This blog is for suggestion, only. It’s our personal experience with prepping for times when medical help might not be available short or long term. For times when the power might be out, or we experience the end of civilization.
Stash. You definitely want one. What to stash? Let’s start with the bare necessities of diabetes management. You need a way to monitor your blood sugar and ketones, and you’ll need insulin and a way to administer it.
Blood sugar meter, lancing device and lancets and meter strips. CGMs are a luxury. If you have time to grab the supplies, go for it.. But the bare necessity of blood sugar monitoring is meter, lancing device/lancets and strips. Don’t forget the batteries or a way to charge it if it’s plug charge. We have a powerbank with an option for solar power for this purpose and to charge pump and cell phone. You may want to keep extra chords with the powerbank that work with your device(s). I got our powerbank here, and right now there’s a 10% coupon you can click to save (Sept 24th, 2020).
As for pricking your finger to draw out the blood to test, you can buy some small lancets as a backup for if you run out of lancets for your lancing device, they are called disposable safety lancets. We don’t use these regularly as they are more painful. I cannot recommend reusing lancet needles unless you have to because you are almost out. Reusing lancet needles can cause damage to your fingers and increase risk of infection.
Insulin, a way to keep it cool, and a way to administer it. Again, pumps are great!! But pumps are a luxury and the supplies needed for pumping can take up a lot of space, so if you only have time to grab some things, make it the insulin and syringes. Syringes are small and can be used with vials or pens, so I recommend them in addition to your pen needles so if you run out of pen needles, you can still administer the insulin. Please know that if you take insulin out of a pen with a syringe, you cannot go back to using a pen needle for that pen because the vacuum in the pen is damaged by the syringe. You will need to draw out with syringes for the remaining life of that pen. As for a way to keep the insulin cool, a temporary solution is an ice box with ice packs and insulation. Yeti is our preferred brand of ice boxes, because it holds a consistent temp for a long time. Put the insulin in ziplock bags to keep it waterproof, then wrap the insulin bag(s) in a thin cloth towel so it’s not touching the ice packs directly. A wonderful tool to have is a thermometer. I recommend a MedAngel bluetooth thermometer. It lets you set up alerts by adding a medication to the app on your phone, and it will let you know when it goes out of range from the manufacturer's recommended temperatures. You can get it here with a 20% coupon for the time being (Sept 24th, 2020).
If the world is coming to an end, you can always dig a 6 ft deep hole to store the insulin in, or if you have access to a fast moving stream, anchor it to the water bed. Remember insulin that is kept at room temperature for more than 12 hours will begin it’s shelf life expiration timeline. For Humalog, Novolog, Basalglar and Lantus, room temp shelf life is 28 days. Levemir’s shelf life at room temp is 42 days. Insulin that is above room temperature, >86℉, will lose effectiveness even quicker than the shelf life. Expired insulin will be less effective as time goes on, but is still usable in extreme emergencies, just remember you’ll need to use more to get the same results. I refuse to recommend rationing unless you are really close to being out of insulin completely. Opt for lower carb food, but remember that starvation ketones are a thing. In addition, reusing syringes can increase damage to the body and increases the risk of infection on/in the body AND contaminates the insulin.
Speaking of ketones, you want a way to monitor for those. Ketostix brand urine strips are small, inexpensive, have a long shelf life unopened, a 6 month opened life, and are easy to use and read.
So our basic needs list is: blood sugar meter, strips, power for the meter; insulin, cooling method, syringes; ketone urine strips or blood ketone meter with strips and power method for the meter.
Luxury items: CGM, Insulin Pump.
There are 3 parts to a Dexcom CGM. The sensor, the transmitter, and the receiver (usually phone or even insulin pump). When it comes to the receiver, all three options require a battery charger. But even so, back-ups are great, so don’t get rid of the dexcom receiver device (and manual) that you get when you start Dexcom because if your phone breaks, you’ll still be able to read the BG numbers if you have a backup. The sensor lasts 10 days, unless you restart--more on that later. The transmitter lasts around 90 days, but cannot be restarted. If you are able to grab CGM supplies during whatever disaster you are encountering, make sure you grab all three parts!
Insulin pump parts. If you have an Omnipod, you’ll need pod packs (they come with syringes to fill the pod) and the controlling device. If you have a t-slim, you will need the pump (the part that is on the person), reservoirs and syringe/needles to fill them, and site sets or infusion sets. Site or infusion sets usually include tubing (ours does). I am unfamiliar with pump supply lists for other pumps like Animas or Medtronic, as we have only used Omnipod and Tslim. Omnipods have to be changed every 78 hours at maximum. Tslim can be changed as far out as you have insulin in the reservoir. There are other methods to extend the life of Tslim usage, but I will cover that later. If you are leaving your house for whatever disaster you are encountering, grab everything YOU need for your brand of pump. It’s also important to have your insulin settings written down somewhere so you know how much insulin to give at what times to give it. In your pump settings (or maybe history) you should be able to see how much basal insulin is given for every 24 hour period. This would be the long acting insulin equivalent if you experience pump demise and need to switch to long acting.
Cleaning supplies: soap and water, rubbing alcohol (wipes, or bottle with cotton or rags), skin prep and repair items.
Remember that you need a way to keep your fingers clean when testing blood sugar. To prevent infection, you want to wipe the tip of your insulin vial or pen, as well as the site you are injecting or placing the infusion site into. We suffer from skin sensitivities to rubbing alcohol (it can dry skin out) and so we have a skin prep process to prevent breaking out underneath tech adhesives so all those items are in our evac list. It’s also a good idea to have after creams in case skin breakout or infections happen, like steroid cream, and antibiotic creams.
Low Blood Sugar Supplies. You want to have fast acting carbohydrates in a shelf stable form. Our favorites are fruit snacks because they are fun and American smarties because they don’t melt.
Glucagon, Baqsimi, or Gvoke. It’s always a good idea to have these in case of emergency hypoglycemia where fast acting carbohydrates cannot be used safely.
So the long list of evac items are:
□ Blood sugar meter, lancing device and lancets and meter strips
□ Insulin, a way to keep it cool, and a way to administer it. Both fast acting AND long acting, even if on a pump.
□ CGM sensors, transmitters, receiver devices and ways to charge them.
□ Insulin pump, reservoirs and syringes, infusion sets, ways to charge the pump.
□ Soap and water, rubbing alcohol (wipes, or bottle with cotton or rags), skin prep and skin repair items
□ Fast acting carbohydrates in shelf stable form
□ Glucagon, Baqsimi, or Gvoke
How to increase your stash: Here are some tips and tricks to get more for your stash.
Insulin stash: you can talk to your endocrinologist to see if s/he will write the prescription for more than you need to help build your stash or in case of dropping a vial or accidentally leaving it in your car after picking it up from the pharmacy. Sometimes 1 vial or pen more per month is enough to build off of. Don’t forget to fill for long-acting insulin even if you are on an insulin pump. That way, if your pump dies, or you run out of pump supplies, or you don’t have time to take them, you are covered for your basal insulin. You can purchase insulin syringes over the counter (meaning you don’t need a prescription) in most states. I bought a box of 100 for $20.
Blood sugar meters, strips, and lancets are also over the counter items. Pay for a couple extra using a flexible spending account or health-savings account if you have them available to you.
Dexcom is harder to build the stash for. You can extend the life of the sensor by restarting it, but doing so regularly leads to scar tissue and unusable sites in the future and may cause sensor accuracy issues. It is also not FDA okay to restart sensors. In the event of emergencies… who cares about FDA, right? You also want to make sure that every sensor that does not last 10 days (falls of, fails, etc.) and every transmitter that dies prematurely is called into Dexcom to replace. You can now file a replacement request online here. If you are a Tslim user and have your pump set up to read your Dexcom, you will need to contact Tandem for Dexcom replacements here. Here’s a link to a youtube video showing how to restart a Dexcom G6 sensor, it involves keeping the code from when you started the sensor originally: https://youtu.be/1DLjEywtIrc.
Pump supplies: Ask your endocrinologist to write the prescription for changing sites every 2 days instead of 3. This will help increase your stash quickly so long as you change it every 3 days as scheduled. You can even extend pump supplies further, for t-slim, if you change your reservoir every other site change, or change out the reservoir without changing your site, then saving the tubing when you change your site next. This, too, comes with warnings. Once an infusion set has been opened, the tubing is no longer sterile when setting aside (I put them in a ziplock bag), also the tubing can become degraded over time which can lead to occlusions. In addition, leaving a pump site in the body longer can lead to scar tissue and unusable sites. Using the same reservoir for longer than 3 days can lead to insulin viability issues. Since the pump is on a person, the insulin inside the reservoir is closer to being body temperature which is warmer than room temp, so the shelf-life in the pump is shorter than the shelf-life in the vial or pen.
For everything, buy in bulk when available (many insurances will allow you to buy 3 months at a time). Refill as often as insurance will allow. Many pharmacies have auto-refill you can set up with a text message notification when it’s ready to refill or pick up. Set a calendar event to remind you when you can refill items if you can’t have it on auto-refill.
When it comes to storing your stash, you should create a FIFO method of inventory. First in, first out. That means, the items with the shortest expiration dates should be used up before those with longer expiration dates. So, if you have a vial of insulin that expires in 2021, you should use it before one that expires in 2022. Same goes for non-refrigerated supplies. To have a good insulin stash, I recommend a mini fridge dedicated to insulin so you don’t slowly take over your kitchen fridge. Be wary of mini-fridges, though, because most are not consistent in temperatures and will have wide swings meaning your insulin may freeze or be too hot consistently enough to throw off the viability of it. Frozen insulin is NOT viable insulin, nor is frozen but thawed. You can tell if your insulin has been frozen ever by the color and consistency of the insulin.
I recommend the Danby Compact Fridge because it uses the same method of cooling as a full size fridge. I got ours here.
Don’t forget to keep track (or watch) the expiration of the long acting insulins in your stash. If you are a pumper, it’s easy to forget about the long acting since you don’t use it daily. Ask for a replacement script from your endocrinologist when they are close to expiring.
Remember, you want to have shelf stable food and potable water, and everything else that is recommended for natural disaster preparedness.
This article from Beyond Type 1 Covers much of what I have listed here (except building stash), and includes phone numbers to major manufacturers and resources on how to get needed items through donation foundations.
Here’s to stash building and prepping for disasters, and then having them not occur. Don’t forget to breathe.
For school building preparedness, I'd love to refer you back to a previous blog I wrote, but I guess I only wrote it in my head. I'll save that for another day's blog project.