Before, during and after a severe weather event
By Carolien Koreneff, CDE-RN
Natural disasters and emergencies
Natural disasters, with their erratic and destructive nature, can cause substantial damage, injury, trauma, and anguish. Our vast continent regularly experiences a range of natural disasters, including bushfires, floods, heatwaves, severe storms, and tropical cyclones, with the expectation that their intensity and frequency will rise in the future.1
A consequence of a natural disaster or emergency is that they can exacerbate the health challenges faced by a person with diabetes. Ensuring they are aware of the importance of self-management is integral to maintaining their safety and directing limited resources to those requiring immediate medical attention for acute conditions.
Preparedness before, and response during and after an emergency demands careful planning at the individual, community, and national levels. Even individuals usually adept at managing their condition may face challenges during emergencies because of disruptions to their regular support systems and difficulty accessing medication, clean water, food or medical help.
Recovery after a disaster can be a lengthy process and may impact communities in diverse ways. However, communities that invest time in pre-planning for natural disasters or emergencies can experience shorter recovery times and lessen the impact.
To assist with planning there is ‘The needs of people with diabetes and other chronic conditions in natural disasters and emergencies‘2. This guide was developed in an effort to reduce morbidity and mortality in people with diabetes and other chronic conditions in natural disasters and emergencies, while minimising the strain on hospital resources. It is an important resource for anyone who deals with natural disasters and emergencies during the planning stages, for those who deal with ‘on-the-ground’ situations after a natural disaster has occurred, and for people caring for people with diabetes.
Diabetes in emergency situations
Research shows that people with diabetes often have higher glucose levels after a disaster event.3 People using insulin injections to manage their diabetes tend to experience even greater deterioration in their diabetes management than those who do not require insulin.4 Some of the effects can last months.
During and after a disaster, diabetes management can deteriorate, as the body processes glucose differently in an emergency. Stress, changes in activity levels and limited access to certain foods may necessitate an adjustment in medication or insulin during and after an emergency. It is, therefore, recommended that people with diabetes monitor their glucose levels more frequently during emergencies, as both high and low levels can increase the risk of long- and short-term health problems.
Diabetes emergency plan and kit
Having a diabetes emergency plan is about empowering people with diabetes to navigate emergency situations with a greater sense of control, which is beneficial to their health, safety, and overall well-being. A diabetes emergency plan is also about facilitating communication with medical and emergency services by providing relevant information about the person’s medical history, existing conditions, and prescribed medications. The ‘My Diabetes Plan for Natural Disasters and Emergencies‘5 is a guide developed by the NDSS for use in such situations. The plan should be kept together with a portable diabetes emergency kit, with all the necessary supplies.
A diabetes emergency kit should contain:
- A copy of your photo ID
- A list of your medical and surgical history
- A letter from your diabetes healthcare provider outlining your medication schedule
- A copy of your sick day management plan
- A copy of your completed: My diabetes plan in natural disasters and emergencies
Diabetes-specific medical supplies may include:
- A 14-day supply of medications, including insulin, insulin injection device and pen needles or syringes if on insulin therapy
- glucose monitoring supplies:
- a blood glucose monitor, extra batteries, lancets and lancet device; or
- flash or continuous glucose monitoring (CGM) supplies
- Empty sharps container
- urine or ketone checking strips (If applicable)
- Hypoglycaemia kit containing jelly beans, glucose tablets, cans of soft drink, glucagon (if applicable), a supply of non-perishable foods (e.g. peanut butter, crackers, meal replacement shakes or bars)
- Cotton balls and tissues
- A pen and notebook to record glucose levels
Additional items for those on insulin pump therapy
- Insulin pump settings and passwords
- Insulin pump consumables including quick sets and reservoirs
- A 14-day supply of insulin injections – in case of damage to the pump
- Spare batteries for the insulin pump
Regular checks of both the plans and kits are encouraged to ensure medical information and important contacts are current and the kit’s contents are within their use-by date.
Blood glucose monitoring
Blood glucose levels should be checked more frequently during emergencies as levels likely will increase due to the stress experienced, due to higher-than-usual physical activity and due to erratic meal times. Dehydration can also worsen diabetes management, so staying well hydrated is important.
If it is not possible to wash hands before finger pricking, suggest the person wipes away the first drop of blood, to reduce the risk of contamination of the blood sample with any sugar that may have been left on the finger.
The person may be at increased risk of hypoglycaemia due to missed or delayed meals and unplanned or more strenuous physical activity than usual. It is important to treat any hypos immediately, to stop the glucose level from dropping any further and from potentially becoming a life-threatening situation.6
Some people will also need to check for ketones, because of physical and/or emotional stress, any illness or injury and missed or reduced insulin doses can increase the risk of developing ketones, which can be life-threatening if not dealt with promptly.
People should not share their equipment with other people, as this can increase the risk of transmission of blood borne conditions such as hepatitis B, hepatitis C and HIV. If it is essential to share a meter or lancet device with others, the equipment must be cleaned and disinfected with 1:10 dilution of household bleach and clean water.
Diabetes medications
Although diabetes medications, insulin, pen needles, blood glucose monitoring strips and other diabetes supplies are generally easily available from the local pharmacy, during an emergency situation the pharmacy may be closed or there can be disruptions to delivery of supplies.
If the person’s regular medication or insulin is not available, it is vital that they seek medical advice before substituting with a different type of medication or insulin. Telehealth appointments are available across Australia.
Insulin and some medications can become less effective if exposed to extreme temperatures. Insulin that has been frozen, exposed to temperatures above 25oC or left unrefrigerated for more than 28 days should generally be replaced. Although not ideal, in an emergency it is better to use insulin that has been exposed to higher temperatures or has been out of the fridge for more than 28 days if no other supplies are available. However, it is important these supplies are replaced as soon as possible.
Medications that are exposed to flood or unsafe water may become contaminated and can cause serious health effects. Even if they are in their original packaging, if medications appear wet, they should not be used.
If people are not able to return home for a long period of time, they may request an extended-day supply of their medication.
Other important considerations
People with diabetes are at greater risk of injury due to nerve or blood vessel damage and may have slower healing times for infections. This can increase the risk of ulceration and amputation. During emergencies, it is important they avoid conditions such as ‘immersion foot’ or ‘trench foot’, which occurs when feet are wet for extended periods.
Trench foot is preventable and treatable by keeping feet clean and dry, changing socks regularly (at least daily) and removing socks when sleeping or resting. People with diabetes should be encouraged to check their feet at least once per day for possible signs of infection, blisters, pain, swelling, and/or blotchy skin. Additionally, they should monitor for any worsening of symptoms.7
People with diabetes have an increased risk of eye problems due to damage to the small blood vessels in the eye. It is important they pay particular attention to the risk of foreign bodies or irritations to the eye caused by smoke, dust, chemicals and wind. If eye pain, redness, discharge, blurriness, floaters or loss of vision occurs, they should seek medical attention immediately.
Increased risk of developing diabetes after a disaster
Disasters affect individuals and communities in a range of ways and can cause major disruptions to people’s lives, both emotionally and physically. Evidence from research indicates that disasters could contribute to the development of diabetes. For example, increased levels of stress can result in excess secretion of cortisol, which, in turn, can lead to an increase in blood glucose levels.
There is evidence to suggest that those impacted by disasters may be more susceptible to developing substance use disorders and post-traumatic stress disorder (PTSD). Notably, PTSD increases the risk of diabetes development and is also connected with unhealthy behaviours such as poor diet and physical inactivity—also recognised risk factors for developing diabetes.9
Diabetes and mental health
It is not uncommon for people with chronic conditions, including diabetes, to also experience depression and anxiety. 9 This suggests that people living with diabetes may require additional monitoring of their mental health during and after a emergency.
Keeping physically active, following a healthy and regular diet and limiting alcohol intake will help mental health recovery. Management of any mental health conditions should run parallel with the management of physical conditions, as each affects the other.
Strategies to support yourself
There are important steps that you can and should take for your own well-being amidst disasters or emergencies.
Despite the urgency of the situation, it is important that you monitor the amount of time you spend at work. Ensure you take scheduled breaks, avoid (or at least limit) working overtime and maintain regular sleep habits.
Remember to stop and eat healthy meals, stay in contact with family and friends and pursue activities that bring you joy and relaxation. It is important to maintain a work and personal life balance.
Maintain an awareness of your stress levels. Set aside time for self-reflection by asking yourself, ‘How am I doing?’ and ‘What do I need?’ Share your experiences and feelings with supportive individuals. If you find yourself stressed, don’t hesitate to seek assistance, whether from colleagues, your GP, or through services like Lifeline, Beyond Blue or MensLine Australia.
‘Prepare. Act. Survive.’ These three words, displayed on Fire Danger Rating signs across Australia, are equally fitting to summarise managing diabetes in an emergency. The well-being or survival of someone with diabetes is best supported through swift actioning of their diabetes emergency plan.
References
- Bureau of Transport Economics. Economic Costs of Natural Disasters in Australia, Report 103. Canberra, Australia (2001). [Cited 8th Sept 2023]. Available from: https://www.bitre.gov.au/sites/default/files/report_103.pdf
- Australian Diabetes Educators Association. The needs of people with diabetes and other chronic conditions in natural disasters and emergencies. A guide for emergency services, local councils and the not-for-profit sector. Department of Health, Canberra, Australia (2015) [Cited 8th Sept 2023]. Available from: https://www.ndss.com.au/wp-content/uploads/resources/booklet-emergency-guide-services-councils-not-for-profit.pdf
- Fujihara K, Saito A, Heianza Y, Gibo H, Suzuki H, Shimano H, et al. Impact of psychological stress caused by the Great East Japan Earthquake on glycemic control in patients with diabetes. Exp Clin Endocrinol Diabetes. 2012;120(9):560-3.
- Ng J, Atkin SL, Rigby AS, Walton C, Kilpatrick ES. The effect of extensive flooding in Hull on the glycaemic control of patients with diabetes. Diabet. Med. 2011;28(5):519-24.
- NDSS Factsheet: My Diabetes plan for natural disasters and emergencies. [Cited 8th Sept 2023]. Available from: https://www.ndss.com.au/wp-content/uploads/resources/emergency-my-diabetes-plan.pdf
- NDSS Factsheet: Managing Hypoglycaemia. [Cited 8th Sept 2023]. Available from: https://www.ndss.com.au/wp-content/uploads/fact-sheets/fact-sheet-managing-hypoglycaemia.pdf
- Bush JS, Lofgran T, Watson S. Trench Foot. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 8, 2023.
- Miller-Archie SA, Jordan HT, Ruff RR, Chamany S, Cone JE, Brackbill RM, et al. Posttraumatic stress disorder and new-onset diabetes among adult survivors of the World Trade Center disaster. Prev Med. 2014;66:34-8.
- https://www.diabetesaustralia.com.au/living-with-diabetes/preventing-complications/depression-and-mental-health/