Disaster planning in diabetes

The world's largest crystal ball is in Washington D.C. It weighs 48.5kg (106.8lb). Yet even this massive sphere cannot predict our future.1 We hope to be happy but, as recent events remind us, we should prepare for the worst. extent of that preparation, nationally and personally, subject much current discussion with considerable application power hindsight. Pandemics are uncommon but other major disruptive events, ‘disasters’, occur every year. These include earthquakes, tsunamis, volcanic eruptions, landslides, famines, droughts, hurricanes, tornadoes, cyclones, typhoons, extreme weather, flooding, wildfires, well accidents or conflict. Worldwide, there about 16 earthquakes each year.2 Between 2010 2019, were 166 tropical 155 storms, 72 hurricanes (30 hurricanes) North Atlantic3 similar South Pacific Oceans. Disasters can affect production transport drugs medical supplies worldwide. A pharmaceutical plant was damaged an Italian earthquake.4 degree which us prepares a disaster influenced by many factors including education, health, responsibilities such dependents, job, where live, time year, risk disaster, previous local disasters. Our situation, personality, purse determine how effort actually put into preparing may never happen. Do nothing? Build doomsday bunker? US affected disasters most years so has extensive planning advice citizens.5 UK government also advice.6 ‘Diabetes makes more important.’7 People diabetes vulnerable, especially if they on insulin have significant complications like cardiac, renal, foot disease. Having increases injury infection, consequences disaster. now rely technology – flash glucose testing, pumps. Problems accessing advice, prescriptions, cause great anxiety, harm. carry personal identification warning diabetes, insulin, example MedicAlert,8 mobile phone emergency section, tag bracelet. They list medications allergies, passport, record additional health problems, contact number advice. waterproof pack could details copy prescription, clinic letter, instructions dressing leg ulcers, continence care on. Include paper records copies electronic media memory sticks. Teach everyone manage their condition, both everyday life accident illness. organising maintaining medication technology, how, when, seek help, from services, nationally. relying internet, phones, pumps, monitoring must know what do powered breaks down. Everyone up-to-date immunisations, influenza tetanus. Some people don't check news. all need going via trustworthy source. In UK, news obtained television among 75% people; internet 65%, radio 42%, newspapers 35%; 45% use social dips news.9 ‘You Island, without power, except one generator at hospital left standing. hurricane category five, not only did you lose everything, your friends family. Cell towers out, relief slow come. There no communications, when coming. Would ready 10 days, likely two weeks, basic provisions? enough supplies? fresh water drink, take bath in, flush toilet? toilet, roof over head, anymore? What food? 3.4 million same boat are, stuck island, help. Will survive?’10 (See Box 1.)10 • Enough least week syringes injection supply An extra meter Extra batteries Lancets lancing devices weeks Insulin pump sets Glucagon kits Ketone strips Alcohol wipes Glucose tablets, 15g quick carbohydrates (check expiration dates) For oral medication, store two-week Copies prescription eye prescriptions (print it place sealed plastic bag, thumb drive) Current dosage times administration Basal rates, insulin-to-carbohydrate ratio, correction pumpers live zone plan includes evacuation routes shelter. West Sussex example.11 Homes child-safe general medicine cabinet12 first aid kit, alcohol gel wipes, face masks. glucose-lowering glucose, it. professionals, ensure regular clinical items. help this, those who internet.13 seems prudent weeks’ medication. Pump consumables, dressings, non-drug items different routes. using pumps injectable pens/syringes; continuous finger-prick revision use. Education appropriate storage Ideally, kept water-proof box will keep out dirt, insects, rodents (mice tablets). cooling wallet outside fridge. Basic bottled water, ring-pull cans ready-to-eat food, carbohydrate bars biscuits (cookies), some multi-vitamins, perhaps purifying tablets devices. Keep car fuel levels topped up bicycles well-maintained. Back-up (solar wind-up) packs, torches, radios. warm clothing, waterproofs, durable footwear, blankets sleeping bags. American Diabetes Association Centers Disease Control Prevention provide guidance US.14, 15 based experience care.10 ‘Hurricane Katrina powerful storms ever hit coastal U.S… As brutal destructive winds storm surge were, aftermath wreaked greatest havoc… disruption normal routine particularly difficult had deal chronic diseases. Caring disease, demands attention daily basis… addition… physical common case Katrina, evacuees wading contaminated flood despite skin abrasions, led serious infections… ‘It come surprise best planning, aspects “system” rapidly interrupted Physicians’ offices pharmacies close due evacuation, professionals staff suffer loss tragedy, making them needs patients. This lead feeling abandonment Furthermore, centers inaccessible three teaching hospitals Orleans parish surrounded floodwater remain closed months after Loss electric telephones, means communication closure roads flooding fallen trees add complexity… highly unlikely these individuals knew would returning home anytime soon. Most, all, done very little terms preparation days away adequate supplies, records, etc… high prevalence unanticipated formal agencies, chain failed mobilize stockpiles shelters. Approximately 11% population… diabetes.’16 evacuated, meant 100,000 diabetes. long-term adverse effects emotions, blood pressure, cholesterol; exacerbated disparities related socio-economic status.17 taking Hull East Yorkshire worse control six nine afterwards than unaffected.18 multiple Africa Indian subcontinent experienced plagues locusts COVID-19; places been flooded too! Health across world changed COVID-19. Could better prepared? Can lessons used disasters? Have learnt Hurricane Katrina? How caring patients during pandemic? And disaster? happen tomorrow.