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Diabetes community rallies to meet insulin needs after hurricanes
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In the wake of two unprecedented category 4 hurricanes that struck Florida and Texas in the span of 2 weeks this summer, local diabetes organizations quickly took stock of the damage and organized an effort to deliver insulin supplies to those who need it most.
Hurricanes Harvey and Irma stressed many aid organizations, which have worked to meet the needs of residents. For storm victims with type 1 and type 2 diabetes, those needs included insulin, testing supplies, pump supplies and glucagon, among other items.
Soon after, a third category 4 storm, Hurricane Maria, overwhelmed Puerto Rico, leaving it without power and communication almost impossible.
“We have a plane leaving tomorrow morning with cases of glucometers, test strips and lancets donated by Walgreens heading for Puerto Rico, and the space on the plane was donated by Mark Cuban and his people,” Tom Karlya, vice president of the Diabetes Research Institute Foundation and “Diabetes Dad” columnist, told Endocrine Today on Oct. 3, as the island continued to struggle with meeting basic needs 2 weeks after the storm. “Eli Lilly has a plane landing shortly with 39 pallets of insulins.”
The hope, Karlya said, is that the four relief centers on the U.S. territory, set up with assistance from the nonprofit diabetes-supply relief organization Insulin for Life, and 40 Walgreens stores operating on generated power will serve as distribution centers to the communities that are farther away from the cities.
The size and scope of three back-to-back natural disasters striking the U.S. and its territories are unprecedented, creating new challenges for diabetes relief organizations, said Insulin for Life president Mark A. Atkinson, PhD.
“There was no break, there was no down time [between storms],” Atkinson told Endocrine Today on Sept. 13, 3 days after Irma made landfall in Florida. “If you asked me a week to 10 days ago what we needed, we needed supplies — either from manufacturers, or through donations, or financial donations — because the efforts that the coalition are undertaking were not planned for and were in nobody’s budget.”
Atkinson, speaking from Gainesville, Florida, said many Florida residents, particularly those in the Florida Keys, could not communicate their needs for several days following the largest storm on record to hit that region.
“There usually is a little bit of lag time between when the disaster hits and when we start to hear those needs,” said Atkinson, also a professor in the department of pathology, immunology and laboratory medicine at the University of Florida in Gainesville. “We are having some communication difficulties. When you have areas where 30% to 50% of the people are without power — myself included — that leads to issues.”
On Sept. 1, Houston-area residents were just beginning cleanup efforts and taking stock of the damage, where flooding is estimated to have destroyed at least 40,000 homes.
“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 Baylor Scott and White Healthcare in Temple, Texas, and the American Association of Diabetes Educators 2018 Diabetes Educator of the Year, told Endocrine Today at that time. “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 1 in 4 residents are undiagnosed. Although 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 were nonstop in the days after parts of Texas were hit with more than 40 inches of rain.
To meet the growing needs, Insulin for Life partnered with a group of organizations, including the American Diabetes Association, JDRF, American Association of Clinical Endocrinologists, AADE, the Endocrine Society and T1D Exchange, among others. The coalition has shipped thousands of pounds of donated diabetes supplies to people affected by both storms, including analogue and human insulins in both vial and pen forms.
Atkinson said he has been moved by the large effort to help from so many groups.
“These are all the stakeholders,” Atkinson said. “I’ve been in type 1 diabetes efforts for 34 years now, and I’ve never seen — around any cause — this large a group of organizations, all coming together for one purpose.”
Lessons learned
The editors of The Lancet Diabetes & Endocrinology noted, just before Hurricane Irma destroyed parts of Florida, that the continued provision of medical care for patients with diabetes and other noncommunicable diseases is posing an “enormous challenge” after Harvey; however, lessons learned from previous natural disasters have led to improved responses in the U.S.
After Hurricane Katrina in 2005, some charities and agencies were criticized for their actions during and after the storm.
“For care of people with diabetes, in particular, some commentators suggested that relief agencies failed to anticipate the number of people with diabetes who were likely to be affected,” the editors wrote. “In 2005, around 11% of the population of Louisiana had diabetes — with around 1 million people evacuated, that meant more than 100,000 people with diabetes potentially displaced by the storm. A substantial proportion of these people would have been reliant on medication for their well-being or, in the case of those with type 1 diabetes, for their lives.”
After hurricanes Harvey and Irma, the response from agencies to meet the needs of people with diabetes has been stronger and faster, in part thanks to the connectivity of social media platforms, many of which did not exist in 2005.
Karlya, also the father of two children with type 1 diabetes, was one of many diabetes advocates working to connect people in need with partner organizations like Insulin for Life after hurricanes Irma and Maria, relying on platforms like Twitter and Facebook.
“The need right now is coming in on an individual basis, people reaching out on social media,” said Karlya, speaking from his second home in South Carolina on Sept. 13, after evacuating from Hollywood, Florida. “It’s unfolding in live time. [Partner organizations] are standing and are ready to help. There are a lot of ears to the ground, so when somebody hears something, we’re ready to act.”
In the immediate days after Hurricane Irma, Karlya said diabetes supply needs were not as great as anticipated, in part due to good preparations combined with the connectivity of social media.
In Texas, 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. “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.”
Steps to prepare
Storm victims who have diabetes often experience worse blood glucose control because natural disasters create conditions that lead to rapid deterioration in health, Susan Weiner, MS, RDN, CDE, CDN, an incoming member of the 2018 AADE board of directors and an Endocrine Today Editorial Board Member, said.
“If you are not in your home, one of the priorities is to identify yourself as having diabetes, so you can get not only the care you need in place, but so relief workers may be able to get you more appropriate foods because of the seriousness of your medical condition,” Weiner told Endocrine Today.
For storm victims with diabetes, Weiner said, a lack of access to clean water and appropriate foods to maintain blood glucose, and the loss of a daily routine — combined with a shortage or lack of diabetes supplies — can quickly become a dire situation if needs are not addressed as soon as possible.
“A major concern that is often overlooked is dehydration,” Weiner said. “This is a major concern for people in shelters or those who initially did not take the appropriate amount of insulin or diabetes medications they need, and because of the stress associated with the hurricane, they may be experiencing hyperglycemia or high blood pressure, which can lead to more dehydration. The additional loss of fluid can occur when sweating, and access to clean water can be a problem.”
The risk for diabetes-related foot infection can also rise in the days after a hurricane, Weiner said, particularly if a person with diabetes is also a flood victim.
“Normally, I say, if your shoes and socks get wet, you change them,” Weiner said. “What are they changing into? It is important for them to do their best to avoid walking in contaminated water. Feet should be inspected on a regular basis to look for cuts, sores or blisters. These are things we may not think of because it doesn’t seem to be a priority.”
For people with diabetes staying in storm shelters, access to nutritious food can be a challenge in even the best situations, Weiner said, noting that most shelters rely on donated or volunteer-prepared meals.
“If adequate insulin is temporarily unavailable, then we must be careful in these situations,” Weiner said. “We may not know exactly what is in the food. People with specific needs who may usually be watching carb intake, are absolutely eating, at best, differently, and it may be difficult to account for that. That is why it is so important to let people know that you have diabetes.”
Weiner advised that people with diabetes eat as regularly as possible, monitoring blood glucose when able to help lower the chances of hypoglycemia.
“The food is not going to be ideal, but my best advice is not to skip meals,” Weiner said. “You’re going to do the best that you can do with what you have.”
Help is still needed
Ponder said the needs of affected residents with diabetes will not go away as media attention from the storms fade. Additionally, the size and scope of the disasters will complicate any plans to help storm victims get the medications and supplies they need, particularly outside of the greater Houston area and in Puerto Rico.
The ADA has a call center to assist with hurricane relief. Call 800-DIABETES Monday through Friday between 8:30 a.m. and 10 p.m. EST. If you are a health care provider in an affected city and need diabetes supplies, call the ADA supply request hotline at 314-INSULIN.
For more information on ways to help with relief efforts, including how to donate extra supplies or make a monetary donation, visit www.diabetes.org or Insulin for Life at www.ifl-usa.org. – by Regina Schaffer
- References:
- South Asian Floods and Hurricane Harvey: Diabetes in Crisis. Lancet Diabetes Endocrinol. 2017;doi:10.1016/s2213-8587(17)30291-7.
- Information regarding insulin storage and switching between products in an emergency. Available at: https://www.fda.gov/Drugs/EmergencyPreparedness/ucm085213.htm.
- Safe drug use after a natural disaster. Available at: https://www.fda.gov/Drugs/EmergencyPreparedness/ucm085200.htm.
- For more information:
- Mark A. Atkinson, PhD, can be reached at Insulin for Life, 5745 SW 75th St., #116, Gainesville, FL 32608; email: atkinson@pathology.ufl.edu.
- Tom Karlya can be reached at the Diabetes Research Institute Foundation, 200 S. Park Rd., Suite 100, Hollywood, FL 33021; email: tkarlya@drif.org.
- Stephen W. Ponder, MD, FAAP, CDE, can be reached at Baylor Scott and White Health, 1901 SW H K Dodgen Loop, Temple, TX 76502; email: stephen.ponder@bswhealth.org.
- Susan Weiner, MS, RDN, CDE, CDN, can be reached at Susan Weiner Nutrition, PLLC, 124 N Merrick Ave., Suite 5, Merrick, NY 11566; email: susan@susanweinernutrition.com.
Disclosures: Atkinson, Karlya, Ponder and Weiner report no relevant financial disclosures.