March 3, 2010 -- Stranded in Santiago, Chile, after the earthquake Saturday, "American Idol" alum and diabetic Elliott Yamin said he feared for his health after he realized he did not have enough insulin to treat his Type 1 diabetes while he waited for a flight home.
"I only packed enough to get me to Sunday," he said, when his flight was supposed to leave for the United States.
Given the interruptions to medical care and supply transport caused by the earthquake, many other diabetics may be facing the same life-threatening dilemma, said Dr. Vivian Fonseca, chief of section of endocrinology at Tulane University.
Yamin said he has been able to get a six-day restock for his insulin pump through the U.S. Embassy and the manufacturer of the pump that he hopes will last him until he is able to get a flight.
The airport in Santiago reopened Monday, according to Yamin, but flights are currently only carrying supplies in, not people out.
The earthquake, which has already led to death tolls over 700, may result in longer-term health complications without adquate medical care and aid, Fonseca said.
"The important thing now is getting emergency supplies, testing kits and insulin, to victims on the ground," he said, because "for those with Type 1 diabetes, running out of insulin becomes extremely dangerous within a day or two.
"Obviously injured people need attention as well," he said. "But people tend to put on a back burner those with chronic disease like diabetes."
Managing the Aftermath
Fonseca chaired the American Diabetes Association task force on disaster management following Hurricane Katrina and he said the organization has "learned a lot from Katrina" about the difficulties facing those with diabetes after natural catastrophes.
"Caring for diabetes on a daily basis demands constant attention in the best of times [and] despite the best planning, many aspects of the health care 'system' can be rapidly interrupted in a disaster," Fonseca and the other authors wrote in an ADA statement following Katrina.
"Physician's offices and pharmacies close due to evacuation, ... major medical centers may be inaccessible, ... loss of electric power, telephones, and other means of communication and closure of roads ... add to the complexity," the ADA statement said.
And amid the chaos following a natural disaster, diabetic needs can jeopardize life within hours after a lack of insulin, experts say.
While for those with Type 2 diabetes, complications are slower to progress and less life-threatening, for those with Type 1 diabetes, the body makes almost no insulin and things get risky rather quickly, Fonseca said.
For those taking insulin shots, that can happen within 24 hours, said Dr. Charles Clark Jr., director of the WHO/PAHO Diabetes Collaborating Center for Continuing Health, and for those with an insulin pump, like the one Yamin uses, running out would pose a threat much sooner.
What's more, in situations of extreme stress, blood glucose control can be further depressed, leading diabetics to need even more insulin than usual, Fonseca said.
"Stress hormones can cause blood sugar levels to be erratic and these physiological changes combined with lack of good access to food and water" can complicate matters, said Dr. Amir Afkhami, assistant professor of psychiatry and global health at George Washington University.
Back-Up Plan Buys Time for Diabetics
There is little a Type 1 diabetic can do to "stretch out" limited supplies, said Dr. Joshua Cohen, associate professor of medicine at the George Washington University Medical Center.
"Insulin [shots are] an absolute necessity," otherwise within hours, a patient can develop ketoacidosis, when the patient's body, unable to process glucose, breaks down fat, leading to dehydration and electrolyte imbalance, he said.
To help diabetics be more prepared for the health risks that can arise rapidly in emergency situations, the CDC advises keeping a few weeks supply of medication in an emergency kit to buy time until health care systems are back up and running.
The CDC suggests keeping diabetic-appropriate foods, such as peanut butter, cheese and crackers, in this kit as well, to ameliorate some of the problems associated with irregular food supply.
But for the many in Chile who will not have back-up supplies, the key issue now is to get medical aid to victims in Chile, Fonseca said.
This isn't "just a short-term thing," he said. "It affects victims for a long time because health care systems take a long time to get back together fully."
During Katrina, the ADA partnered with the International Diabetes Federation to provide specific diabetic disaster support and Fonseca said he suspects and hopes they will do the same for Chile, though the ADA said that, as of yet, no such plans have been made.
Yamin echoed this need to address conditions in Chile:
"It's been a traumatic experience," he said. "I'll get home when I get home. I just want to encourage everybody to pray for people who are far worse off than I am."