In Hurricane Harvey’s wake, endocrinologists, CDEs work together to meet diabetes supply crisis in Houston

Stephen W. Ponder

As Hurricane Harvey slowly made its way out of the greater Houston area after dumping unprecedented amounts of rainfall in the region, pleas from affected residents with type 1 and type 2 diabetes have grown increasingly desperate, according to an area endocrinologist.

“This is an area the size of New Jersey, and we all know that Houston has a high prevalence of diabetes to begin with,” Stephen W. Ponder, MD, FAAP, CDE, a pediatric endocrinologist with Scott and White Healthcare in Temple, Texas and the American Association of Diabetes Educators 2018 Diabetes Educator of the Year, told Endocrine Today. “So, this is really the worst-case scenario for a city with a high population of people with diabetes.”

According to Cities Changing Diabetes, a digital publication produced by Novo Nordisk, 9.1% of Houston residents have type 2 diabetes, and an estimated one in four residents are undiagnosed. Though data are not available on the number of Houston-area residents with diabetes who require insulin, Ponder said requests for help from the nation’s fourth-largest city have been non-stop since parts of Texas have seen more than 40 inches of rain over the course of a few days. He said two residents well-known in the Houston-area diabetes online community, Kelley Champ, RN, CDE, and Anne Imber, a type 1 diabetes advocate and mother of a college-aged child with the disease, began fielding calls for help through social media, and quickly started coordinating their own supply donation effort.

“As this started to unfold, they were getting requests from people around the area for insulin and other supplies,” Ponder said, speaking from his office in central Texas, which he said was on the edge of the storm-ravaged areas. “They started reaching out and providing supplies. It all came together just a few days ago like you wouldn’t believe. We started distributing supplies to people in acute need with the intent to be a bridge until the larger organizations can come in and establish a foothold. We knew social media would be the way to find people.”

Reaching those in need

The American Diabetes Association, JDRF and Insulin for Life announced a partnership Friday to ship more than 3,000 pounds of donated diabetes supplies to people affected by Hurricane Harvey, including 200,000 syringes, 50,000 pen needles and 20,000 alcohol pads. Accompanying each pallet are separate packages containing dozens of blood glucose meters along with thousands of glucose test strips and lancets, which will allow an individual to test his or her blood glucose three times per day for nearly 2 months. More than 25,000 units of analogue and human insulins, in both vial and pen forms, will also be delivered for each pallet, pending safe delivery and temperature-control conditions at the locations, the organizations announced.

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In the meantime, Ponder said, calls have come in from remote and hard-hit areas, like Katy and Port Arthur, Texas, inquiring about insulin. Additionally, he said, the storm has moved on to Memphis, where a large FedEx hub is located, further complicating plans to deliver promised diabetes supplies in a timely manner.

“There are people who have lost everything and are almost out of insulin and are were very close to developing [diabetic ketoacidosis],” Ponder said. “So they are prioritizing the needs based on how acute they are and are keeping request forms.”

The group includes people in the diabetes online community, who are spreading the word through social media on who needs help and where, Ponder said. Individual “runners” then bring the requested supplies to where the affected person is or, through networking, connect the person with someone who has the supplies now that flood waters are beginning to recede.

“Some of these rural areas and shelters have no power, and a lot of those patients are type 2 requiring insulin, so the needs are quite significant,” Ponder said. “As you can imagine, you have to think on your feet. We’re organized in a way, but you’ve got to be flexible. The flights out of Memphis have just been blocked. We thought we were going to get the insulin tomorrow, and now, it may not be until Tuesday because [planes] can’t leave from the Memphis hub.”

Ponder said donations have poured in and currently, there is an adequate supply of insulin.

“It will be nice to have a central system, but even then, not everyone can get to that place,” Ponder said. “It’s not easy to get around right now, so having local support, and being able to micro-target the needs, that seems to be the model that works well for us right now.”

A long road to recovery

In a presentation on disaster preparedness and diabetes at the 2015 American Association of Diabetes Educators annual meeting, Pamela Allweiss, MD, MPH, of the CDC, Division of Diabetes Translation, spoke of the specific risks to affected residents with diabetes and the lessons learned from Hurricane Katrina, which devastated New Orleans in 2005.

“Even though the emergency preparedness world traditionally has been very different from the chronic disease management world, things are getting better,” Allweiss told Endocrine Today at the time of her presentation. “The issue of preparing people with diabetes is on the radar screen of both groups, so CDEs can be a great source of education to people who work in emergency preparedness, a group that CDEs have not usually worked with.”

Storm victims who have diabetes often experience worse blood glucose control as natural disasters create conditions that lead to rapid deterioration in health, Allweiss said, including a lack of clean water and fresh food, and even the loss of a daily routine that is so key in diabetes management. More cases of gangrene and diabetic ketoacidosis are also encountered in shelters, she said.

But the most serious disruption, Allweiss said, is lack of access to diabetes supplies and medications.

Ponder said the needs of Houston residents with diabetes will not go away next week or next month. Additionally, the size and scope of the disaster will complicate any plans to help storm victims get the medications and supplies they need, particularly outside of greater Houston.

“We have people in rural areas not getting a lot of attention,” Ponder said. “We’re going to continue to have a need for supplies. Hopefully soon we’ll have more sophisticated ways to get supplies to people, and I’m hoping the major institutions here will step up.”

Ponder said there is a need for the following:

Blood glucose meters and strips
Ketone sticks
Hand sanitizer
Medical tape for pump and CGM sites
High-sugar snacks (fruit snacks, Starburst, Smarties)
Glucose gel
Juice boxes
0.3 and 0.5 syringes

Supplies may be mailed to Kelley Champ Crumpler RN, 48 Lakeridge Dr., The Woodlands, TX 77381.The ADA has also created an online resource with links to more information on how to help affected residents. For more information, visit www.diabetes.org/hurricaneharvey. – by Regina Schaffer

For more information:

Stephen W. Ponder, MD, FAAP, CDE, can be reached at Scott and White Medical Center, 2401 South 31st St, Temple, TX 76508.