Diabetics After the Apocalypse
People are fascinated by their own destruction, and diabetics are no exception.
More particularly, people are fascinated by society’s hypothetical destruction, and what human life would look like afterwards. Books, movies, and video games that depict post-apocalyptic worlds are often successful (financially if not artistically), and it’s easy to see why: there’s an undeniable appeal to imaginatively putting yourself in such a bleak, dangerous world and moving around in it.
Perhaps this is because we know that industrial civilization has choked the mystery out of the world, and a post-apocalyptic landscape is the most plausible version of a world in which we’d be able to confront something unknown again.
Industrial civilization, however, has also kept Type 1 diabetes from becoming a private, miniature apocalypse for its sufferers (it was such an apocalypse for most of human history). The thing that draws us to imagine the apocalypse is also the thing that keeps us (diabetics) alive. It’s a tough paradox. If civilization failed, if the medical scaffolding around diabetic life fell away, I suspect diabetics would be screwed.
But how screwed? This is something I think about fairly often. How long would I, a Type 1 diabetic, survive after an apocalypse? If insulin supplies dwindled to nothing, how long could I run around hunting rats, squabbling with other looters and training an army of dogs to do my bidding? How long would it take before I became an unusually sweet snack for cannibals? This all depends, of course, on the human body’s capacity to survive without any insulin.
Before I talked to anyone about this subject, I knew that a diabetic would die pretty quickly without insulin, but I assumed that there were things you could do to stretch out your final days, perhaps turning them into weeks or months. Maybe it would help to avoid carbohydrates completely?
This line of thinking is fairly old. Before the discovery of artificial insulin, some physicians put their diabetic patients on a starvation diet, which would extend the patients’ lives up to a year. Apollinaire Bouchardat, a French doctor, figured this out at the end of the nineteenth century, and scored some genuine successes with respect to extending his patients’ lives.
This method couldn’t really save anybody, though — without insulin, the glucose in your blood grows more and more concentrated, poisoning you. Insulin is the only antidote. Even if you eat nothing, your body metabolizes itself, breaking down fat and muscle into simple sugars. Sweet poison pools in your limbs and you die.
So, in an apocalypse scenario, would a starvation diet (or near-starvation diet) buy you a little time? Probably not. Starvation diets sort-of-kind-of worked because the patients were new patients; that is, their diabetes was fresh and they still had some undestroyed beta cells producing a little bit of insulin.
For folks who’ve had diabetes for years, it’s unlikely that any beta cells are still around to help in a post-apocalypse scenario.
Wil Dubois wrote a nice article (“Our Lifespan Sans Insulin”) in which the implications for post-apocalyptic diabetics are not cheerful: once your body contains no insulin at all, hyperglycemia and Diabetic Ketoacidosis (DKA) will set in within one or two days. Once you’re in DKA with no access to medical treatment, the longest you can reasonably expect to survive would be a few days. Two weeks at the absolute most.
So, on the surface, the prospects for the post-apocalyptic diabetic don’t look good. Fine. Are there any other options?
Why not do what Frederick Banting did? He pureed a dog’s pancreas, and injected that into his patients (you’d need to loot some syringes). It was a little primitive, sure, but it worked! Besides, this is the apocalypse we’re talking about; you’ll do what you have to do.
Let’s lay off of dogs, though, and consider animals that are harder to anthropomorphize, like pigs and cows, and puree their organs. Would that work? Maybe you could invent a sort of tube that travelled from a living pig’s pancreas into your bloodstream. The pig would follow you around, and you’d both look very cool, connected by the tube, and very intimidating, sharing insulin.
I asked my brother, a biomedical engineer studying diabetes in Denver, about the pig idea, and surprisingly, he did not say, “You’re an idiot.” He gave me some serious advice regarding how a diabetic might survive in an apocalypse, and then told me gently, “I don’t think ‘magic pigs’ are a legit option.”
Okay, fine, so magic pigs are out. I still think it would be a good look.
His serious advice was this: stockpile insulin, find a way to keep it cool, get lots of exercise, avoid unnecessary carbs, and hope for the best. Stockpiling insulin might be difficult unless you begin early. Keeping your insulin cool could be problematic, depending on the climate, but there are nice cool caves most places, so you could stash the precious stuff underground.
I imagine “getting enough exercise” wouldn’t be a problem, post-apocalypse. The problem would be avoiding exhaustion. Your diet would consist mostly of pigs, which (I assume) apocalypses are full of. This would be good: lots of protein.
It’s unlikely that any of this will become pertinent in our lives. For that I’m grateful. Still, stuck in the comfort of the modern world, it’s fun to imagine a gang of post-apocalyptic diabetics strolling down a dusty road, eached flanked by his or her magic pig. The image is enough.
Read When a Diabetic Loves a Non-diabetic by Forester McClatchey.