of all the medications in your kit regularly. You can also store your insulin and test strips where you can access them quickly and place into your kit when an emergency arises. It is also recommended that you wear medical alert identification in case you become unconscious. Don’t forget to use your insulin sliding scale guide to correct high blood glucose levels.

Food

Read and make a copy of the DaVita.com article “Emergency preparedness for people with kidney disease.” This article includes a three-day emergency menu that may only need minor modifications depending on your blood sugars.

Because you may experience low or high blood sugar, prepare for both. If you are not eating as much and your blood glucose is low, you may be able to follow the meal plan in the aforementioned article. Include sugar-free drinks and artificial sweeteners in your emergency kit and use these to replace juice or sugar-sweetened drinks if your blood glucose is high. Remember to limit your total fluid intake to no more than 16 ounces per day until you are able to resume dialysis treatments as prescribed.

Sick days

Continue taking your diabetes medications as prescribed. If you are unable to eat, drink kidney-friendly beverages that contain sugar instead of sugar-free choices. Eat at least 50 grams of carbohydrate every 3-4 hours. For example: 4 ounces of juice, six unsalted crackers and one half cup of fruit such as applesauce. Symptoms to watch out for include an elevated body temperature and increased breathing and pulse rates. Contact a physician if you experience such symptoms.

Wound care

To avoid unnecessary injuries to your feet, wear shoes with comfortable clean socks at all times. If you’re near broken glass, nails or contaminated water, take extra caution to avoid contact with these hazards. Your emergency kit should also include a small first aid kit with bandages and a five-day supply of a topical antibiotic to treat any superficial wounds. If you do have wounds, apply basic first aid and seek emergency help when available.

Summary

The first 72 hours after a disaster are most critical, especially when waiting for rescue. Being prepared for an emergency with special attention to your diabetes can greatly decrease complications and increase your chances of survival. Diabetes patients on dialysis should maintain an emergency survival kit at all times.

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