Preparedness with Type 1 Diabetes

Introduction:
Managing Type 1 Diabetes in an emergency or survival situation is a significant challenge, but it is not impossible. In this document, we will go over some of the preparations you can make to give yourself the best chance of survival.


Test Meters:
A fundamental problem with storing diabetic testing strips over long periods of time is that they expire and become unreliable or simply do not work at all. There are different products on the market called CGMs or Continuous Glucose Monitors; the most useful of these for our purposes is the Freestyle Libre, which is essentially a CGM and works similarly but only delivers readings when scanned and not continuously. These systems generally depend on electronics to obtain readings, so having a method of powering them (such as a generator as discussed below) is important. Unfortunately, these devices have the same shortcoming that standard meters do; it should be noted that the Libre uses sensors that must be replaced after 2 weeks, and expire in 6 months but studies have shown that they remain effective 18 months past this date, which means that although it requires stockpiling, it is still an alternate option to standard test strips.

All that being said, it is still a good idea to also have a standard monitor and test strips in your stock in case of emergencies, even if you have a CGM. Ensure that you stock the brand with the test strips with the longest expiration dates. I know, for example, Accu-Chek have an 18 month expiration date from manufacture, but am unsure how these rate in terms of longevity among all competitors. This can always change over time, so make sure to do research to see which currently available test strips last the longest before expiring. I have conducted limited testing on Accu-Check strips that were 2 years expired and they were still accurate compared to in-date control strips. This may not be representative of all Accu-Check strips but I felt it worth sharing.


Stockpiling:
Stockpiling Insulin can be accomplished relatively easily. Currently, in all states other than Indiana, one can get Insulin over-the-counter at Wal*Mart locations for approximately $25 per vial. This offers a convenient and easy way to create a sizable stockpile of insulin, but there are a few important factors to keep in mind.

Even properly stored insulin only lasts a year, so that is the maximum amount of time that you should be stockpiling insulin for. Assuming that one goes through 2-3 vials per month, you would need to stockpile between 24 and 36 vials, at a starting cost of $600-$900. After this initial cost output, you would only need to buy a month’s supply every month to replace the oldest insulin in your freezer so your monthly cost for this exercise would be $50-$75.

It is also very important to note that the Insulin available from Wal*Mart is the older human insulin and not the insulin analogues that most people now take. This insulin requires a strict eating schedule, takes longer to work, doesn’t last as long, and has other downsides. In short, it works, but it works differently. As such, it is important to figure out how it works for you, what the proper dose is, and everything else now while society and more importantly modern medicine is still intact so that a mistake doesn’t lead to death.

There is one kind of insulin that can be stored frozen for much longer than normal insulin and insulin analogues. It is inhalable and is called “Afrezza.” It is FDA approved and may be worth talking with your doctor about; for example, if you can get this under prescription and store your prescription supplies while using the OTC insulin, you may be able to build a very sizable stockpile that would not otherwise be possible.


Proper Insulin Storage:
Insulin and insulin analogues must be stored at a temperature of 36F to 46F. For emergency situations, you need to consider the best way to protect your stockpile from power grid failures. There are several solutions, some more versatile than others.

For those who are making plans to stay where they are at all costs, a simple mini-refrigerator will often suffice. You must do testing beforehand to ensure that they are temperature stable and to determine exactly what settings on the refrigerator will maintain the proper temperature, but this is relatively easily accomplished. Look for positive reviews on temperature stability.

A more versatile solution is a portable refrigerator; these are designed to be moved and can be run off of a vehicle’s power source if necessary. When looking at these, look for one with a freezer built in and one that reaches specific temperatures and avoid ones that only reach a certain temperature below the ambient temperature as these will not maintain the needed temperature stability in all environments. You also want to make sure that it is able to be plugged into a standard wall outlet for other situations.

There are some portable refrigeration units designed specifically for insulin, but these are often relatively small and thus not suited to the desire to have a larger stockpile that can be moved if necessary.

Once you have the refrigeration method decided, the next crucial thing to consider is alternative power sources to keep it running in the event of a power grid failure. Solar is a good solution for this, but it has a high startup cost. There are many articles on solar energy out there already, so it will not be covered in depth here. Even if you have a solar setup, you will need to have a normal generator as a backup in case of extended cloud cover or a systems failure.

Mini-refrigerators do not require a great deal of power from a generator; most have a running load of 50-100 watts and thus a startup load of around 100-200 watts. As such, a portable 2000 watt generator will always be sufficient for this purpose. It is strongly recommended that you get an inverter generator that will regulate the power draw, and it is also strongly recommended to get a dual fuel generator. While generators that run on gas are useful, generators that can run on propane as well are a much better bet long term as propane does not go bad and full propane tanks can be safely stored for at least 12 years, much longer than gasoline which will normally only store a year with stabilizer added. Always do research on the brand and the generator itself and make sure that the reviews are largely positive before buying.

An example of a good portable refrigerator and generator combo is as follows:
-A-iPower SUA2000iD 2000 Watt Portable Inverter Generator Gas & Propane Powered ($449.98)
-Alpicool C15 Portable Refrigerator 16 Quart(15 Liter) ($179.99)
Total Cost: $629.97

There are many brands and types of both refrigerators and generators, and you may want your generator to power other things as well so be sure to do your own research and select an option that is right for you; the above is just an example case designed for maximum utility and portability for this purpose.


Stretching Your Supply:
I have read a lot of things on the internet about reducing your insulin usage, with solutions ranging from things like cinnamon and other supplements designed for this purpose to much more outlandish ideas. That being said, I have only managed to find two study backed methods for this, which I will now discuss.

The first is obtaining the medication Metformin and taking daily doses of this. Several studies have shown that daily doses of 500mg of Metformin will reduce the amount of insulin required, reduce weight gain, and most importantly, reduce metabolic syndrome. Metformin is, as of the writing of this document, not a standard treatment in managing Type 1 Diabetes so obtaining it now may be problematic; it is, however, a very commonly prescribed medicine and thus the likelihood of being able to obtain some in an emergency or collapse situation is reasonable.

The second method involves soybeans and a plant called the Jerusalem Artichoke. There have been a few studies that have shown that when properly prepared and administered can reduce glucose levels. Jerusalem Artichokes can have this effect when eaten on their own, but there is a better method to maximize this effect. Beginning with the soybeans, ferment for 107 degrees for 46 hours, then dry or freeze-dry and reduce to powder. The artichokes should be sliced, steamed at 212 F for 30 minutes, then hot air dried at 176F for 24 hours and reduced to powder. Mix these two together in equal amounts. At that point, 40g of this powder should be taken three times per day. When taken in this manner, studies have shown it to be effective at reducing glucose and oxidative stress levels.

An additional consideration: Immune support vitamins and supplements should be stockpiled and taken regularly to support the immune system as illness can cause unnecessary glucose level fluctuations. There are also some studies that indicate Vitamin D can assist with glucose control which makes it another important part of a well-rounded stockpile.

Please note that NONE of the above are substitutes for insulin; nothing is. A type 1 diabetic will die without it. These are just ways to possibly reduce the rate of insulin usage.


Food Storage Considerations:
You should make sure that any food storage you have has either no carbohydrates or as few carbohydrates as possible to further reduce the amount of insulin that you will need. Much of the prepackaged survival food and foods that are considered survival staples are very carbohydrate heavy so this can be a bit of an issue.

The best alternative is simple canned food; most canned goods will last indefinitely as long as the can is intact. You will want to avoid any cans that have easy open tops, any damaged cans, food in oil, and cans of food that are high in acidity such as tomato based goods. Canned meats (in water not oil), canned vegetables, canned soups, seasonings, lard, powdered eggs, nuts, sweeteners, canned milk, nut butter, almond flour, coconut flour, cauliflower rice, edamame pasta, are examples of solid staples. Learning to make pemmican would also be a valuable skill to have.


Insulin Production:
Currently, there is simply no simple or reliable method for making your own insulin. There are some interesting projects using CRISPR and yeast for insulin production, but they aren’t far along enough yet. There is, theoretically, a way you can make insulin. It was done successfully by a woman in WWII named Eva Saxl. It is not easy, it requires lab equipment and chemicals and a decent amount of background knowledge. It should not even be attempted if there are any alternatives available. I won’t pretend to understand it. It has been floating around the internet for some time now and I’m not entirely sure of its accuracy. But I strongly believe in providing all available options; that being said, the method is listed below:

“The present method of preparation is as follows. The beef or pork pancreas is finely minced in a larger grinder and the minced material is then treated with 5 c.c. of concentrated sulphuric acid, appropriately diluted, per pound of glands. The mixture is stirred for a period of three or four hours and 95% alcohol is added until the concentration of alcohol is 60% to 70%. Two extractions of the glands are made. The solid material is then partially removed by centrifuging the mixture and the solution is further clarified by filtering through paper. The filtrate is practically neutralized with NaOH. The clear filtrate is concentrated in vacuo to about 1/15 of its original volume. The concentrate is then heated to 50oC which results in the separation of lipoid and other materials, which are removed by filtration. Ammonium sulphate (37 grams. per 100 c.c.) is then added to the concentrate and a protein material containing all the Insulin floats to the top of the liquid. The precipitate is skimmed off and dissolved in hot acid alcohol. When the precipitate has completely dissolved, 10 volumes of warm alcohol are added. The solution is then neutralized with NaOH and cooled to room temperature, and kept in a refrigerator at 5oC for two days. At the end of this time the dark coloured supernatant alcohol is decanted off. The alcohol contains practically no potency. The precipitate is dried in vacuo to remove all trace of the alcohol. It is then dissolved in acid water, in which it is readily soluble. The solution is made alkaline with NaOH to PH 7.3 to 7.5. At this alkalinity a dark coloured precipitate settles out, and is immediately centrifuged off. This precipitate is washed once or twice with alkaline water of PH 9.0 and the washings are added to the main liquid. It is important that this process be carried out fairly quickly as Insulin is destroyed in alkaline solution. The acidity is adjusted to PH 5.0 and a white precipitate readily settles out. Tricresol is added to a concentration of 0.3% in order to assist in the isoelectric precipitation and to act as a preservative. After standing one week in the ice chest the supernatant liquid is decanted off and the resultant liquid is removed by centrifuging. The precipitate is then dissolved in a small quantity of acid water. A second isoelectric precipitation is carried out by adjusting the acidity to a PH of approximately 5.0. After standing overnight the resultant precipitate is removed by centrifuging. The precipitate, which contains the active principle in a comparatively pure form, is dissolved in acid water and the hydrogen ion concentration adjusted to PH 2.5. The material is carefully tested to determine the potency and is then diluted to the desired strength of 10, 20, 40 or 80 units per c.c. Tricresol is added to secure a concentration of 0.1 percent. Sufficient sodium chloride is added to make the solution isotonic. The Insulin solution is passed through a Mandler filter. After passing through the filter the Insulin is retested carefully to determine its potency. There is practically no loss in berkefelding. The tested Insulin is poured into sterile glass vials with aseptic precautions and the sterility of the final product thoroughly tested by approved methods.

The method of estimating the potency of Insulin solutions is based on the effect that Insulin produces upon the blood sugar of normal animals. Rabbits serve as the test animal. They are starved for twenty four hours before the administration of Insulin. Their weight should be approximately 2 kg. Insulin is distributed in strengths of 10, 20, 40 and 80 units per c.c. The unit is one third of the amount of material required to lower the blood sugar of a 2 kg. rabbit which has fasted twenty four hours from the normal level (0.118 percent) to 0.045 percent over a period of five hours. In a moderately severe case of diabetes one unit causes about 2.5 grammes of carbohydrate to be utilized. In earlier and milder cases, as a rule, one unit has a greater effect, accounting for three to five grammes of carbohydrate.”

https://docs.google.com/document/d/1..._VhP68y68/edit