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Diabetes Management
Fortunately, these matters can be successfully addressed by appropriate diabetes education.
33
The US and other countries are currently at war.
interventions. First, the patient’s ‘personal obstacles’ need to be There is therefore a risk that the standard distribution network of
identified and acknowledged. The patient’s sense of personal control medical supplies could suddenly be disrupted by an act of war. Supplies
needs to be re-established. Introducing insulin therapy as a brief trial in could also be disrupted in the event of a major earthquake or hurricane.
which the patient is told that he/she can opt to continue or not at its end If such events were to occur, the patient would need to rely on him- or
can help to rebuild a sense of control. Once insulin has been started, it is herself for a period of time.
important to follow up expeditiously on dose adjustments. If adjustments
are not made until a future visit a month or more away, the perceived The American Association of Clinical Endocrinologists therefore
advantages of insulin therapy may not be as apparent and the patient recommends that the patient make a portable diabetes disaster kit that
might become reluctant to continue. For those patients who are truly is both insulated and waterproof.
33
If the patient is on insulin, the kit
fearful of needles, referral to a psychologist or psychiatrist proficient in should contain at least a 30-day supply of insulin syringes and insulin
cognitive behavioral therapy for ‘systematic desensitization’ can often vials or insulin pens and needles, along with cold packs. It should also
quickly resolve the issue.
32
contain blood testing supplies including lancets, test strips, and a
glucose meter (preferably two) with extra batteries. Do not forget to
Disposal of Sharps advise that a sharps container be included for disposal of the lancets
Healthcare workers are not the only ones at risk of sharps injuries. and needles. At least a three-day supply of non-perishable food and
People at high risk of being stuck by used sharps include children, bottled water is also recommended. The kit should be personalized for
janitors, housekeepers, sanitation and sewage treatment workers, and each patient and kept in a handy spot ready to go.
33
workers at recycling facilities and landfills.
3
As part of their initial training
in proper insulin injection techniques, therefore, patients should be Conclusion
taught how to safely dispose of sharps. The laws vary by state. The Diabetes education, especially in terms of proper insulin injection
Centers for Disease Control and Prevention provide helpful information techniques, takes a great deal of time and effort. Without it, however, the
regarding proper disposal and the various states’ regulations (at right type of insulin at the right dose might not necessarily give the right
www.cdc.gov/needledisposal). Another very helpful organization in this results. As a consequence, marked glycemic excursions could occur and
regard is the Coalition for Safe Community Needle Disposal (at optimal blood sugar control could prove to be elusive. n
www.safeneedledisposal.org). Various programs are available to address
this problem. Some even include a mail-back option. Syringes, pen
Richard Dolinar, MD, is a Clinical Endocrinologist in private
needles, and lancets are not recyclable and should therefore never be
practice at the Arizona Endocrinology Center in Phoenix.
placed in a recycling bin. He is co-author of the book Diabetes 101 and serves on
the editorial advisory board for Endocrine Today. He is a
Disasters of Nature and Man
board member of the Association of American Physicians
and Surgeons (AAPS). Dr Dolinar is a past board member
Not taking insulin can be life-threatening for patients with type 1 of the American Association of Clinical Endocrinologists
diabetes. Therefore, a disaster plan needs to be prepared in advance for
(AACE) and also the Arizona chapters of both the Juvenile
Diabetes Research Foundation (JDRF) and the American
them. If disaster strikes, how will they be able to continue taking their
Diabetes Association (ADA).
insulin injections? This should be included as an integral part of their
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52 US ENDOCRINOLOGY
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