Letter Re: Insulin Dependent Diabetics When TSHTF

Sir,
Like so many others, I thank you for all that you and your family do with SurvivalBlog. It is immensely helpful. I just caught up on a bunch of recent posts related to diabetic preps and thought I'd toss in my 2 cents' worth.

For the record: I am a (female) type 1 diabetic, diagnosed at age 13 and currently in my mid-thirties. The info below is based entirely on my own 20+ years of personal experience; I am not in any way a medical or pharmaceutical professional. As always, consult a medical professional if you need advice regarding diabetes management - YMMV.

I am currently taking Lantus once daily (basal dose) and Humalog with every meal (bolus dose, thrice daily). I am personally still a little freaked out by needles (can apply them to myself, but prefer to do so as minimally as possible), thus the idea of having an insulin pump semi-permanently attached is not appealing. I am still old-school, with syringes & vials (this becomes important later). I test my blood sugars before every meal, and keep a written record to help spot patterns of highs or lows, so that I can adjust my dosages accordingly.

When I started contemplating diabetes management and long-term preparedness, two problems stood out: the ability to acquire a stash of meds, and the ability to store them. I'll address these in that order.

How does one acquire even a minimal store of vital meds when severely constrained by both budget and insurance bureaucracy? A sympathetic doctor is very helpful if you can find one (mine is only a phone call away; I usually address him as "Dad," and he's on board with the whole prepping thing), but there's not much he can do if my insurance won't play along. The thing that helped me the most in building up a supply of insulin is the fact that one vial of insulin lasts me more than one month, but less than two. Ditto test strips for the glucose meter. The idea is to refill like clockwork every month, whether you need to or not. Over time your stash will accumulate ahead of your actual usage. You may be able to refill every three or four weeks, instead of monthly (gives you at least one extra month's supply every year) - ask your pharmacist, or just go up to the counter and try it. If it's too soon for your insurance to pay out again, they will tell you when to come back. Note that this probably won't work for pills - they know exactly how many of those you will use in a given time frame. I use this strategy for test strips, too - they are just a little cheaper on prescription with a copay than OTC (over the counter), although if you have the budget for it you can just walk up and ask for them. Store brands work just as well as the big names, as long as you have the meter to match.

Other supplies (syringes, alcohol swabs, lancets, extra/replacement meters) are readily available OTC, and should be part of your regular prepping budget just like water, food, and other goods. Do the math on how many you use in a day/week/month, multiply by how long your prepping time frame is (i.e. 3 weeks/3 months/3 years), and build up to your goal. Extra alcohol swabs are good to have in the first aid stores anyway; I keep my spare meter(s) in a Faraday cage, with the rest of the last-ditch electronics.

Once you have it, how do you store it? FYI, I personally break a LOT of rules. See disclaimer above re: medical advice. The micro-print on the insert tells you to keep insulin at 36-46 F if unopened, below 86 or refrigerated after opening, and that you must discard the stuff 28 days after you open it, regardless of whether the vial is empty. And don't freeze it, either. Expiration dates on my refills are nearly two years from date of purchase.

I have NEVER discarded a drop of insulin just because it was 28 days old. My vials last about 40 days, and I have never had a problem. The vial currently in use rides around in my purse, at room temperature, the entire time. Still no problems. Last year, I started to carry spares of each type, in addition to the ones currently in use, with me at all times. This means that by the time I finish one, rotate the spare into use, then use it up, it has spent 80-100 days out of refrigeration, at room temp. STILL no problems.

A word about grid-down: you really can't let this stuff freeze, and it will denature (become completely inert and useless) above 80-86. If you are caught out in winter weather, remember to keep your insulin warmish but not clear up to body temperature. Try a pocket; in the BOB/GHB is probably a bad idea. If you are dealing with summer temperatures and need to keep it cool, IT JUST HAS TO STAY BELOW 80. Do a web search on "Frio case" for a nifty little portable evaporative cooling pouch (I am not affiliated or compensated in any way, just a satisfied customer). There are other companies with similar products. For medium-term grid-down, I have a cooler-sized propane-powered fridge; a root cellar would be a more permanent, less fuel-dependent option. I would not care to test both expiration dates AND temperature tolerances with my entire store of meds. I have yet to push past an expiration date, but I figure that slightly expired insulin has to be better than no
insulin at all. I appreciate the input from an earlier poster on the subject.

A word about BOB/GHB: don't forget the extra syringes! You may be able to get away without finger sticks for a couple of days, but don't try skipping the shots. And for crying out loud, throw alcohol swabs in so you can keep the whole process clean. You should carry enough to match the quantity of insulin you carry around every day. For me, that's about 50-90 days.

A word about syringes and lancets: I break the rules, big time. I reuse both of these items, and have for more than a decade with no ill effects (no infection, no noticeable difference in site irritation). Lantus does not play well with others (I can't mix it in the syringe with another type of insulin), so I use one Lantus needle every two days. I keep that vial and syringe tucked in same interior pocket of my purse, next to my spare vials. I use one other needle for all three of my daily Humalog injections, and one lancet for all three (or more) daily blood tests. So I go through three syringes and two lancets in two days, plus six test strips and alcohol swabs. I originally did this on a purely economic basis - I couldn't afford to blow through four syringes and three of everything else, every single day. Now I'm just used to it, and why spend more than I have to? You may not want to take measures this extreme (and if you are prone to infections or irritation at your injection sites, DO NOT ATTEMPT this). It may come in handy if you need to stretch your supplies.

A word about insulin pumps: I don't use one, so don't take only my word for it. But I have heard from those who do that the cartridges must be discarded every three days, empty or not, due to risk of infection. This would make it difficult or impossible to sneak your supply ahead of your usage. And my dad (who has spent his career in emergency medicine, and is an EMS medical director) has confided that he is glad I've never gotten one, because they seem to be associated with a higher risk of hypoglycemic reactions. I know there are a lot of people out there who love their pumps and wouldn't go back to vials/syringes for anything, but IMHO insulin pumps are not the best choice for preparedness.

One more thing. Diabetes management is a three-way balancing act with medication, food, and exercise. We all know we'd be better off eating right, exercising, yada yada blah blah blah. I did not realize what a dramatic difference that last one would make until I started self-defense classes last summer. My insulin requirements started to drop almost immediately; at this point, my dose is down twenty percent across the board! And still falling! (I'm getting ready for a belt test this month.) And I've lost two clothing sizes! And I know how to put fingers, fists, feet, elbows, knees, heel palms, head butts, and shins into an attacker's soft tissue, from a crazy number of vantage points! (Yes, it's krav maga. "We do bad things to bad people.") Bottom line, getting in shape is part of both diabetes management and emergency preparedness. Find something you like, that is useful and fun, that you will stick with.

Thanks for reading; hope it comes in handy.
Keep your powder dry and your insulin cool! - Sarah in Missouri