Manage diabetes, asthma, heart conditions, and epilepsy when normal healthcare is disrupted — ration medication, recognise emergencies, improvise management, and plan ahead.
In the United States alone, more than 130 million people live with a chronic health condition — diabetes, heart disease, asthma, epilepsy, hypertension, and others. During a disaster or prolonged emergency, the supply chains, pharmacies, and healthcare access that keep these conditions managed can collapse simultaneously. The 2005 Hurricane Katrina response revealed this gap catastrophically: more people died from preventable chronic disease complications in the weeks after the storm than from the initial flood.
Managing a chronic condition during a crisis is not about improvising from scratch. It is about planning before the emergency, knowing the warning signs that indicate a manageable situation is becoming life-threatening, understanding how to ration and stretch limited medication supplies, and knowing when to seek emergency care even when access is difficult.
Approximately 37 million Americans and 400 million people globally have diabetes. The condition requires either insulin (Type 1, and some Type 2) or oral medications — along with the ability to monitor blood glucose and maintain food/fluid intake. All of these can be disrupted in a crisis.
Unopened insulin should ideally be refrigerated. Once opened, many insulin formulations are stable at room temperature (below 25°C/77°F) for 28–30 days. In a heatwave or tropical climate, this window shortens significantly.
Improvised cooling:
Recognise: shakiness, sweating, confusion, pale skin, rapid heartbeat, hunger, headache.
Immediate treatment:
Severe hypoglycaemia (unconscious or unable to swallow):
DKA develops when there is insufficient insulin and the body breaks down fat for energy, producing acidic ketones. It is life-threatening without insulin.
Signs: extreme thirst, frequent urination, nausea/vomiting, abdominal pain, fruity-smelling breath, confusion, rapid deep breathing.
Field response: If insulin is available, administer per the person's prescribed protocol. If insulin is unavailable, this is a medical emergency — seek hospital care urgently. Hydration (water, not sugary drinks) can slow progression slightly but does not treat the underlying cause.
In an insulin shortage, some Type 2 diabetics can manage for days on oral medication alone while reducing carbohydrate intake significantly. This is a temporary measure only — medical consultation should occur at the first opportunity.
Type 1 diabetics cannot survive without insulin. Any shortage for a Type 1 diabetic is an emergency that requires active pursuit of medical resources.
An estimated 235 million people worldwide have asthma. In a crisis, triggers multiply: smoke from fires, dust from collapsed buildings, mould from flooding, stress, cold air, and exercise. Supply of inhalers may be interrupted.
Mild to moderate: wheeze, cough, chest tightness, shortness of breath; speaking in sentences; peak flow 50–80% of personal best.
Severe/life-threatening: speaking in words only; sitting forward; using accessory muscles to breathe; unable to complete a sentence; peak flow below 50%; silent chest (no wheeze heard — very severe, air movement almost stopped).
Improvised spacer: If the spacer is lost, a 500 ml plastic bottle with a hole in the base where the inhaler fits can serve as a substitute — this significantly improves drug delivery compared to inhaler alone.
Preventer inhaler: Encourage continuing the preventer (corticosteroid — usually brown/purple/orange inhaler) even if the reliever is overused — preventing attacks is more valuable than treating them.
If inhaler supply is running low:
People with heart failure, angina, arrhythmias, and post-heart-attack require regular medications (beta-blockers, ACE inhibitors, anticoagulants, antiarrhythmics). Missing doses has consequences ranging from manageable to life-threatening.
| Medication Class | Risk of Abrupt Stopping |
|---|---|
| Beta-blockers | Rebound tachycardia, angina, risk of heart attack |
| Anticoagulants (warfarin, DOACs) | Increased clot and stroke risk |
| Antiarrhythmics | Return of dangerous arrhythmia |
| ACE inhibitors/ARBs | Blood pressure may rise sharply |
If medications run out, reduce doses gradually rather than stopping suddenly when possible, and seek medical advice at the earliest opportunity.
These require emergency services regardless of crisis conditions.
Stress, sleep deprivation, irregular medications, and flashing lights (fires, emergency lighting) can all trigger seizures. During a crisis, the combination of all four simultaneously creates heightened seizure risk.
Call emergency services if:
Do not skip doses — anti-epileptic medications have specific therapeutic levels that must be maintained. Missing even one dose significantly lowers the seizure threshold for many people. Medication should be one of the first items prioritised in a pre-crisis preparation kit.
Regardless of the specific condition, everyone with a chronic health condition should have:
| Preparedness Item | Detail |
|---|---|
| 30-day medication supply | Rotated regularly to maintain freshness |
| Written medication list | Names, doses, prescribing physician, indication |
| Medical ID | Bracelet, card, or phone health profile |
| Copy of prescriptions | For emergency dispensing |
| Knowledge of generic names | Brand names may not be available universally |
| Emergency contact for physician | Direct line if possible |
| Condition-specific supplies | Glucose tablets, spacer, glucagon kit, etc. |
| Condition | Crisis Emergency Sign | Immediate Action |
|---|---|---|
| Diabetes — hypoglycaemia | Shaky, sweating, confused | 15–20g fast carbohydrate; repeat if no response |
| Diabetes — DKA | Fruity breath, deep breathing, vomiting | Insulin if available; emergency care urgently |
| Asthma — severe attack | Words only; silent chest; peak flow <50% | 6–10 puffs salbutamol; emergency services |
| Cardiac — chest pain | Pressure/pain + radiation | Emergency services; aspirin 300mg if prescribed |
| Epilepsy — prolonged seizure | Over 5 minutes | Emergency services; recovery position after |
| Any medication run out | Critical medications | Seek emergency prescription; do not stop abruptly |
This guide provides general guidance for chronic disease management during emergencies. It does not replace personalised medical advice. People with chronic conditions should discuss emergency management plans with their healthcare providers before a crisis occurs.
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