Before Disaster Strikes

With severe weather predicted for Tuscaloosa, Alabama, Meredith Cummings thought carefully about where to park her car-eyeing the large trees in her historic neighborhood-when she arrived home on the afternoon of April 27. As she walked to her door, she reassured herself: Those trees had been there for more than 100 years. What were the odds of them coming down today?

Later, as tornado sirens blared and she ushered her eight-year-old daughter into a closet to take cover, Cummings, who has had type 1 diabetes since age 13, continued to plan for the worst. She grabbed a small pouch containing insulin pump supplies and placed her shoes right outside the closet (“just in case”) before wrapping pillows and her own body over her daughter.

“I’m an exceptionally prepared person,” Cummings says. “My family knows my mantra is ‘Plan ahead.'” But nothing could have prepared her for the F4 tornado that roared through her neighborhood at 5:13 p.m., leaving a six-mile-long, nearly half-mile-wide gash of destruction through the college town of Tuscaloosa. “It was the most frightening thing I’ve ever been through,” says Cummings, who has suffered several near-death experiences, including technically “dying” when her daughter was born. “I’ve never in my life felt a more loud and violent thing. It was shaking us like the world’s most violent tilt-a-whirl.”

When it was over, the century-old trees were in the bedroom adjacent to the closet where Cummings and her daughter had taken shelter, but that was the least of their concerns. The sky was still ominous, and cell phone service was jammed. Cummings finally got a call through to her brother, who told her “you have 30 minutes” before the next one hits. Cummings absentmindedly snatched her glass-filled purse and began the mile-long hike over trees and debris to her office at the University of Alabama, where she’s a journalism instructor.

The purse, which contained a small vial of insulin and her glucose meter, and the pouch of supplies proved invaluable when Cummings arrived at her mother’s home near Birmingham almost exactly 12 hours after the tornado struck and realized that her pump was nearly out of insulin.

In hindsight, Cummings wishes that she had stored insulin and other supplies somewhere other than her home prior to the storm. The American Diabetes Association recommends keeping basic supplies at home, at work, and in the car. In addition, an emergency kit should contain medications, supplies, food, and documentation. (See the sidebar for a detailed list.) Many people, however, fail to assemble such a kit. In a recent dLife network poll, 44 percent of respondents said that they’ve thought about preparing a diabetes emergency kit, but don’t currently have one.
“What I often see is complacency,” confirms Jackie Kloosterboer, emergency coordinator for the city of Vancouver, British Columbia, author of “Plan for the Worst-A Common Sense Guide to Emergency Preparedness,” and a person with type 1 diabetes for more than 40 years. “People have great intentions to put their kits together, get the supplies they need, but we all live busy lives and we never get to it. The time to prepare is now, before the disaster strikes.”

Here are more tips for planning for an emergency, be it a tornado, flood, hurricane, earthquake, or terrorist attack.

Keep extra supplies on hand

This is easier said than done because prescriptions are generally written just for the amount of supplies/medication/insulin that a person needs for a given time period. Kloosterboer advises stocking your emergency kit with items you need to survive without any outside help for a minimum of 72 hours. A month after tornadoes tore through the Southeast, the Alabama/Mississippi chapter of ADA was still fielding requests for supplies, mainly test strips and insulin. Aimee Casey, executive director of the chapter, says that some insurance companies didn’t pay for prescription refills for people who had filled prescriptions within the previous 30 days. Ways to start building a reserve without spending a lot of money include:
• Getting help from your doctors and care providers. Physicians usually have free samples that they’re happy to share with you. They might be able to write prescriptions for back-up medication as well.
• Buying an extra supply of cheap, generic type 2 medications.
• Obtaining a free glucose meter. Many manufacturers provide meters free or almost free (check their websites), and doctors often receive free meters to give patients.

Don’t store extra insulin in your emergency kit

Keep insulin in a designated area in your refrigerator. “When evacuating-and if it’s safe to do so-one extra step to the fridge is all that’s needed to grab your insulin,” Kloosterboer says. Also have freezer packs that you can place in a bag to keep insulin viable, says Lynn Russo, registered nurse, certified diabetes educator, and American Red Cross volunteer in northern New Jersey. If you’re not able to get your insulin, advise shelter authorities of your situation as soon as you arrive.

Insulin remains safe to use when stored at room temperature (59 degrees to 86 degrees Fahrenheit) for up to 28 days. Insulin pens in use can be stored at room temperature according to manufacturers’ directions. Freezer packs can protect insulin from extreme heat following a disaster, when air conditioning might not be available.

A note on the outside of your emergency kit could remind you to get items from the refrigerator/freezer, Russo says. If you don’t think you’ll need a reminder, consider Cummings’ experience: After the tornado struck, she didn’t even think about diabetes until after arriving at her office.

Build a good relationship with your pharmacist and establish an account with a major pharmacy chain

“Pharmacies are generally very helpful to people with diabetes, although I’ve found this more true when I know the pharmacist,” says Sean Kelley, incoming chairman of the Alabama/Mississippi ADA chapter. “Building a good relationship with someone local-even when you buy most of your medications through mail order-may be helpful in an emergency.”

Establishing an account with a major chain could make obtaining supplies in an unaffected area after a disaster easier because the pharmacy will have access to your information.

Create an ICE (in case of emergency) file

This should be in your emergency kit. As with supplies, however, storing the information somewhere other than your home is important. Kelley keeps his online as a Google doc. ICE apps for smart phones are available, and keeping a printed ICE file in your wallet or purse and at your workplace is also a good idea.

ICE files typically contain your name, birth date, social security number, address, list of medications and doses, pharmacy and physicians’ names and numbers, prescription copies, and medical insurance information.

“If we were to lose everything, as many people did in the tornadoes, we’d still be able to access important information and begin trying to get replacement supplies,” Kelley says.

Call your insurer

Ask about the company’s emergency policies. That way, at least you’ll know where you stand should an emergency occur.

Know what to do if you are affected by a disaster

According to ADA, people with diabetes should identify themselves as such, drink plenty of water, watch what they eat, and stick with their regular testing and medication schedule. You should also be wary of supplies that might have been compromised. Moisture can affect pills, blood glucose meters, and other supplies. When in doubt, and if you have the option, throw out affected supplies and get new ones.

In the week after the April 27 tornado, Cummings says, her blood glucose levels fluctuated more than usual-a fact that she attributes to the loss of routine, roller-coaster emotions, and the stress of dealing with debris cleanup, home and vehicle insurance claims, and rebuilding plans. For days she didn’t want to eat; other times she forgot. But at the one-week mark, Cummings says, her blood sugar began leveling off. At times, her diet was healthier than usual, thanks to volunteers who brought hot plates of food into affected neighborhoods. “The outpouring of support is unbelievable,” she says.

[Sidebar] Your Emergency Kit

A diabetes emergency kit should be housed in a backpack or other easily transportable container and should include:
• List of prescriptions and doses
• Names and phone numbers of physicians, pharmacy, and/or mail-order company
• Copy of medical insurance card and flexible-spending-account card
• Alcohol swabs
• Back-up glucose meter and extra batteries
• Test strips*
• Pills for type 2 diabetes*
• Lancets
• Glucose tabs or gel to treat low blood sugar
• Extra medical alert bracelet or card identifying you as diabetic
• Extra glucagon kit*
• Non-perishable food
• Water

If you use insulin:
• Syringes (even if you use a pump in case, there is a problem with it)
• Pen needles (if you use insulin pens)
• Site-change supplies and batteries (for pump users)

*These items have expiration dates, so you should use and replace them as necessary. Put a note on your calendar to help you remember.

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