Diabetes Information

I have type 2 diabetes, and my usual medication is taking 2 metformins a day. I have no symptoms if I don't eat, until I get hungry (low blood sugar). If I don't eat when I'm hungry I start to feel shaky and cold, possibly sleepy. If I eat stuff which contains no sugar or starch (for example meat, cheese, and green leafy veggies) I do okay without medication. If I eat stuff with starch or sugar I can tolerate a little but first I get extra thirsty and sleepy (can't win, either too little or too much blood sugar makes me sleepy and I would be screwed if I couldn't sleep 10 hours a day), then if I've had too much I get a headache and might faint. If he's got blood circulation problems he might also have slow-healing wounds and particular danger from foot wounds such as blisters or frostbite.

Here's what I know about my diabetic friend.

He can only have a certain amount of carbs a day. He has to eat this amount of carbs on a very strict schedule or his blood sugar could plummet. He also has to take small injections of insulin with every meal. He has to take a very large injection of insulin once a day because his pancreas is slowly failing.

If he doesn't get enough carbs/the insulin on a good schedule, his blood sugar will plummet and he will go into a diabetic coma. He would die from that.

Understanding the science may help.

There are two important hormones in regulating blood sugar.
Insulin removes sugar from your blood and stores it. A healthy pancreas releases insulin after a meal to stop sugar levels getting too high.
Glucagon releases sugar from your stores to your bloodstream so you can use it between meals or at times of starvation.

Textbook diabetes means the body either doesn't release insulin or doesn't respond to it. Broader pancreatic problems may have different consequences. Most people with diabetes make glucagon ok.

The "treatment" for diabetes is to eat sensibly to prevent wild swings in blood sugar and artificially provide either insulin or a tablet to reduce blood sugar at mealtimes.

Eating too much sugar and not taking your treatment can lead to high blood sugar and that can be dangerous.....confusion, coma, death

Eating too little sugar AND taking your treatment leads to low blood sugar and is dangerous....confusion, coma, death.

In the situation you describe, assuming your character understands their diabetes, then they'll know that it's dangerous to take their treament and not eat, or to eat a lot and not take treatment.

It's safer (not completely safe) to eat their rations as sensibly as they can....small but regular portions, and if food is limited, to consider not taking their treatment. Assuming their glucagon production is ok, then their body will release glucagon to try to raise their blood sugar if levels are too low, and small, sensible, regluar portions are unlikely to send blood sugar too high.

Now, throw in the level of activity needed to try to escape the cave (burning up precious sugar) and you have an unpredictable situation, but your answer may be as boring as...................nothing will happen if they eat sensibly, omit their treatment and pace their physical activity until they run out of food, then their problems will be the same as you or I would face due to lack of food.

The two worst things they could do are:

1 Take their treatment, push themselves too hard and eat too little....then they could have dangerously low blood sugar and onset of coma within a few hours.

2. Miss their treatment and eat too much and they could be looking at high blood sugar, confusion and coma within a day.

Craig