DOC News November 1, 2005
Volume 2 Number 11 p. 3
© 2005 American Diabetes Association
Diabetes Care in the Wake of Natural Disasters
William T. Cefalu, MD
The devastation from Hurricane Katrina caused disruptions in most of our
lives. But it was the aftermath of this disaster, the likes of which we have
never seen in the U.S., that appeared to wreak the most havoc. The hardships
were particularly difficult for those with chronic diseases such as diabetes,
which demands constant attention even in the best of times.
It is not uncommon in south Louisiana or other coastal regions to evacuate
in the threat of a hurricane. More times than not, those who leave can return
home and resume their normal lives. In the case of Katrina, most who evacuated
fled to homes of family, to hotels, or, for the very unfortunate, to shelters
in arenas, schools, civic centers, etc. It is unlikely they realized that many
would not be going back home any time soon, if they even had a home to which
they could return.
OBTAINING NEEDED SUPPLIES
As a result, many evacuees simply did not take appropriate medical supplies
for days away. Thus, the most immediate concern for individuals with
diabetes—particularly in shelters—was obtaining the medication
(including insulin and oral agents) and supplies (syringes, glucose meters,
and strips) required on a day-to-day basis ("Unprecedented Medical
Response Follows Katrina's Path of Destruction," see
page 1).
Without medical records, patients' medical histories, medications used, and
appropriate doses could only be obtained from personal accounts. Chances were
that available replacement medication did not match a patient's normal
regimen. For example, some on basal insulin combined with shorter-acting
analogs had to settle for what the shelter could get, generally NPH or
regular. Patients on glitazones or newer secretagogues may have had to switch
to an older sulfonylurea and/or metformin. Obtaining and disposing of insulin
syringes created yet another hurdle in shelters housing thousands. If a
glucose meter was available, it may not have been one with which the
individual was familiar.
Other concerns were the major changes in diet. Evacuees either went without
significant calories during this time of stress, or had to adjust to provided
meals that may not have met their daily requirements. Managing diabetes in
these cases did not consist of aggressively treating blood glucose, but of
trying to prevent acute complications such as hyperosmolar states and
hypoglycemia.
As the coming months unfold, we as a medical community will learn much more
about what is needed if ever we are faced with this situation again. Let's
take those lessons and work to ensure that planning for the multiple
complexities of providing continuous medical care is given the attention it
deserves. 
Footnotes
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William T. Cefalu, MD, is chief of the division of nutrition and chronic
diseases at Louisiana State University System's Pennington Biomedical Research
Center in Baton Rouge.
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