M.D asked me to write an article relating to “Diabetes and long-term isolation.” I interpreted that request to mean diabetes in a survival situation, in other words Survival Diabetes.

Diabetes as a disease presents a very complex story to even professional health providers. A continuing education class on diabetes for Registered Nurses lasts eight hours. Beyond the eight hours one has to sift through the incredibly complex constellations of problems diabetes causes. Diabetes is probably the most complex diseases one faces in the health care setting. Even when controlled and managed by physicians expert in the field of endocrinology, diabetes still manages to throw curve balls when least expected.

For the average non medical person, diabetes can be summed up as “having too much sugar”. Denial of the disease process as far as managing it correctly is due to its complexity. Diabetes requires knowledge, discipline and a hands on approach on the part of the patient. Diabetes is not for slackers.

So when M.D asked me to write a piece on what I call Survival Diabetes I found myself challenged knowing what I know about the disease. But I’m not one to turn down a challenge, and I think everyone will benefit from this article in one way or another.

The first thing I did was a book search on Amazon. I found the following books worth exploring: Diabetes 911 by Larry Fox and Sandra Weber (which I ordered); Your First Year With Diabetes
: What to do, Month by Month by Theresa Garnero; and The Real-Life Guide to Diabetes: How to handle everyday emergencies-and more by Hope Warshaw and Joy Pape.

These books are very well designed for you, the patient. I highly suggest all of them if you are a Type 2 or Type 1 diabetic. It is difficult to find a book which communicates vital information at a level comfortable for the average non medical person.

What do I expect to accomplish with Survival Diabetes?

First, I’m going to cover the basics starting with Type 2 (NIDDM, Non-insulin dependent diabetes) and Type 1 (IDDM, insulin dependent diabetes). The reason I like to go in that sequence is that Type 2 is the least serious though I want to qualify several things: it can become very serious if life style and weight loss are not changed and reversed. Second, Type 2 and Type 1 require blood sugar monitoring. Third, Type 2 can progress to Type 1 if life style is not changed and weight is not decreased. So don’t get me wrong: Type 2, as far as I see it, is a warning call. It sets the stage, if ignored, for Type 1 with all of its complications.

Type 2, NIDDM, usually occurs later in life with obesity as a main causal factor. Obesity, actually increases insulin resistance (where muscle and fat and peripheral tissue become insensitive to insulin). When diagnosed, patients with NIDDM are started on a oral antidiabetic agent such as Amaryl, Glucotrol, Actose, DiaBeta. NIDDM can be reversed thru weight loss and life style changes such as a radical diet change. Type 2 patients need to monitor their blood sugar daily and their main goal in life is to avoid progressing towards Type 1 through weight loss and life style changes.

Am I repeating myself? I hope so, because if you have Type 2 you don’t want to progress to Type 1. Type 1, IDDM, insulin dependent diabetes. A small percent of the population appear to be predisposed to Type 1 thru genetics or a viral infection which destroys the cells of the pancreas which produce insulin. As mentioned previously, many Type 2 diabetics eventually become Type 1 over many years.

Because many Type 1 diabetics start this disease at a very early age, true Type 1 diabetics, based on my observation are very compliant and disciplined relating to their disease process. However, I have noticed that many Type 1 diabetics who have become Type 1 after being a Type 2 for many years are less compliant and less disciplined. Perhaps it’s because they incurred the disease later on in life. Unfortunately, being undisciplined results with many highs and lows relating to blood sugar, causing, over time, damage to organ and nervous tissue.

Second, I would like to explore what could be done if our societal infrastructure collapse; Survival Diabetes. What I would like to do, though, is review symptoms relating to hyperglycemia and hypoglycemia.

Per the Wikipedia, free encyclopedia on line, “Hypergycemia, hyperglycaemia or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma.” Symptoms include “frequent” or “pronounced hunger”; “frequent” or “excessive thirst”; Symptoms include “frequent” or “excessive urination”; “blurred vision; fatigue; weight loss; poor wound healing (cuts, scrapes, etc.); dry mouth; dry or itchy skin; impotence (male); recurrent infections such as vaginal yeast infections, groin rash, or external ear infections (swimmer’s ear); Kussmaul hyperventilation; deep, rapid breathing; cardiac arrythmias irregular heart action); “stupor; coma” and I add-death.

“Hypoglycemia or hypoglycaemia is the medical term for a state produced by a lower than normal level of blood glucose.” Symptoms include “shakiness, anxiety, nervousness; palpitations, tachycardia” (rapid heart rate); “sweating, feeling of warmth; pallor, coldness, clamminess; dilated pupils; feeling of numbness, “pins and needles”; hunger, nausea, vomiting, abdominal discomfort, headache; abnormal mentation, impaired judgment; nonspecific dysphoria” (depression, mood changes); “anxiety, moodiness, depression, crying; negativism, irritability, belligerence, combativeness, rage; personality change, emotional lability; fatigue, weakness, apathy, lethargy, daydreaming, sleep; confusion, amnesia, dizziness, delirium; staring, “glassy” look, blurred vision, double vision; automatic behavior, also known as automatism; difficulty speaking, slurred speech; ataxia, in coordination, sometimes mistaken as “drunkenness”; focal or general motor deficit, paralysis, hemiparesis” (one sided paralysis); “paresthesia” (prickly, stinging feeling); “headache; stupor, coma, abnormal breathing, generalized or focal seizures.” And I add- death.

Notice a lot of mental changes with hypoglycemia; the brain needs glucose to function. Being the control center it just can’t do its job without fuel. A simple intervention is to give a patient glucose orally if a patient presents those symptoms. Just remember this: when in doubt give glucose. That was a question on my RN boards. You can’t kill someone by giving them sugar. Glucose is available in small tubes. I have revived patients by placing some glucose under the tongue-it absorbs through the mouth lining. Usually two tube will do it followed by a complex carbohydrate and protein (like a ham/cheese sandwich and choco
late milk).

Both hyperglycemia and hypoglycemia can result in death if poorly controlled, especially with brittle diabetes. I have brought up that term before, and the definition of brittle diabetes is per Tabor’s cyclopedic medical dictionary: “Diabetes mellitus that is exceptionally difficult to control. The disease is marked by alternating episodes of hypoglycemia and hyperglycemia. Frequent adjustments of dietary intake and insulin dosage are required. ETIOLOGY: diabetes may be brittle when 1. Insulin is not well-absorbed; 2. Insulin requirements vary rapidly; 3. Insulin is improperly prepared or administered; 4. The Smogyi phenomenon is present; (When “In diabetes mellitus, rebound hyperglycemia following an episode of hypoglycemia caused by counterregulatory hormone release. Reduction of insulin dose will help control this condition.”) 5. The patient has coexisting anorexia or bulimia; 6. The patent’s daily exercise routine, diet, or medication schedule varies; or 7. Physiological or psychological stress is persistent.”

Brittle diabetes is one of the most serious complication of diabetes (Type 1). Its buddies are tombstones. The huge swings present in brittle diabetes makes it extremely difficult to manage, and as you can see, the correct diagnosis for its cause is paramount. Number 7 is especially interesting to survival situations: physiological or psychological stress (or both at the same time). I have mentioned stress before and when diabetics are stressed, more glycogen is released into the blood stream eventually increasing the blood glucose dramatically.

Neuropathy (loss of feeling due to nerve damage), severe impotence in males, limb loss, blindness, cardio vascular events, organ failure including kidney failure, coma, death.
Poorly controlled diabetes (either Type 2 or Type 1) will eventually result in a cascading, downward spiral with increased severity. Just taking oral antidiabetic medications and following a diabetic diet as in Type 2 is not enough; aggressive action towards weight loss and life style changes are paramount. Monitoring blood sugars at least twice daily is critical.

As a Type 1, you have crossed the Rubicon by administering yourself insulin injections daily, possibly twice or three times a day depending on the severity. At this point, insulin is for life because the pancreas is unable to produce insulin anymore. Your glucose meter is your life line; your diabetic diet, of absolute importance; keeping your stress levels low, and being on top of any injury and signs of infection will be part of your daily monitoring.

Then comes a situation, one bright day which plunges society into a survival mode. It could happen in stages over a period of days to several months slowly choking off supply lines. Or it could happen suddenly, without warning like in the novel One Second After
. Supplies and medicines just vanish within days. Pharmacies are looted.

You’re a diabetic and you have only three weeks until you run out of your medication. What will you do?