Hi… I have a theoretical question. Suppose there was an earthquake or other situation that made it hard to access food, but I still had my insulin. Say that I had my insulin (I have Humalog and Lantus pens), but my access to food was limited. Maybe there is some cans of beans, or rice, or minimal amount of fruit/veggies. How would you manage this situation? Could I just stop taking my long-acting (Lantus) and just use my short-acting to manage effectively? What would be your strategy in this situation. Again, just to be clear, I would have plenty of insulin, just trying to figure out how to manage my levels with less food rations.
It would be better to take basal and graze small bits of food. With minimal food, rapid insulin could drop you and require you to eat more than is available.
Only using basal would be the way to go if food was limited. Only use the rapid if you had a BG spike or if you stumble across a stash of food.
Why not try it for a few days, before you have to? Practice. It’s not too hard.
Also, if you are in an earthquake or disaster zone, make a prep kit that includes things like syringes, test strips, staple food, can opener, sugar or glucose tabs.
There is an interesting book, ‘Not im Notstand,’ literally meaning ‘Dire Need in a State of Emergency,’ which describes the plight of diabetics living in Germany at the end of the Second World War, when the local production of insulin was temporarily interrupted. It deals with some of the considerations you have in mind, though it is available only in German.
I do have my earthquake, wildfire emergency kits. One for the family and one for me with all my diabetes stuff. My kit also has some bars in it just in case. But as far as the insulin goes, I agree. You should always keep the basal insulin going. If it is set correctly, it should keep you level without any food. But keep in mind during those disaster situations can cause some major problems just due to stress.
But always good to have a game plan if anything happens.
I don’t know if you are a type 1 or a type 2 but if you are a type 1 you cannot stop taking your long-acting insulin or you will go into DKA so fast your head will spin (literally). You can survive without plentiful rations for quite some time (just like a healthy person) if you watch your BG’s carefully. I personally keep a reasonable store of dry goods and staples around as I live in a very isolated area and if I get snowed in or something I am good to go.
If you aren’t allergic to it, peanut butter (the processed kind, with preservatives etc) is great for emergency food stashes since it has a good balance of carbs, protein, and fat. When I was a kid living in an earthquake prone region, it was one of the items requested for the classroom emergency food stash, but I’m sure PB/nut butters are out now due to allergies.
I agree that basal insulin is absolutely required. I find fasting much less of a challenge, blood sugar-wise, than eating my regular meals. When I’m forced to fast for medical procedures, I’m often pleased that my blood glucose behaves so well. Now part of that is maintaining a good basal routine.
I feel keeping good quality fast acting glucose in an emergency kit is far more important than missing food for a day or two. Test strips and meters, of course, are a fundamental emergency tool as well. Staying well-hydrated is important also.
If I’m not eating anything for a day, I just cut the normal basal level of insulin in half and take no rapid-acting insulin at all, and I find that keeps things under control.
This topic has given me something to think about that I hadn’t seriously thought of before (other than causally wondering how long I’d last in a zombie apocalypse with limited insulin). I don’t have a kit or a real disaster plan! Some good information here…
I was able to put a bunch of stuff in this very small kit - 8.5" x 7.5" x 3".
Here are the details with the list of stuff I have packed:
If not eating makes you cut your basal insulin in half, instead of making it so that your basal alone is more or less sufficient without any bolus, I would think that’s why you struggle with hypoglycemia so much more than most of the rest of us and have a very different perspective than most on diabetic control and dangers. That sounds horrible and like WAY WAY too much basal and, frankly, dangerous. If I regularly took twice what I needed when fasting, I would also be constantly fighting the threat of hypos! There might be a better and much safer way to do things. Diabetes doesn’t have to be controlled that way.
@seydlitz I agree with @cardamom . Before using a CGM I did my best to calibrate my basal but I was taking twice as much as I should. I cut my basal in half and my hypos decreased significantly. My basal dosage keeps my BG stable with no food and no boluses.
It’s so funny how so many of us are really taking more insulin than we really need. I have always hated the highs so would take more and more insulin to try and keep them down. But I was really just on one big roller coaster and bouncing up and down. It took a big mind shift to realize that I was taking way too much insulin.
And yes, if your basal is set correctly, you should be able to go without food. I have gone 2 days with no food due to surgery and things getting pushed back. But because my basal is set correctly, it was no problem.
And another thing with too much insulin is that weight gain because you are feeding the insulin, it is a lot of empty calories.
The down side to having a very low basal set, is I can’t snack whenever I want. When it was higher than it should have been, I could have something to eat and not worry about it. Now if I want a cookie or an apple, I have to dose for it. But now I have to think, is it worth the effort to have that snack?
Many diabetics, as a result of having had to inject insulin over a lifetime, develop insulin resistance, so the basic insulin dose they have to take is higher than normal. A person of normal physiology and weight uses about 50 units of insulin a day, and I find that I need to take about 22 units of Lantus and 12 units of Humalog per day, which is not excessive, though I am also extremely thin. When fasting I find that taking 0 units of Humalog and 11 units of Lantus keeps everything under control.
This is pretty indicative that you’re doing it wrong if your normal basal dose is being used to cover an appreciable amount of food. Properly adjusted basal is not dependent on what you eat. This goes a long way toward making sense of statements such as,
My life is nothing like that, but if I was taking twice as much basal when eating as when not eating, I can certainly see how it would feel that way
I agree with everyone else here. If you can’t go a day without eating without halving your basal insulin, it’s clear you’re taking far too much. Basal insulin should keep you steady when you don’t eat, not drive your blood sugar down.
As for emergencies. I have an earthquake kit with everything I would need to survive for about a week. I keep rapid-acting insulin in there and rotate it to use in my pump as needed, so it’s always fresh. I don’t keep long-acting insulin in there, but that’s mostly because it would spend months without refrigeration. I think keeping extra insulin on hand is something anyone who lives in danger of an emergency like an earthquake should do. I also keep a tiny emergency kit in my backpack that I always have with me, just in case an earthquake happened while I was at work or on the bus.
When I’m talking about the ‘desperate struggle’ of type 1 diabetics to avoid hypoglycemic episodes I’m talking about everyone’s experience, not mine in particular. Many studies have found that the incidence of hypoglycemic episodes triples with strict control, which many patients are now following, so all patients trying to take good care of themselves will be bothered by hypoglycemia, and sometimes seriously bothered by it, requiring hospitalization or help from other people to overcome it. For everyone trying to maintain control, hyperglycemia is a problem, and sometimes a lethal one.
Do you use a CGM? If not, you might find it useful. It can alert you long before you are actually low, so you can head off those lows at the pass. Using one has drastically reduced my incidence of hypoglycemia.
In your kit, what is the reason for both the pen and the vial?
(We have never used a pen so I am admittedly ignorant when it comes to pens.)
We live in what I would consider a very safe and stable area. It is not historically prone to sudden natural disasters. Having a “packing checklist” may be just as good. I do have a box (filled and ready to go) that I take for any roadtrips further than maybe 45 minutes from the house. My concern there is more about vehicle breakdown or storms that force change in travel plans resulting in longer than expected duration away from the house. This is just short term box intended for 1 week max.
For an emergency kit or emergency checklist, I used to keep on hand (current) paper prescriptions for both rapid and long acting insulin. These have expired (the ones we get expire 1 year after being signed) but I will pick up a new set at our next Endo appt. I will also ask for a paper prescription for insulin syringes. Although our state does not require a prescription for insulin syringes, there are other states in the general vicinity which do require such.
We have not been on long acting insulin for some years now so I have become unfamiliar with dosing.
If somebody were to (suddenly) switch to long acting insulin from a pump, is there a general consensus on the best starting dose in relation to the pump daily basal amount? Specifically with either Lantus or Basaglar? To make suggestion more concrete, assume current 25 basal daily dose using Humalog or Novolog from a pump.
It is for a bit of redundancy. And also, while pens are easier, syringes give you the ability to move insulin from one place to another (not just inject it like pens do).
For example, you can use a syringe to take insulin out of a pump reservoir and inject it into your body if your pump fails. You can’t use a pen to remove insulin from a pump reservoir.
Yes, but imagine a sudden unplanned emergency hospital visit, for either you or your daughter. A kit would help for something like that. If you have to go to the hospital, don’t make your daughter frantically scavenge for her supplies!