Guidelines for Emergencies

These basic general guidelines for handling diabetes supplies during emergencies are for informational purposes. Please confirm with your doctor that these recommendations are suitable for you.

The most important thing you can do is to plan ahead at all times. Do not wait until the last minute to refill your medications or order supplies. Please ensure that your physician prescribes 90-day supplies of your medications and testing supplies whenever feasible. Contact your physician and pharmacy whenever you have less than two weeks of medication or supplies left.

Insulin:

• Keep all unused/unopened insulin products refrigerated. Avoid temperatures below freezing or above 86 degrees Fahrenheit.
• Do not use an insulin pen or vial once it becomes frozen, even after it thaws.  If no refrigeration is available, you can often store unused/unopened insulin pens or vials at room temperature for 24 to 72 hours. However, when using, watch for changes in the strength of the medication (repeated unexplained high blood glucose levels). When in doubt, switch vials/pens.
• If you lose power, remove insulin from the refrigerator after two days if the power does not return. After two days, the refrigerator may become warmer than room temperature.
• Once you open/use an insulin vial or pen, store it  at room temperature.
• If you keep your insulin in a cooler, do not use dry ice, which is too cold to properly store insulin. Keep the ice  in a sealed container (e.g., a zipper type plastic bag). Insulin pens can become damaged from direct contact with moisture. One solution is to put the insulin in a sock or wrap it in a towel to avoid direct contact with the ice.

Other injectable diabetes products, including Victoza ®, Bydureon ®, Byetta ® and Symlin ®:

• You can keep any opened pens and injection kits  at room temperature.

For unopened products, treat the same as insulin. Glucose test strips:

• Avoid extremes in heat or cold as these can affect the accuracy of glucose tests strips. These extremes vary according to the brand of strips but typically exposure of more than 30 minutes of less than 45 degrees Fahrenheit or more than 90 degrees Fahrenheit may be a cause for concern (check on the label with your specific brand).
• Discard any frozen test strips should be discarded. Do not store tests strips in a cooler/refrigerator or a parked car exposed to extreme cold or heat for a prolonged period of time. 
• If you are out  in the cold with your glucose meter/tests strips, keep them in an inside coat pocket.

Oral diabetes medications (pills):

There are many oral products for the treatment of diabetes, so these are just general guidelines. Please check the package label or speak with your doctor or pharmacist for more specific instructions about your medication.

• Most oral medications for treatment of diabetes are best maintained at room temperature, between 68 and 77 degrees Fahrenheit (20 and 25 degrees Celsius).
• You can briefly store  medications at temperatures between 59 and 86 degrees Fahrenheit (15 and 30 degrees Celsius) for no more than three hours. Try to keep them  away from heat, moisture, and light.  
• If you notice any changes in the effectiveness of your medication after it was exposed to excessive heat or cold, consider getting new product.
• Check with your doctor/health care provider before doubling a dose as you might take more medication than is safe.   

Frequently Asked Questions

People with diabetes often ask what to do in case of an emergency situation. Here are some of the most common questions we hear.

What if I am worried that  my medication might not work or  is showing reduced effects and I cannot get more?

• Try to reach your health care provider to see if he/she knows of any pharmacies that are open and have supplies.
• Remember that even if your medications have  reduced potency, they may have some effect and you should keep taking them. Do not borrow a friend’s medication without discussing with a health care provider first.  
• Replace questionable medication as soon as possible, and if your blood glucose values remain persistently over 300 mg/dl or you experience extreme thirst, nausea/vomiting, or dehydration, seek out urgent medical care.

What should I eat when the usual foods are not available?

• The best food options for people with diabetes are a combination of high fiber carbohydrates, colored vegetables, and lean proteins. Less desirable options are simple sugars and white starches and fried foods.
• If you are traveling, some safe options are  nut butters (assuming you have no nut allergies) with high fiber crackers; canned meats or fish such as tuna, salmon, or chicken, canned vegetables like string beans; low sodium canned soups;  hard boiled eggs (if you have refrigeration available). You should always have something with you  to treat episodes of low blood sugar, such as boxed juices (or even sugar packets).
• Disaster shelters, such as those operated by the American Red Cross, often have heated prepared meals. We recommend meals that offer a combination of protein and colored vegetables when possible. Limit starches to one cup per meal and try to avoid simple sugars.

If you have  little or no choice and options, remember that it is better to eat multiple small meals of high carbohydrate products (like pasta, rice, or bagels)  than one or two very large meals. If at all possible, try to combine high carbs with some type of protein. In the end, though, it is better to eat something than nothing.