Any Fellow Type-1 Diabetics Here? An Added Element For Our Survival.

[Tolly]

As I was sitting here putting together another B.O.B. last night I started to wonder if I had any fellow Forumites with serious medical conditions such as myself (type-1 diabetic) here on BladeForums. We have an added element, don't we, And it isn't just making sure that we always have something to bring use out of an insulin reaction, it is much deeper than that if you think about it. It really depends on what you are going to be doing outdoors, and how far from help you are willing to go. The more remote, the more prepared you better be. It occured to me just how much I had thought this through when I was packing up my bag last night whilst talking to one of my good friends who is also an EMT. Without telling him exactly what all extras I carry because of my situation, I asked him what he thought I should take(he is an outdoorsman too), and it surprised me that he only named things that seemed obvious, i.e., meds, glucose tabs/gel, alternative quick sugar fixes for elevating blood sugar levels in the event of insulin reaction. I realize that this isn't a thread for everyone, but even if you aren't a diabetic, you may have some other health concern that you really should evaluate deeper to make sure you are carrying enough stuff with you to ensure your survival should things go wrong. Just a few examples from me personally are my medical kit. I carry a Maxpedition FR-1(awesome pouch:thumbup that has the essentials that most everyone else would carry, plus lots of extra things for dealing with any type of cuts/blisters/burns/. The meds I carry are not all standard over the counter stuff either. I carry insulin of course, Surclens, antibiotic ointment, prescription antibiotics (Z-Pack) , prescription painkillers (hydrocodone10-10tabs) & ( Immediate Release Morphine MSIR 30mg-10tabs), lots of things for wound cleaning and treatment(diabetics know why)as well as the normal things most people carry, and sometimes on long trips where we are way back in the woods on horseback or down the river(boat trips) I carry an IV start kit as well as a couple of saline IV bags. I know this probably sounds absolutely insane to some of you, and I don't carry IV bags everywhere I go, all of the other stuff fits in my FR-1 pouch, but you really do have to think about things differently if you have a special medical condition. I have found that just like when doing most other things, the brain is still our best tool. Don't let that little rub turn into a blister, eat something before you are in a full blown insulin reaction, because we all know how well our brain works when the blood sugar plummets..Also guys, I want to add, that no, I am not a doctor or any kind of medical professional, but I did obtain everything that I carry in my pack legally. I have a very good relationship with my doctor who is also an avid outdoorsman, and we have talked about these things at length. I take the schedule II meds (morphine) in with me everytime I have a doctors appointment or check up so that he can count them and see that I still have them, that is our agreement. We have also talked at length about situations that would warrant the use of any of the prescription meds, and I have been educated on the use of the IV set. I don't know if any of you have thought about talking to your doctors about things like this, but there are doctors out there that understand and are willing to help. I will add more later if anyone wants to continue this discussion.

 

[JD Mandrell]

Type II here, and so far I've been able to control it without meds, but I have made sure my kits have really good wound care/infection prevention stuff.

 

[TDahlgren]

Paragraphs, please.

Yes diabetes is going to add another layer of difficulty to any aspect of life, including wilderness survival but in general (and assuming no significant injury or illness) if you extend the same equipment and patterns of behavior that get you through a normal day onto the period of time you would realistically expect to survive in the wild then you should be o.k. Basically, you just keep on keeping on.

Obviously this means adequate stocks of insulin and needles, but also testing supplies. Carrying an extra bottle or two of insulin might be expensive, but is hardly a weight/space concern. Unrefrigerated most insulins are 'good' for at least 30 days. At normal dosing ranges one to two bottles of longer acting insulins are usually sufficient for a month.

In a pinch (sorry for the pun) you certainly can re-use your own needles (can get painful, but they still work) any time you anticipate this it might be better to go with a heavier gauge needle than you prefer since a 27 ga. will withstand repeated use alot better than a 30 ga.

Blood glucose testing supplies are going to be a little more problematic depending on the conditions you find yourself in. Those damn machines are finicky and, although plenty accurate, amazingly unreliable as they will stop functioning if you look at them wrong. They also need batteries and are not in any way waterproff and that's two more levels of hassle.

There used to be old fashioned testing strips available - ones where you wet them with blood, waited a few seconds, wiped them, then compared the color to a chart of the side of the jar. They weren't the most precise things in the world but they were quick, easy and plenty accurate for basic survival. I wonder if they are still made, if so they might make an excellent backup plan should your regular meter fail.

That's all well and good, but the problems really start to arise when things are not as they should be, when you are sick or injured, dehydrated, or have run out of normal food sources.

Then you will not only have to deal with 'the problem' at hand, but also this problem will likely require you to deviate from your normal pattern of diabetes treatment. Your ability to do this will be dependent on multiple factors, but especially you understanding of the disease and the specifics of treatment, eg. when your caloric intake is cut in half what changes will you make to your insulin regimen? Halving all your doses is probably not the correct answer.

I would go so far as to say that, in a true survival situation, the goals of treatment aren't even the same. In everyday life the goals of treatment are to minimize the long term consequences of elevated blood sugar. This means trying to maintain a very high degree of control on blood sugar levels. In survival mode I'd say that the goals of treatent are to prevent significant hyper- or hypoglycemia and pretty much anything in between those ranges is tolerable in the interim.

 

[Tolly]

I would go so far as to say that, in a true survival situation, the goals of treatment aren't even the same. In everyday life the goals of treatment are to minimize the long term consequences of elevated blood sugar. This means trying to maintain a very high degree of control on blood sugar levels. In survival mode I'd say that the goals of treatent are to prevent significant hyper- or hypoglycemia and pretty much anything in between those ranges is tolerable in the interim.

Yep!

Having been a brittle diabetic for 18 years I have a lot of practice at managing blood sugar levels in all kinds of situations, such as being sick, dehydrated, having infections, so on and so forth.

As far as reusing syringes goes, it's no big deal at all as long as after you use them you recap them and keep them sealed in something that protects them from any outside bacteria that might sneak past the mechanical seal of the cap.

As far as keeping insulin refrigerated, as stated, it isn't really important to do so at all with insulin that is being used or will be used within the next 30 days. I would even recommend to any new insulin diabetics out there that once you start using a bottle of insulin, you keep it at room temperature. It will be much more comfortable when you inject it that way. It does need to be kept in the frige though if you won't be using the whole bottle within 30 days or so.

As far as testing supplies go, yes, you can still buy the visual blood glucose test strips http://www.betachek.com/new_BV.htm and I highly recommend and carry them myself, because as mentioned earlier, while modern glucometers are very accurate they can and do malfunction easily.

Lastly, my thoughts to any of on insulin, consider talking to your doctor about taking a once a day injection of one of the long acting insulins like Lantus along with various multiple injections on a sliding scale of a short acting insulin like Humalog if you have an active lifestyle that varies from day to day. Chances are you will find that you can acheive much better control of your blood sugar levels this way as this more closely mimmics the way a normal body works. This method makes a lot of sense for someone who is very active and participates in lots of various activities.

 

[TDahlgren]

Cont.

As far as the other serious medical supplies you really need to ask yourself when you would likely use them, and what real benefit they would provide. If you are not super clear in answering those questions then I'd suggest that those items, while potentially useful, are not the best use of your storage/carrying capacity. Chances are you would be better served upping your stocks of more ordinary items. This applies equally well to wilderness kits and BOBs.

But I'm mainly thinking about things such as the IV kits and fluid bags. That's bulky heavy stuff. Consider - under what circumstances would you find yourself using them? The specific circumstances where you would risk venipuncture on any conscious individual in any non-medical setting are few and far between. Better to hydrate them by ordinary means.

So now you are talking about initiating treatment of an unconscious individual, and that is an incredibly complex situation. One that requires a fair degree of knowledge and skill in patient assessment. Do you even know what the problem is? Sure in a rare instance you might know that what this person needs is fluids, but how often is that going to occur compared to times when you will not know what the problem is? What good are fluids if you can't maintain an airway? etc...

And if you are anticipating treating shock or volume depletion forget about it -you won't have enough of anything to do more than waste precious time. A couple liters of saline or LR just isn't going to accomplish anything. There apparently are some newer emergency type volume expanders available, but again they are only useful when used as part of a total patient management approach.

So, even if you do come up with a scenario where you do initiate treatment, then what? How long can you maintain it and what has that really gotten you for the tiem and effort?

Again, there are better (meaning more likely to be useful) ways to fill that space/weight in your pack.

That's why your EMT buddy doesn't carry much. He knows from practical experience your choices are 1) carry everything or 2) accept the fact that you haven't carried everything and just deal with it the best you can.

 

[Tolly]

As far as the IV set and bags go, in my case they are carried on specific trips when a certain individual that has a particular condition is along with us per doctors orders. If they were ever needed we would be glad we had them. This is an extreme condition I realize, and I completely agree that in general the space would be better used to carry other things.

Another thing I would like to mention is that it is always wise to inform others who are in the woods with you about your condition/s. Sometimes it might no seem like the manly thing to do, but they need to know. You should also educate your friends on what to do if you have a medical issue and can't help yourself, such as an insulin reaction or any myriad of other things.

 

[TDahlgren]

Another thing I would like to mention is that it is always wise to inform others who are in the woods with you about your condition/s. Sometimes it might no seem like the manly thing to do, but they need to know. You should also educate your friends on what to do if you have a medical issue and can't help yourself, such as an insulin reaction or any myriad of other things.

Excellent point the last thing you want is sombody starting chest compression when all you need is some sugar.

The last area I was going to touch on was oral meds, but honestly the issue is so vast because of all the different types and classes of meds and also the differences in the potential situations - short term wilderness vacation vs longer expedition; quick BOB to get you someplace stocked and secure vs longer term who-knows-where-it-will-take-me kit. Never mind all the ways you might need to manage any problems that could arise in those given sets of circumstances.

In general though I tend to stock a short term wilderness kit about the same way I stock a kit for a week in Disney World. Since any major problem (serious illness, deep laceration) pretty much means stop what you are doing and seek medical attention. The only difference between the two being what you could reasonably need in that interim from injury to professional assistance.

Anything more pretty much would involve a book on expedition medicine.

 

[okbohn]

My daughter is Type 1 with a pump. In some ways it would be easier than with shots, but in others vastly more complex (ie more things to go wrong) It is a challenge!

 

[Esav Benyamin]

I'm on Lantus once a day myself, and I no longer take supplemental injections of faster-acting insulin. I had a lot of trouble with that, constantly chasing my insulin levels up and down. It's easier for me to just watch diet and activity levels, and adjust the Lantus long-term if it's too much or too little. I'm Type II so it's a bit easier for me to get away with this. Also, I test 3 to 4 times a day.

Big problem: blood glucose levels dropping from exertion and I know it and I still wait too long to snack. Sugar tablets aren't real effective when I'm starting to shake. I carry Mainstay rations (I get them from Brigade Quartermasters) because they are compact, aren't just empty calories, and I can carry 600 calories in a small plastic box even walking down the street.

For longer trips, the whole insulin, syringes, meter, pillcase business fits into an Otter box for security and convenience.

 

[Esav Benyamin]

My daughter is Type 1 with a pump. In some ways it would be easier than with shots, but in others vastly more complex (ie more things to go wrong) It is a challenge!

I have 2 cousins on the pump. Got it from the same grandmother I did. They are quite active and have been doing it for most of their young lives, so it is a well-practiced routine.

I did speak to my doctor about it after doing a headaching amount of internet research, but he said I'm doing so well just now, it might not be worth it for me.

 

[fnc]

Do you have a bug out partner that can diagnose and
administer your meds as you pass out?
To the inexperienced, too much sugar and too much
insulin look the same: he passed out.
Maybe, start dating nurses, bonus!

As you mentioned, letting your hunting acquaintances know
of your condition is better than nothing, but they really need
to have some knowledge and experience. At a minimum, I
would ask them to watch basic procedures.

Are feet a problem for you? Maybe they will be, so get
ahead of the curve. Maybe carry extra pair of form fitting
shoes. If your feet ulcerated, how should they be treated?

Keeping Medicines Cool in Hot weather.
Can you find bug out locations that have cool springs or
cool well water? My grandparents refrigerated milk this way.
A frozen bottle of water, under a blanket can keep things
cool. A white towel soaked in water, can be spread over
meds, in a hot car, and the meds will stay cool. YMMV with
heat and humidity.

 

[fnc]

If you start out with normal levels as you are sitting in
a chair, now you get up and do work. You need sugar
so you take some.

Now, do you need insulin to metabolize the sugar you
just took??
Or, could you possibly take small amounts of sugar/carbs
with no insulin, as you worked through the day?

 

[Halfneck]

Not a diabetic, but I do have to take Synthroid 50mcg for hypothyroidism. My thyroid got hit a bit during my radiation treatments for melanoma. I can go maybe a week without meds before I start feeling sleepy all the time.

 

[silenthunterstudios]

Type II here, thanks for the thread!

 

[Esav Benyamin]

Now, do you need insulin to metabolize the sugar you
just took??
Or, could you possibly take small amounts of sugar/carbs
with no insulin, as you worked through the day?

Each diabetic is different. Type I basically exists on injected insulin. Type II produces insufficient insulin so needs pills or injections.

On Lantus, a slow-acting insulin, I have enough to metabolize a normal days intake. I don't need to add more insulin during heavy activity/additional food intake. If I were going backpacking in rough country, I would increase my one daily dose because I would be increasing my food intake.

Type I diabetics would generally be much more sensitive to changing conditions during the day.

 

[TDahlgren]

Big problem: blood glucose levels dropping from exertion and I know it and I still wait too long to snack. Sugar tablets aren't real effective when I'm starting to shake. I carry Mainstay rations (I get them from Brigade Quartermasters) because they are compact, aren't just empty calories, and I can carry 600 calories in a small plastic box even walking down the street.

Ugh, I hate to be the bearer of bad news, but you might want to rethink any regular use of that product.

The problem with Mainstay (or any similar rations) is that their caloric content is primarily fats in the form of saturated vegetable shortening and good old pure sugar. Great when you need something compact, high in calories, that resist spoilage and that does not increase the bodies' demand for water (that last bit is actually one if their primary features for meeting SOLAS requirements.) In other words, they really are emergency food but are not particularly healthy when used in other situations.

In the case of a diabetic trying to maintain good blood sugar control they are an even worse choice. The fact that they are raw sugar and saturated fat makes them horribly problematic. The refined sugar content can lead to large blood sugar swings (up and/or down) and the saturated fat is about as heart unhealthy as you can get (heart disease being one of the primary long term health concerns for diabetics.) In the short term they may work fine, but in the long term they may be doing alot more harm than good.

In your case the solution to the problem is a combination of protein and complex carbohydrates found in sports bars tailored to diabetics such as Glucerna or VPX Zero Impact bars. Look for ones that contain minimal amounts of sugars and saturated fats and that contain a good mix of protein, complex carbs, and fiber. Yes they will place more demand on your body for adequate hydration than Mainstay, but adequate hydration is essential for diabetics anyway.

They can be spendy but if you shop eBay find a product you like then watch for wholesalers selling short dated lots - they are worthless to regular retailers who typically cannot sell anything beyond their dating but they stay edible much past their expiration and can be a real bargain. The only other downside is that sugar and saturated fats are pretty much what make sports bars palatable so the diabetic bars are not exactly top flite in the taste department. Although since Mainstay bars are pretty much like eating lemon flavored shredded cardboard just about anything else is a step up.

 

[Esav Benyamin]

Do you have a bug out partner that can diagnose and administer your meds as you pass out?

To the inexperienced, too much sugar and too much insulin look the same: he passed out.

At a minimum, family and friends and people you spend the most time with should be aware of the basics: if you become weak, dazed, irritable, nervous, or nauseous, you are probably suffering from hypoglycemia -- low blood sugar. Untreated, this can lead to coma.

A quick way to get sufficient sugar into your system is a half pint of orange juice. A convenient way to provide for your own security is to carry a tube of decorative frosting for cakes. (Baking aisle of the supermarket.) It's pure sugar in a thick paste form and forcing it into a collapsed diabetic's mouth is an easy way to stabilize him.

Under no circumstances should anyone but a knowledgeable doctor or other experienced medical professional administer insulin. Insulin will lower blood sugar levels, which is exactly what a hypoglycemic diabetic does not need.

* ****** **** ****** *

Hyperglycemia, or excess blood sugar, is not an immediate threat. In the long term, it will overstress the body, but on a spot basis, it is probably best characterized by ... uhhh ... zzzzzz ...

* ****** **** ****** *

Alcohol. Basically, better not. Alcohol converts readily into sugar and spikes your blood sugar levels with a consequent quick falloff soon after. That kind of nutritional rollercoaster can be dizzying, especially since diabetics who generally avoid alcohol will have heightened sensitivity to it on the few occasions they indulge.

Alcohol is like candy or ice cream or cookies: mostly empty calories, which lead to drastic changes in blood sugar levels and no true nutritional benefits. Save it for when you're hypoglycemic and need a boost.

As a relatively new diabetic, I hadn't had any alcohol for a couple of years. One swallow of beer got me a little dizzy.

 

[Esav Benyamin]

In other words, they really are emergency food but are not particularly healthy when used in other situations.

In the case of a diabetic trying to maintain good blood sugar control they are an even worse choice.

I agree absolutely! I hardly ever eat the stuff, but .. they last and last, and carry well and compactly, so I always have that 600 calorie pack in my gear bag or bail out bag. I've been out on a long walk on a hot day, sat down to cool off, and boom! realized I was going hypoglycemic in a hurry. Walking along felt so good, I missed my symptoms.

A 200 calorie snack and I was good to go in minutes. Back home, cool off, fix a salad, and I'm back on track. The Mainstay is not food, it's strictly emergency.

 

[Esav Benyamin]

I'm not into sports bars as a regular item because I'd rather eat real food. The problem I was solving, and that Lantus was a big help with, was eating too much real food before going out knowing my activity level would be high. I didn't like the big boost/heavy drain cycle. Eating small meals/snacks along the way is better, but not necessarily convenient. I go for the inconvenience: it's healthier. And also with Lantus, I rarely go hypoglycemic the way I used to, anyway.

 

[Tolly]

A note on the insulin pumps. I have an insulin pump, and I tried it for about six months. I managed to maintain pretty good control with it. It all comes down to personal preference though. I found that it was too much of a hassle and one more thing that could screw up and cause problems in my very active lifestyle. Let's see, I SCUBA dive, I hunt, fish, swim, ride horses, wrestle wild hogs occaisionally while hunting them from horseback, and do a fair amount of sparring(too old to actually fight anymore), so I found that the pump itself was in the way and just too much trouble. I have been a diabetic a long time and taking shots doesn't bother me, so I find more freedom by not wearing an insulin pump personally.

I try to keep good records of my blood sugar levels during most all of the activities I do so that I can eat accordingly when I head out into the woods or water. I really had to learn to do this well when I got serious about diving and started decompression diving. The key is staying one step ahead and not getting to the point where it's an urgent situation.