Ready for anything

Remember the Scout motto, “Be Prepared”? It still applies as an adult. Here’s how to brush up on your diabetes preparedness plan so you’re ready for whatever comes your way

Fire, flood, or pandemic – it’s time to get you and your family prepared

As a nurse and certified diabetes care and education specialist Joe Trotter is always telling patients to be prepared for anything. That was on his mind in March 2020, he says, when it gradually became clear he hadn’t followed his own advice. “There was more and more news about [COVID], and it seemed to be escalating,” recalls Trotter, who has type 1 himself. Living in a big city, he’d always taken its resources for granted, assuming that if he ever needed something in a pinch, “I’d just go out and get it.”

That calculus changed with the pandemic bearing down. If he was going to suggest to patients that stocking up on critical supplies was in their best interest, Trotter realised there was no reason that advice shouldn’t also apply to himself. “I realised I should probably do some planning ahead; that maybe I should take preparedness a little more seriously, and not only for COVID, but for emergencies in general.”

Toward that end, Trotter says, he bought finger-stick glucose monitors and test strips he could use if there came a time when his primary CGM wasn’t available. He worried that his pump, which is charged by USB, would no longer work if the power went out, so he contacted his provider and secured a prescription for a long-acting insulin he could use if he needed to adopt a basal-bolus routine. He made sure he had extra pen needles on hand, and he bought extra batteries for all of his devices. And he spent some time refreshing his regular medicine cabinet, replenishing his shelves with basic necessities like ibuprofen, cold and sinus medications, and first-aid supplies like alcohol swabs and Band-Aids.

Finally, Trotter says, he started stashing snacks. It wasn’t that he thought that COVID-19 might lead to food shortages or a run on essential medicines, but he didn’t want to take his chances, he recalls. “Honestly, you never know what’s going to happen.

I just decided these were relatively easy things for me to do, and that I’d rather be ready than caught unprepared.”

Why You Need a Plan

While emergency situations can be difficult for anyone, they’re often especially challenging for those with diabetes, says Karl Nadolsky, a spokesperson for the American Association of Clinical Endocrinologists and a clinical endocrinologist at Spectrum Health in

Grand Rapids, Michigan. “It depends on the type of diabetes you have, and on the kinds of medications you’re on, but you have to be thinking about the potential for complications when something big like a natural disaster happens that’s out of your control.”

Whether it’s a virus, bushfire, flood, or cyclone, an emergency that affects large swathes of the population can disrupt your regular care plan. Aside from drastic changes, like a forced evacuation or shelter-in-place order, emergencies can cause smaller, longer-term impacts such as localised medication and supply shortages or road closures that make it harder to get to stores and doctors’ appointments.

Still, Nadolsky says, if you’ve given thought to such scenarios – and you’ve taken the time, like Trotter did, to assess your personal circumstances and health-related risks – you can make things significantly easier on yourself should they actually occur. “For any type of broad emergency,” he notes, “it’s so critical you have a plan in place so you’re not trying to figure out what to do at the last minute.”

So where should you begin and what should your plan include? Here’s what Nadolsky and other experts have to say.

Maybe I should take preparedness a little more seriously, and not only for COVID, but for emergencies in general

Take Care of Your Health Now

Before you look to the future, Nadolsky recommends, start by taking stock of what you’re currently doing well. Are you finding time for regular exercise? Are you getting enough sleep and eating a nutritious diet? If you’re leading a relatively healthy lifestyle today, you’ll be in a better position to manage your diabetes, he explains. “Your goal should be to optimise the condition, because that can help prevent complications.”

If you’re among those who could use a boost in this regard, work with your healthcare team to identify your personal risks and the actions you can take to mitigate them. That might mean making changes to what you eat or asking a friend or family member to join you on daily walks. (If outdoor exercise is inconvenient or impossible, consider trying a fitness app or video and doing your workouts from home.) For some people, a self-care upgrade might include activities for reducing or managing stress – like art, yoga, or meditation – while for others it might involve trying new social pursuits to create a sense of community and build new relationships. Follow your interests, experts recommend, and be open to developing new ones that promise to improve your health.

Last, Nadolsky says, stay on top of your regular doctors’ appointments to ensure your medications are what they should be. Should an emergency arise, he notes, you don’t want to find – when it’s too late – that the regimen you’re on is no longer adequate, or that the prescription you have is outdated. “Take care of the details while you can now, and you’ll set yourself up for success later,” he says.

Build Your Emergency Team – and Your Supply of Emergency Medicine

Once you’ve taken steps to fortify your health, it’s time to do the same with your medical team. Talk to your providers about their plans for different emergencies, and ask them specifically how they’ll approach diabetes management.

(If you found that during the early months of the coronavirus pandemic your providers were hard to reach or unresponsive, ask them if they’ve made any changes to improve their services in such situations in the future.) Make a list of any medical-office phone numbers you may need, as well as any backup or emergency numbers.

Can you email your provider or message them through their portal if the electricity is out or the phones stop working? Do they have a system in place where you can access telemedicine if you can’t see your doctor in person? Find out what they plan to do if they can’t hold normal office hours. What will they offer instead?

Also talk to your providers about ensuring you’ll have the medications you need in the event that a major emergency prevents you from getting prescription refills on time. Marty Irons, a pharmacist and certified diabetes care and education specialist, recommends accumulating a three-months’ supply of insulin and then rotating your inventory in your refrigerator so you’re always using your oldest insulin first (most insulin is dated to last about two years before first usage). To do so, he notes, may take 12 months or more. “Just try to get your refill as early as possible, and start to slowly build a stockpile.”

Other advice from Irons: In addition to the pharmacy you regularly use, get your personal information and insurance information on file at a backup pharmacy you’re likely to turn to during an emergency (where a close family member lives, for example). “That just gives you some flexibility, so if something happens [and you’re forced to leave home] your medications or prescriptions can be transferred very readily,” he says.

Finally, Irons recommends building a “diabetes kit”: a container with at least one week’s worth of critical diabetes supplies. “It’s your ‘go bag’ with everything but the insulin or GLP-1 medications,” which should remain refrigerated until the last minute, Irons says.

Among the items not to forget: glucagon for hypoglycemia (if you take insulin) as well as fast-acting carbs; snacks like dried fruits and protein bars; extra needles and other testing and insulin-delivery supplies; and any oral medications you take on a regular basis.

Also include a written list of all current medications and doses, as well as the times you normally take them, and include the contact information for your key providers and your primary and backup pharmacies.

Build a “diabetes kit” with at least one week’s worth of critical diabetes supplies

Stock Up on Other Supplies

One only has to remember the “panic buying” at the start of the COVID-19 pandemic (toilet paper, anyone?) to understand the importance of stocking up prior to any emergency. Hoarding supplies is not recommended, nor is it feasible if you have limited space. But you can make sure you have extras of a few key staples – especially those you depend on to manage your diabetes.

Focus on what you’d need if you were confined to your home for several weeks (include items for entertainment), but also on what you’d take with you in an evacuation. For your emergency kit, the NDSS recommends packing a Hypoglycaemia kit – including jelly beans, glucose tablets, cans of soft drink, a glucagon kit and a supply of nonperishable foods – and at least a three-day supply of bottled water. First-aid supplies, extra clothing, and extra batteries and chargers also make their list, as do a few less-obvious items, like a pen and notepad for recording blood glucose levels and tracking your general state of health.

At home, replenish any over-the-counter medications that are in low supply, and ensure you have what you need for personal hygiene. And aim to stock your pantry with shelf-stable and nutritious foods so you can continue preparing healthy meals for as long as you’re prevented from getting to the store. Among the items recommended by registered dietitians: canned beans, vegetables, and fruits (in their own juice); brown rice and whole-grain pasta; canned tuna or chicken; and bags of nuts and seeds you can add to meals or eat on their own when you need an energy boost.

Shore Up Your Social Support

Joe Trotter, for his part, made it through the hardest weeks of COVID-19 without tapping any of the emergency supplies he assembled at the start of the pandemic. Like a lot of people, however, he leaned on family and friends, and that’s a strategy he’d recommend to anyone with diabetes. “Having social support is always important for any chronic condition, just so you don’t feel alone,” he says. As you work on your emergency plan, he suggests, make a list of the people you know you can turn to and talk to when the going gets rough – or whenever you crave a little human contact. Also be sure to write down their numbers (in case your phone dies), and tell them that they’re in your plans so they know that you feel your relationship is valuable.

At Emory Healthcare, Trotter notes, he talks about the need for social support with many of the people he sees. And in the months since COVID first came on the scene? He and his colleagues are still conveying the importance of emergency preparedness, he says, “But now we’re definitely giving it a little more weight because I think we’ve all seen how important it really is.” ■