Ask Doc: Diabetes in Austere Medicine
Doc Rader 11.01.16
Following on with the second topic that JB asked last week, let’s talk about diabetes. It is a huge topic (and a lot of medical-sciencey stuff) that we can boil down to a couple of base concepts. For the purposes of this article we are going to differentiate between insulin dependent (Type 1) and non-insulin dependent (Type 2) diabetics .
Non-insulin dependent diabetics have become insulin resistant. Simple as that. Basically the body is not efficiently using insulin, which could be from things like poor diet, lack of exercise, obesity, etc. The solution is really to correct those deficiencies. Maintain a balanced diet. Strive to be fit. Try not to carry around extra weight. A SHTF scenario is generally too late to manage this–kind of a sink or swim prospect. You should start working on this now. The only plus side is that Type 2 diabetics are not dependent upon external insulin.
Type 1 diabetics, by contrast, have significantly decreased (or completely absent) insulin production. They must have external insulin for normal metabolic function. Without insulin the body cannot absorb the sugars needed for energy. If you are Type 1 and preparing for a situation where you will have limited resources, you should obviously stockpile syringes and testing strips (since titrating the insulin dose to the body’s need is super critical).
The real problem is insulin. Insulin has a shelf life. Not a “manufactured” shelf life which results in reduced efficiency (like ibuprofen), but an actual “this will kill you” toxicity when it is expired. And unless you have access to a lab, livestock, and possess a degree in biochemistry, manufacturing insulin is going to be a significant challenge. Sorry to burst the bubble here, but even high quality insulin from a modern lab is only going to last a few months (less if already in use). And if you are thinking about trying to produce your own, the time and resource requirements are going to be a significant challenge–and not one you are just going to be able to figure out on the fly.
One thing that can be considered is consuming a “ketogenic” diet (basically very low carb, high protein), which is something that most diabetics that attempt to normalize through diet are familiar with. The thing to watch out for is that since you may not have the safety net of insulin (which is still required for Type 1s even on a diet plan–the amount just may be reduced), you need to make sure that you are drinking adequate fluids (non-carbohydrate, but with added electrolytes, especially potassium). Consuming sodium (or potassium) bicarbonate may also be beneficial as there is a significant risk of Diabetic Ketoacidosis.
The important take away from all of this is to learn how to manage your personal conditions prior to a situation where you have no choice. If you are diabetic is worth it to consult with your nutritionist (or endocrinologist) for advice about how to manage in a limited resource medicine environment. A way to approach is to bring up questions of how to manage the condition on a long backcountry trip with limited evacuation procedures, or by asking how to reduce dependence on insulin in general.
Mandatory Disclaimer (so none of you run off and start pretending to be medics): This article is not a replacement for actually receiving training. It is for your own personal knowledge and is based on best practices and standards of training.
If you have a burning question about a wilderness medicine related concept, feel free to send an email to [email protected] I will pick a question (or two) each week to discuss. You can read about my background below.