Diabetes 911. Larry A. Fox

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      Diabetes 911 covers both general emergencies and extreme emergencies. General emergencies are those day-to-day, common pediatric and adult situations. Extreme emergencies are those rare dangerous situations for which you need to be prepared, such as severe weather and power outages. For easy reference, each chapter ends with a summary of its important points.

Chapter 1 Preparation and Prevention

      People with diabetes experience unique, day-to-day emergencies specific to their condition. Because you have diabetes, you need to be prepared to deal with these emergencies. Alexander Graham Bell, the famous inventor, once said, “Before anything else, preparation is the key to success.” Preparing for diabetes emergencies is no exception—expect the unexpected. Many diabetes-related problems can be prevented with proper preparation. Here are some beginning steps in preparing for (and hence preventing) a variety of simple but common problems in day-to-day diabetes care.

      DIABETES SUPPLY KIT

      Scouts are not the only ones who should be prepared. Everyone should. There are many situations when simply having another diabetes supply kit readily available can save you a lot of aggravation and time. Many of these emergencies can be avoided by having all of the necessary diabetes supplies ready and waiting for you. The list above shows the supplies that should be in your kit. You may need additional items depending on your specific situation or if you are preparing for a specific circumstance (for example, a standard kit might not include a flashlight, but it should if you are preparing for a severe weather event).

      YOUR DIABETES SUPPLY KIT INVENTORY

      

Diabetes medicines (such as unopened insulin vials and diabetes pills)

      

Blood glucose test strips

      

Lancets

      

Alcohol wipes

      

Urine and/or blood ketone strips

      

Items to treat mild or moderate low blood glucose levels (hypoglycemia)

      

Glucagon emergency kits (2), if you are at risk for severe hypoglycemia

      

Insulin syringes and/or pen needles

      

Extra blood glucose meter and batteries

      

Insulin pump supplies—infusion sets, reservoirs, batteries, transparent medical dressings (if used)

      

Written instructions from your diabetes team regarding an insulin regimen to follow when off pump therapy (be sure to include the right kind of insulin)

      

A list of emergency contact phone numbers for your diabetes team (weekday and evening/weekend numbers), primary care physician, and pharmacy.

      Things to Know about

      Your Diabetes Supply Kit

      1 Keep a diabetes supply kit at home and at other places you frequent (such as work, school, or relatives’ houses). Also, if your child has diabetes and is in daycare or with a babysitter, be sure to keep a backup kit there as well.

      2 Remember that unopened insulin should be refrigerated. Opened vials, on the other hand, do not have to be refrigerated. We do not recommend putting opened vials in your diabetes supply kit because opened vials have a shorter shelf life (usually two to four weeks). So, if your diabetes is managed with insulin, your emergency supply kit would have to be kept in the refrigerator.

      3 Don’t forget to check the expiration dates on all medicines and supplies in your kit. Even blood glucose test strips and lancets expire. We suggest checking the expiration dates on items in your kit every month. Set a routine, so it becomes habit and you don’t forget (for example, the first day of every month).

      4 Your kit must include items for treating low blood glucose levels. Most cases of hypoglycemia are treated using 15–20 grams of carbohydrate in the form of simple sugar (also called fast-acting carbohydrate). Glucose tablets are a small and convenient option. Some people prefer other sources of carbohydrate, such as glucose gel or small juice boxes or pouches (usually 4–6 ounces); these, however, can take up more space in your kit. Glucagon should also be included if you are at risk for severe hypoglycemia (see ARE YOU AT RISK FOR SEVERE LOWS?). Glucagon kits are meant to be given by someone else (i.e., not the person having the hypoglycemic reaction), so remember to teach others how a glucagon kit is used beforehand.

      5 Last, but not least, if your diabetes self-care management changes in any way, make sure you update your kit to reflect these changes. So, for example, if a new medicine is added to your management, go back and add that medicine to your kit.

      Other Recommendations

       EXTRA INSULIN

      Bottles of insulin may break when dropped on hard floors. We’ve had countless calls from frantic patients or parents who need a new insulin prescription called in to the pharmacy because their last vial is now spread across the kitchen floor (and this invariably happens late at night, when most pharmacies are closed). There are many other circumstances in which your time and stress level can be reduced by simply keeping extra insulin available at all times.

       PRESCRIPTION REFILLS

      Don’t wait until the last minute to call your diabetes team for medicine or supply refills. Plan on calling refills in at least one week in advance. You want to be sure that the diabetes team has enough time to review your medical records and take care of your request before you actually run out of insulin, other medicines, or supplies. Remember, diabetes centers treat hundreds—sometimes thousands—of patients and may receive many emergency calls every day. There is no guarantee that they’ll be able to get to your request as soon as you need it.

       INSULIN PUMP ISSUES

      Pump failures can happen, although, luckily, not too commonly. If they do, you may be off your pump for a day or longer. Because the “smart pumps” in use today have the bolus calculations and basal rates programmed into the pump, you may not remember this important information. Avoid being stuck without knowing your insulin doses and keep a written copy of your insulin pump settings, including basal rates, bolus calculations (i.e., meals and high blood glucose boluses), sensitivity factors, target numbers or ranges, and alarms, so pump therapy can be restarted immediately after receiving your replacement. Most insulin pump companies have software that may simplify this process