Diabetes and the End of the World – Part 2 – Blood Sugar Monitoring

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The following is excerpted from my upcoming book, Armageddon Medicine.

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Basically there are two kinds of diabetes:  the kind that can kill you quickly and the kind that won’t.  Most people in the first category have Type I, insulin-dependent diabetes.  A few have advanced Type II, insulin-dependent diabetes.  Without medication, these patients will experience extremely elevated blood sugar levels, leading to coma and death. 

Fortunately, most diabetic patients are in the second group.  Without medication their blood sugar levels may increase to 200, 300, or even 600, but they won’t soar to 1,000 and become rapidly fatal.

At the end of the world as we know it, the outlook for truly insulin-dependent diabetics is fairly grim.  Although insulin may be potent a year, possibly a few years, beyond the printed expiration date under recommended storage conditions, a new source of insulin must be established by the time these supplies run out.  Currently all insulin in the United States used on human patients is genetically-engineered human insulin.  Until the 1990s insulin derived from animal sources (cows or pigs) was prescribed for both humans and pets.  Nowadays human insulin is the mainstay of diabetic treatment for cats and dogs as well as human beings, although one manufacturer is currently producing bovine insulin for use in cats.  This is good news – the art is not lost, although neither your doctor nor pharmacist is the least bit likely to be ready to duplicate the process.  In an Armageddon event, insulin production would likely revert to manufacturing the drug from animal sources until genetically-engineered insulin is again available.  (One veterinary pharmacist apparently figured out to compound bovine insulin on her own by studying old patents.) 

For Type II diabetics the situation is much less critical. However, some Type II diabetics do end up on insulin as the pancreas loses the ability to manufacture insulin.  Most Type II diabetics actually produce more insulin than non-diabetics produce, due to insulin resistance, requiring higher levels of insulin to regulate elevated blood glucose.  In the long run, this stresses the pancreas, essentially causing it to wear out. 

Fortunately some diabetics can reverse this process with significant weight loss and careful dietary monitoring.  For the typical overweight Type II diabetic whose pancreas is still functioning to some extent, caloric restriction either now or in times of scarcity may result in an improvement or even resolution of the diabetic condition.  In short, if you’re overweight and diabetic, lose weight now and preserve your pancreas.  Otherwise you may find yourself in the same boat as Type I insulin-dependent diabetics. 

In the past few decades the goal of diabetic treatment has changed, focusing on tighter blood sugar control to prevent long-term complications.  With this in mind, the definition of diabetes is currently a fasting blood glucose level of 126 mg/dL or higher.  However, years ago the cut-off was 140 mg/dL, and any practicing physician can tell you that many patients experience no apparent symptoms even at blood sugar levels of 300. 

In a scenario where blood sugar levels cannot be easily monitored, reverting to older treatment goals and regimens is likely.  Of course you should stock up now on blood glucose testing supplies: monitors, lancets, batteries, and test strips.  In times of scarcity you should minimize your testing regimen to preserve your cache.  Patients on metformin or acarbose alone run very little risk of low blood sugar levels, and blood glucose testing done only monthly or quarterly may suffice.  Patients on sulfonylurea drugs and other medications that can cause hypoglycemia may require closer monitoring. 

But the question remains, what will you do when you run out of testing supplies?

One of the oldest methods of monitoring diabetes is via frequency of urination.  Diabetes mellitus actually means run-through honey, that is, what a person eats seems to run right through them, coming out in the form of sweet urine, which may be sticky or even taste like honey.  Normally the kidneys will reabsorb all the sugar from the blood being filtered of impurities.  However, at high sugar levels (above 200 or 300 mg/dL) the kidneys are unable to absorb all the glucose; hence some is excreted in the urine.  Sugar in the urine acts as a diuretic (water pill), causing increased urinary volume and frequency. 

Because patients with high blood sugars and resultant excess urination lose calories (as sugar ‘runs-through’ the body), weight loss results (unless you live in America where the calories can be easily replaced).  Except where food as unlimited, for many overweight Type II diabetics this can be seen as a stabilizing mechanism:  caloric loss leads to weight loss, which leads to lower body mass index, which may lead to decreased blood glucose levels and a decreased insulin requirement.  (Beware:  this mechanism does not function in Type I or insulin-dependent Type II diabetics, whose blood sugar will rapidly increase to dangerous levels.) 

I know of no doctor who has actually tasted a patient’s urine (I certainly haven’t), but doing so is one possible test for diabetic control.  A motivated prepper might want to determine at what blood sugar level his kidneys tend to ‘spill’ glucose into the urine.  This is fairly easy to do, but I suggest you discuss the plan with your doctor before attempting the experiment.  One simply allows one’s blood sugar to increase (usually by withholding medication temporarily), meanwhile monitoring blood sugar levels and urinary glucose levels.  For example, at a blood sugar of 150 mg/dL you’re unlikely to find any glucose in the urine on dipstick testing.  However, by the time your blood glucose level reaches 300, you probably will.  Tasting the urine at these various levels may also give a clue as to whether the kidneys are leaking sugar. 

The whole concept of tasting one’s urine probably motivates the reader to stock up on home blood sugar testing supplies.  Currently test strips out-date within a short period, at most a few years.  However, if stored as directed in the original unopened packaging, they may well be stable significantly longer.  Some strips may also have a color-code to allow you to visually estimate your blood sugar level if your meter is not working.

Monitoring frequency and volume of urination is also useful.  Elevated urinary sugar levels cause increased frequency due to increased urine volume.  In contrast, urinary infections cause increased frequency, usually of small volumes, due to irritability of the urinary tract.  A person who finds himself getting up at night with a full bladder or urinating several times a day may well have uncontrolled diabetes.  Weighing yourself periodically is another method of determining your fluid loss.  A pint of water weighs a pound, and increased urinary losses will soon show up on a scale.  Make sure you have the old type of scale on hand, one that requires no battery.  A good balance scale should last you the rest of your life. 

Copyright © 2010 Cynthia J. Koelker, MD

NEXT – diabetic medications to consider at TEOTWAWKI

Also, related articles in my book, 101 Ways to Save Money on Health Care

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