In post-apocalypse fiction, diabetics, if they are ever even mentioned, are typically portrayed as utterly, irrevocably screwed. In fact there was a pretty cynical example in Dies The Fire (a book about technology magically ceasing to function forever) where there was a Mormon couple who both had diabetes because their entire narrative purpose was to stockpile a lot of resources the heroes could use (Mormon) and then die so the heroes could use them (diabetic).

But suppose the hero, or at least one of the main characters, of a post-apocalyptic story was diabetic, and one of the main driving motivations in the story was to keep this guy alive. One thing I’ve been really interested in figuring out is if it can be done.

I’ve done some research about this due to an interest in having a diabetic character in my story that will eventually become post-apocalypse, and what I learned was that there’s a starvation diet you can use to keep a diabetic person alive (if just barely) for about a year or two with no insulin, and I also learned that there’s a complicated chemical process you can use to turn chopped livestock pancreases into homemade insulin. But none of the resources I could find gave any hint at what kind of scale or effort it would take to keep this going, how much insulin you got out of a single pig or cow, how much land it would take to keep a sustainable livestock population, whether or not the chemicals and alcohol were possible to obtain more of once stockpiles and scavenging run out, or what equipment it required to operate.

Suppose some determined type-1 diabetic doomsday prepper set out to design and build a completely off-the grid compound that could, completely without assistance from the power grid, water facilities, or supply networks of civilization after it’s been built, keep a single diabetic alive, and feed, water and house him/her and as many people as it would take to maintain such a compound. What, bare minimum, would such a compound need to have, how big would it be, and how many people would it take to run it?

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    "post-apocalypse" is a phrase that covers an immensely broad set of conditions. Please specify, exactly, the conditions of the question. Is all manufacturing gone and we're down to individuals wandering a wasteland? Does manufacturing exist in small areas? Are cities operable? Has high-tech been lost? Etc., etc., etc. Insulin manufacture is easily researched via Google. What about that research led you to ask this quesiton? Or did you not do any research? – JBH Nov 18 at 15:12
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    Of course not. Was 99% of the population affected? 1%? Something in the middle? Are research/manufacturing facilities in smaller areas viable? How hard is it to kill your zombies? Etc. You (the author) can create a world-condition in which insulin cannot possibly be made, and you can create one wherein insulin is easily made. Without the specifics, the question is POB at best, too story-based at worst. – JBH Nov 18 at 15:19
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    I truly don't understand this question. Insulin production is easily researched. Basically, most insulin is extracted from the pancreases of pigs and cows and then purified using advanced chemistry; and a smaller but significant quantity is produced from genetically modified bacteria or yeasts. While insulin can be synthesized chemically, the process is not used commercially because very costly. So the question has two obvious answer: either the "compound" is a country with several million people, or else the "compound" is a large refrigerator full of insulin vials. – AlexP Nov 18 at 15:50
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    Yup. And insulin works in Type 1 diabetes only; Type 2 diabetics are, as you put it, screwed, even with modern infrastructure. The good news is that you don't really need up-to-date modern infrastructure to purify insulin; WW1-era infrastructure, or even late 19th century infrastructure, is enough if one knows what they are doing. On the other hand, keeping diabetics alive works in the modern world because pigs are very cheap; what's the price of a pig in this post-apocalyptic world? – AlexP Nov 18 at 15:57
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    @AlexP - Your information is outdated, at best. The substantial majority of modern "insulin" is genetically-engineered insulin analogs. Animal-derived insulin is primarily used as a low-cost alternative, at least in the developed world. And type 2 would be a relatively small issue in most post-apoc settings because physical exercise greatly increases insulin sensitivity, which is the primary issue in type 2. This would also substantially reduce the insulin required by people with type 1 - and could lead to major issues with hypoglycemia until you've adjusted for it. – Dave Sherohman Nov 22 at 9:47
up vote 8 down vote accepted

Many Type II diabetics use insulin and others may use different medications that affect insulin production and use but in a slower way. Diet works in most people here. Eat very lowcarb. It's not "starvation."

Type I diabetics don't produce insulin and require it to metabolize their food. A very lowcarb diet (again, not starvation) can greatly reduce the need for insulin so any existing stockpile or new supply will last much much longer.

I'm going to assume your question is about Type I (though your question in its current form does not specify).

https://www.ncbi.nlm.nih.gov/pubmed/9416027 (abstract)
https://journals.sagepub.com/doi/abs/10.1177/014572179702300603 (first page of full text)

Fat doesn't change blood glucose levels. Protein doesn't either, but protein in excess of need will convert in part to glucose in the body. This article suggests that, in the presence of adequate insulin (regardless of if it is naturally produced or supplemented from the outside), protein intake will not affect blood glucose. It's unclear what the effects of protein are in people who do not have any insulin (I can't read the full article).

While it's true that diabetics before the invention of insulin supplementation found it hard to maintain themselves by diet alone, a lot of that was because it took a long time for diagnosis and to realize the importance of diet and the details of how to implement it. In the case of someone who is already diagnosed and who has enough insulin on hand for a transition, that may make it possible.

Now, people living in a world where food resources are scarce, may not have the luxury of choosing their diet. Carb-heavy foods like grains and legumes are the easiest to store.

In this article: http://www.jbc.org/content/106/1/305.full.pdf
The authors found that fetal cows yielded around 30 IU of insulin per gram of pancreas (I am not sure of the weight of the pancreas per animal).

It's a myth that the only source is pigs. That's just what happens to be used commercially. One article says that fish pancreas yields more insulin, but of course extraction would be difficult.

I am not sure how much of the full process you'd need to use to get the insulin. Mostly it is alcohol and acetic acid, both of which are easy enough to make from food stuff, if those versions will work. It's also possible you simply need to eat the fresh pancreas.

Dried pancreas has less insulin (though I didn't come across numbers) but it can also be stockpiled. Raid a health food store's supplement department.

So my guess is a compound with enough space, water, and pasture for a herd of cattle and some other animals, a garden area to grow healthy low-starch vegetables, and enough people to maintain it, is what you need. I'd say you want something large enough that you're not dependent on a couple of animals. You need a herd so they're self-sustaining. Use milk, eggs, and meat as the mainstays of the diet, along with leafy greens and other lowcarb veggies. Farm some grains and legumes to supplement the animals' diets in winter (in cold areas) or summer (in Mediterranean climate areas) and to feed the non-diabetic humans.

So...maybe 20+ cows in 40 acres of pasture (using rotation to grow extra hay), 5 acres to grow grains and vegetables for 25 people, add on an acre or 3 to feed poultry, a milk cow or two, maybe a fish pond. And another acre to house your people and supplies. These numbers are approximate because this is your research, not mine.

Sources:

USDA: 11 beef cows per 20 acres.

Quora: "One acre of wheat, producing 50 bushels in a year (assuming only 1 crop season), could sustain about 2,250 people for a day (eating only bread), or 6.2 people for a year."

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    "It's also possible you simply need to eat the fresh pancreas": insulin cannot be taken by mouth, because it will be hydrolized in the stomach. The search for a form of insulin which can be taken by mouth is on-going, with pharmaceutical firms spending large amounts looking for this Holy Grail -- any company which develops a form of insulin which can be taken by mouth is certain to reap immense profits. – AlexP Nov 18 at 18:07
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    Cows are unlikely to be ideal unless operating in a huge community. Small animals which would be slaughtered on a regular basis (rather than once in a rare while) would likely be better for providing a consistent supply of pancreas for extraction (go for more stable supply in smaller quantities instead of enormous supplies needing processing but available rarely). – pluckedkiwi Nov 19 at 16:26
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    AlexP: Thank you for the correction. Pluckedkiwi: Yes, I agree, but the only doc I found with actual numbers was for cows, so I used them in my example. OTOH, if processing is difficult and there's no refrigeration (drying diminishes the insulin levels), doing large infrequent batches might be the better option. With more research, the OP can make decisions about the best animals to use and then form a community around that. – Cyn Nov 19 at 17:38
  • Thanks a lot for this, this is really helpful! Though while it's encouraging to know it's at least possible, knowing how major an operation it is is making me reconsider who exactly in the story is going to have diabetes, since it feels like it'd be pretty attention-consuming regarding both the setting and the plot, even more so than I thought it would be. – Jason Clyde Nov 19 at 21:51
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    I hope you can make it work. Too often people with disabilities are simply left out of the conversation. Or they have some disability that "doesn't stop them" and has the magical quality of having zero effect on their lives. I love that you're thinking about how to include disability in your world. – Cyn Nov 19 at 22:32

Eva Saxl produced extracted insulin in occupied Shanghai using something like this process. As you can see there are a lot of specific chemicals, I think society with population about some 100s of thousands people and 19th century technology would manage it. Or just people having access to per-apocalypses store of chemicals.

Recombinant insulin was the first human hormone produced massively by genetic engineering, in E. Coli (originally, 1973). And currently it is also produced in beer yeast (since 1987).

What would it take? To preserve a working human insulin yeast. Maybe not the current, but a more advanced and easy to use one.

Do you know kefir? It is an ancient drink made with an ancient microbiota (equilibrium between microbiological lifeforms). Imagine the same, but with insulin.

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    That's actually a good point. Even though the post-apoc people wouldn't have the technology to do the genetic engineering themselves, they may still have the ability to keep existing insulin-producing microbes alive and producing. – Dave Sherohman Nov 22 at 9:57

the old fasioned way

The old fashioned way of harvesting insulin is to take it from the pancreas of livestock like sheep or pigs.

All it requires is medical knowledge and syringes. Gotta do it right or your body will reject it and immune system will freak out and kill you.

https://www.diabetes.co.uk/insulin/animal-insulin.html

In many ways this would be easier and safer than maintaining and processing a microbial supply of insulin. Requires lots of knowledge across multiple fields with lots of steps that can go wrong.

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