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BT 15.000 718.042 Td /F2 21.0 Tf  [(The Great East Japan Earthquake: Experiences and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Suggestions for Survivors with Diabetes \(perspective\))] TJ ET
Q
0.271 0.267 0.267 rg
BT 15.000 675.088 Td /F3 9.8 Tf  [(May 15, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 78.638 675.088 Td /F3 9.8 Tf  [(Discussion)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Miyako Kishimoto)] TJ ET
0.271 0.267 0.267 rg
BT 102.641 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.062 663.247 Td /F1 9.8 Tf  [(Mitsuhiko Noda)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Kishimoto M, Noda M. The Great East Japan Earthquake: Experiences and Suggestions for Survivors with Diabetes )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(\(perspective\). PLOS Currents Disasters. 2012 May 15 . Edition 1. doi: 10.1371/4facf9d99b997.)] TJ ET
q
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BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(The Great East Japan Earthquake and the subsequent tsunami that occurred in the afternoon of March 11, 2011, destroyed )] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(large parts of Japan�s Tohoku district. Owing to the unfavorable living environment, many diabetic patients in the refuges lost )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(control of their blood glucose levels, and in addition, the high-calorie food provided led to severe postprandial hyperglycemia. )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(We recommend that diabetic patients keep personal stocks of medical supplies and the medication that they require daily, as )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(well as records of their medication. We also recommend the creation of basic guidelines to facilitate the practical prescription of )] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(medication for diabetic patients under various conditions that may arise in the aftermath of a natural disaster.)] TJ ET
BT 26.250 494.255 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 474.300 Td /F1 9.8 Tf  [(The authors received no specific funding for this article.)] TJ ET
BT 26.250 445.198 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 425.244 Td /F1 9.8 Tf  [(In the afternoon of March 11, 2011 in Tokyo, we experienced a sudden, strong earth tremor. The floor kept rolling, and people )] TJ ET
BT 26.250 413.339 Td /F1 9.8 Tf  [(were unable to remain standing. This earthquake reminded us of the Great Hanshin-Awaji \(Kobe\) earthquake in 1995 \(M6.9\) )] TJ ET
BT 26.250 401.434 Td /F1 9.8 Tf  [(that killed more than 6400 people and left us deeply scarred. Soon after the quake, what we saw on television broadcasts was a )] TJ ET
BT 26.250 389.529 Td /F1 9.8 Tf  [(manifestation of hell on earth: many houses and cars were swept away by the giant tsunami and nothing but devastated farms )] TJ ET
BT 26.250 377.625 Td /F1 9.8 Tf  [(and residential areas were left behind in large parts of the Tohoku district. To make matters worse, the Fukushima nuclear )] TJ ET
BT 26.250 365.720 Td /F1 9.8 Tf  [(power plant experienced a leak)] TJ ET
0.267 0.267 0.267 rg
BT 161.190 367.227 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 166.009 365.720 Td /F1 9.8 Tf  [( . This massive earthquake with a magnitude of 9.0 was named the Great East Japan )] TJ ET
BT 26.250 353.815 Td /F1 9.8 Tf  [(Earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 76.112 355.322 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 80.930 353.815 Td /F1 9.8 Tf  [(. The disaster left tens of thousands homeless, and many people had to evacuate to refuges. In the end of April )] TJ ET
BT 26.250 341.910 Td /F1 9.8 Tf  [(2012, more than a year after the earthquake, the death toll is over 15,800, and more than 3,000 people are still missing)] TJ ET
0.267 0.267 0.267 rg
BT 538.944 343.418 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 543.763 341.910 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 305.308 Td /F4 12.0 Tf  [(Observations)] TJ ET
BT 26.250 285.354 Td /F5 9.8 Tf  [(Our experiences in the affected area)] TJ ET
BT 26.250 265.949 Td /F1 9.8 Tf  [(The National Center for Global Health and Medicine \(NCGM\) of Japan immediately sent the Disaster Medical Assistance Team )] TJ ET
BT 26.250 254.044 Td /F1 9.8 Tf  [(\(DMAT\), a group of professional medical personnel trained to provide rapid-response medical care, to Sendai in Miyagi )] TJ ET
BT 26.250 242.139 Td /F1 9.8 Tf  [(prefecture of the Tohoku district, one of the affected areas. DMAT had completed its activities by March 16; thereafter, the )] TJ ET
BT 26.250 230.235 Td /F1 9.8 Tf  [(NCGM�s medical support teams, composed of four to six members including doctors, nurses, pharmacists, clinical )] TJ ET
BT 26.250 218.330 Td /F1 9.8 Tf  [(psychologists, and clerical staff were sent every two days. By the end of June 2011, more than 250 NCGM personnel from 51 )] TJ ET
BT 26.250 206.425 Td /F1 9.8 Tf  [(teams had carried out their tasks in the affected area, in cooperation with local public health nurses. Unlike the Hanshin-Awaji )] TJ ET
BT 26.250 194.520 Td /F1 9.8 Tf  [(quake, in which most of the casualties were due to the collapse of structures and subsequent fires, the tsunami itself caused )] TJ ET
BT 26.250 182.616 Td /F1 9.8 Tf  [(most of the casualties. Therefore, the medical support teams were expected to provide care to patients with chronic diseases )] TJ ET
BT 26.250 170.711 Td /F1 9.8 Tf  [(such as diabetes, hypertension, respiratory diseases, and mental diseases, rather than patients with acute diseases, for which )] TJ ET
BT 26.250 158.806 Td /F1 9.8 Tf  [(the DMAT had provided treatment. The medical team made a round of visits to the refuges of Higashimatsushima City in Miyagi )] TJ ET
BT 26.250 146.901 Td /F1 9.8 Tf  [(prefecture and also conducted a health survey for people who resided at home. Initially, we visited 14 refuges every 3 days and )] TJ ET
BT 26.250 134.997 Td /F1 9.8 Tf  [(examined and treated more than 1,110 patients by the end of April 2011.)] TJ ET
BT 26.250 115.592 Td /F1 9.8 Tf  [(After a disaster, conditions such as stress, lack of food or water, extremes of heat or cold, and infection can contribute to rapid )] TJ ET
BT 26.250 103.687 Td /F1 9.8 Tf  [(worsening of a chronic illness that was under control before the event)] TJ ET
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BT 325.390 105.194 Td /F4 8.7 Tf  [(4)] TJ ET
BT 330.208 105.194 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 335.027 103.687 Td /F1 9.8 Tf  [(. For many patients with diabetes, their blood glucose )] TJ ET
BT 26.250 91.782 Td /F1 9.8 Tf  [(control was lost, and their general conditions deteriorated with the unfavorable living environments of these patients. Many )] TJ ET
BT 26.250 79.878 Td /F1 9.8 Tf  [(patients had lost their medication records, and the medical team had no idea what treatments they had received before the )] TJ ET
BT 26.250 67.973 Td /F1 9.8 Tf  [(disaster occurred. Therefore, the team carried a catalog of oral antidiabetic drugs with their photos and an insulin catalog with )] TJ ET
BT 26.250 56.068 Td /F1 9.8 Tf  [(colorful photos, manufactured by the three major insulin companies; these catalogs helped patients to recognize and identify )] TJ ET
BT 26.250 44.163 Td /F1 9.8 Tf  [(their previous medications, to some extent. Even when we could identify the former medication, we sometimes had to change )] TJ ET
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BT 15.000 718.042 Td /F2 21.0 Tf  [(The Great East Japan Earthquake: Experiences and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Suggestions for Survivors with Diabetes \(perspective\))] TJ ET
Q
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BT 15.000 675.088 Td /F3 9.8 Tf  [(May 15, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 78.638 675.088 Td /F3 9.8 Tf  [(Discussion)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Miyako Kishimoto)] TJ ET
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BT 102.641 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.062 663.247 Td /F1 9.8 Tf  [(Mitsuhiko Noda)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Kishimoto M, Noda M. The Great East Japan Earthquake: Experiences and Suggestions for Survivors with Diabetes )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(\(perspective\). PLOS Currents Disasters. 2012 May 15 . Edition 1. doi: 10.1371/4facf9d99b997.)] TJ ET
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15.000 29.878 577.500 607.179 re W n
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BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(The Great East Japan Earthquake and the subsequent tsunami that occurred in the afternoon of March 11, 2011, destroyed )] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(large parts of Japan�s Tohoku district. Owing to the unfavorable living environment, many diabetic patients in the refuges lost )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(control of their blood glucose levels, and in addition, the high-calorie food provided led to severe postprandial hyperglycemia. )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(We recommend that diabetic patients keep personal stocks of medical supplies and the medication that they require daily, as )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(well as records of their medication. We also recommend the creation of basic guidelines to facilitate the practical prescription of )] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(medication for diabetic patients under various conditions that may arise in the aftermath of a natural disaster.)] TJ ET
BT 26.250 494.255 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 474.300 Td /F1 9.8 Tf  [(The authors received no specific funding for this article.)] TJ ET
BT 26.250 445.198 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 425.244 Td /F1 9.8 Tf  [(In the afternoon of March 11, 2011 in Tokyo, we experienced a sudden, strong earth tremor. The floor kept rolling, and people )] TJ ET
BT 26.250 413.339 Td /F1 9.8 Tf  [(were unable to remain standing. This earthquake reminded us of the Great Hanshin-Awaji \(Kobe\) earthquake in 1995 \(M6.9\) )] TJ ET
BT 26.250 401.434 Td /F1 9.8 Tf  [(that killed more than 6400 people and left us deeply scarred. Soon after the quake, what we saw on television broadcasts was a )] TJ ET
BT 26.250 389.529 Td /F1 9.8 Tf  [(manifestation of hell on earth: many houses and cars were swept away by the giant tsunami and nothing but devastated farms )] TJ ET
BT 26.250 377.625 Td /F1 9.8 Tf  [(and residential areas were left behind in large parts of the Tohoku district. To make matters worse, the Fukushima nuclear )] TJ ET
BT 26.250 365.720 Td /F1 9.8 Tf  [(power plant experienced a leak)] TJ ET
0.267 0.267 0.267 rg
BT 161.190 367.227 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 166.009 365.720 Td /F1 9.8 Tf  [( . This massive earthquake with a magnitude of 9.0 was named the Great East Japan )] TJ ET
BT 26.250 353.815 Td /F1 9.8 Tf  [(Earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 76.112 355.322 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 80.930 353.815 Td /F1 9.8 Tf  [(. The disaster left tens of thousands homeless, and many people had to evacuate to refuges. In the end of April )] TJ ET
BT 26.250 341.910 Td /F1 9.8 Tf  [(2012, more than a year after the earthquake, the death toll is over 15,800, and more than 3,000 people are still missing)] TJ ET
0.267 0.267 0.267 rg
BT 538.944 343.418 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 543.763 341.910 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 305.308 Td /F4 12.0 Tf  [(Observations)] TJ ET
BT 26.250 285.354 Td /F5 9.8 Tf  [(Our experiences in the affected area)] TJ ET
BT 26.250 265.949 Td /F1 9.8 Tf  [(The National Center for Global Health and Medicine \(NCGM\) of Japan immediately sent the Disaster Medical Assistance Team )] TJ ET
BT 26.250 254.044 Td /F1 9.8 Tf  [(\(DMAT\), a group of professional medical personnel trained to provide rapid-response medical care, to Sendai in Miyagi )] TJ ET
BT 26.250 242.139 Td /F1 9.8 Tf  [(prefecture of the Tohoku district, one of the affected areas. DMAT had completed its activities by March 16; thereafter, the )] TJ ET
BT 26.250 230.235 Td /F1 9.8 Tf  [(NCGM�s medical support teams, composed of four to six members including doctors, nurses, pharmacists, clinical )] TJ ET
BT 26.250 218.330 Td /F1 9.8 Tf  [(psychologists, and clerical staff were sent every two days. By the end of June 2011, more than 250 NCGM personnel from 51 )] TJ ET
BT 26.250 206.425 Td /F1 9.8 Tf  [(teams had carried out their tasks in the affected area, in cooperation with local public health nurses. Unlike the Hanshin-Awaji )] TJ ET
BT 26.250 194.520 Td /F1 9.8 Tf  [(quake, in which most of the casualties were due to the collapse of structures and subsequent fires, the tsunami itself caused )] TJ ET
BT 26.250 182.616 Td /F1 9.8 Tf  [(most of the casualties. Therefore, the medical support teams were expected to provide care to patients with chronic diseases )] TJ ET
BT 26.250 170.711 Td /F1 9.8 Tf  [(such as diabetes, hypertension, respiratory diseases, and mental diseases, rather than patients with acute diseases, for which )] TJ ET
BT 26.250 158.806 Td /F1 9.8 Tf  [(the DMAT had provided treatment. The medical team made a round of visits to the refuges of Higashimatsushima City in Miyagi )] TJ ET
BT 26.250 146.901 Td /F1 9.8 Tf  [(prefecture and also conducted a health survey for people who resided at home. Initially, we visited 14 refuges every 3 days and )] TJ ET
BT 26.250 134.997 Td /F1 9.8 Tf  [(examined and treated more than 1,110 patients by the end of April 2011.)] TJ ET
BT 26.250 115.592 Td /F1 9.8 Tf  [(After a disaster, conditions such as stress, lack of food or water, extremes of heat or cold, and infection can contribute to rapid )] TJ ET
BT 26.250 103.687 Td /F1 9.8 Tf  [(worsening of a chronic illness that was under control before the event)] TJ ET
0.267 0.267 0.267 rg
BT 325.390 105.194 Td /F4 8.7 Tf  [(4)] TJ ET
BT 330.208 105.194 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 335.027 103.687 Td /F1 9.8 Tf  [(. For many patients with diabetes, their blood glucose )] TJ ET
BT 26.250 91.782 Td /F1 9.8 Tf  [(control was lost, and their general conditions deteriorated with the unfavorable living environments of these patients. Many )] TJ ET
BT 26.250 79.878 Td /F1 9.8 Tf  [(patients had lost their medication records, and the medical team had no idea what treatments they had received before the )] TJ ET
BT 26.250 67.973 Td /F1 9.8 Tf  [(disaster occurred. Therefore, the team carried a catalog of oral antidiabetic drugs with their photos and an insulin catalog with )] TJ ET
BT 26.250 56.068 Td /F1 9.8 Tf  [(colorful photos, manufactured by the three major insulin companies; these catalogs helped patients to recognize and identify )] TJ ET
BT 26.250 44.163 Td /F1 9.8 Tf  [(their previous medications, to some extent. Even when we could identify the former medication, we sometimes had to change )] TJ ET
Q
q
15.000 684.354 577.500 53.646 re W n
0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(The Great East Japan Earthquake: Experiences and )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Suggestions for Survivors with Diabetes \(perspective\))] TJ ET
Q
0.271 0.267 0.267 rg
BT 15.000 675.088 Td /F3 9.8 Tf  [(May 15, 2012)] TJ ET
BT 73.763 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
BT 78.638 675.088 Td /F3 9.8 Tf  [(Discussion)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Miyako Kishimoto)] TJ ET
0.271 0.267 0.267 rg
BT 102.641 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.062 663.247 Td /F1 9.8 Tf  [(Mitsuhiko Noda)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 651.342 Td /F1 9.8 Tf  [(Kishimoto M, Noda M. The Great East Japan Earthquake: Experiences and Suggestions for Survivors with Diabetes )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(\(perspective\). PLOS Currents Disasters. 2012 May 15 . Edition 1. doi: 10.1371/4facf9d99b997.)] TJ ET
q
15.000 29.878 577.500 607.179 re W n
0.271 0.267 0.267 rg
BT 26.250 610.335 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 590.381 Td /F1 9.8 Tf  [(The Great East Japan Earthquake and the subsequent tsunami that occurred in the afternoon of March 11, 2011, destroyed )] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(large parts of Japan�s Tohoku district. Owing to the unfavorable living environment, many diabetic patients in the refuges lost )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(control of their blood glucose levels, and in addition, the high-calorie food provided led to severe postprandial hyperglycemia. )] TJ ET
BT 26.250 554.667 Td /F1 9.8 Tf  [(We recommend that diabetic patients keep personal stocks of medical supplies and the medication that they require daily, as )] TJ ET
BT 26.250 542.762 Td /F1 9.8 Tf  [(well as records of their medication. We also recommend the creation of basic guidelines to facilitate the practical prescription of )] TJ ET
BT 26.250 530.857 Td /F1 9.8 Tf  [(medication for diabetic patients under various conditions that may arise in the aftermath of a natural disaster.)] TJ ET
BT 26.250 494.255 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 474.300 Td /F1 9.8 Tf  [(The authors received no specific funding for this article.)] TJ ET
BT 26.250 445.198 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 425.244 Td /F1 9.8 Tf  [(In the afternoon of March 11, 2011 in Tokyo, we experienced a sudden, strong earth tremor. The floor kept rolling, and people )] TJ ET
BT 26.250 413.339 Td /F1 9.8 Tf  [(were unable to remain standing. This earthquake reminded us of the Great Hanshin-Awaji \(Kobe\) earthquake in 1995 \(M6.9\) )] TJ ET
BT 26.250 401.434 Td /F1 9.8 Tf  [(that killed more than 6400 people and left us deeply scarred. Soon after the quake, what we saw on television broadcasts was a )] TJ ET
BT 26.250 389.529 Td /F1 9.8 Tf  [(manifestation of hell on earth: many houses and cars were swept away by the giant tsunami and nothing but devastated farms )] TJ ET
BT 26.250 377.625 Td /F1 9.8 Tf  [(and residential areas were left behind in large parts of the Tohoku district. To make matters worse, the Fukushima nuclear )] TJ ET
BT 26.250 365.720 Td /F1 9.8 Tf  [(power plant experienced a leak)] TJ ET
0.267 0.267 0.267 rg
BT 161.190 367.227 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 166.009 365.720 Td /F1 9.8 Tf  [( . This massive earthquake with a magnitude of 9.0 was named the Great East Japan )] TJ ET
BT 26.250 353.815 Td /F1 9.8 Tf  [(Earthquake)] TJ ET
0.267 0.267 0.267 rg
BT 76.112 355.322 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 80.930 353.815 Td /F1 9.8 Tf  [(. The disaster left tens of thousands homeless, and many people had to evacuate to refuges. In the end of April )] TJ ET
BT 26.250 341.910 Td /F1 9.8 Tf  [(2012, more than a year after the earthquake, the death toll is over 15,800, and more than 3,000 people are still missing)] TJ ET
0.267 0.267 0.267 rg
BT 538.944 343.418 Td /F4 8.7 Tf  [(3)] TJ ET
0.271 0.267 0.267 rg
BT 543.763 341.910 Td /F1 9.8 Tf  [( .)] TJ ET
BT 26.250 305.308 Td /F4 12.0 Tf  [(Observations)] TJ ET
BT 26.250 285.354 Td /F5 9.8 Tf  [(Our experiences in the affected area)] TJ ET
BT 26.250 265.949 Td /F1 9.8 Tf  [(The National Center for Global Health and Medicine \(NCGM\) of Japan immediately sent the Disaster Medical Assistance Team )] TJ ET
BT 26.250 254.044 Td /F1 9.8 Tf  [(\(DMAT\), a group of professional medical personnel trained to provide rapid-response medical care, to Sendai in Miyagi )] TJ ET
BT 26.250 242.139 Td /F1 9.8 Tf  [(prefecture of the Tohoku district, one of the affected areas. DMAT had completed its activities by March 16; thereafter, the )] TJ ET
BT 26.250 230.235 Td /F1 9.8 Tf  [(NCGM�s medical support teams, composed of four to six members including doctors, nurses, pharmacists, clinical )] TJ ET
BT 26.250 218.330 Td /F1 9.8 Tf  [(psychologists, and clerical staff were sent every two days. By the end of June 2011, more than 250 NCGM personnel from 51 )] TJ ET
BT 26.250 206.425 Td /F1 9.8 Tf  [(teams had carried out their tasks in the affected area, in cooperation with local public health nurses. Unlike the Hanshin-Awaji )] TJ ET
BT 26.250 194.520 Td /F1 9.8 Tf  [(quake, in which most of the casualties were due to the collapse of structures and subsequent fires, the tsunami itself caused )] TJ ET
BT 26.250 182.616 Td /F1 9.8 Tf  [(most of the casualties. Therefore, the medical support teams were expected to provide care to patients with chronic diseases )] TJ ET
BT 26.250 170.711 Td /F1 9.8 Tf  [(such as diabetes, hypertension, respiratory diseases, and mental diseases, rather than patients with acute diseases, for which )] TJ ET
BT 26.250 158.806 Td /F1 9.8 Tf  [(the DMAT had provided treatment. The medical team made a round of visits to the refuges of Higashimatsushima City in Miyagi )] TJ ET
BT 26.250 146.901 Td /F1 9.8 Tf  [(prefecture and also conducted a health survey for people who resided at home. Initially, we visited 14 refuges every 3 days and )] TJ ET
BT 26.250 134.997 Td /F1 9.8 Tf  [(examined and treated more than 1,110 patients by the end of April 2011.)] TJ ET
BT 26.250 115.592 Td /F1 9.8 Tf  [(After a disaster, conditions such as stress, lack of food or water, extremes of heat or cold, and infection can contribute to rapid )] TJ ET
BT 26.250 103.687 Td /F1 9.8 Tf  [(worsening of a chronic illness that was under control before the event)] TJ ET
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BT 26.250 755.571 Td /F1 9.8 Tf  [(maintaining optimal blood glucose levels with strict control, because grief due to the loss of family and property reduced appetite.)] TJ ET
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BT 26.250 532.348 Td /F1 9.8 Tf  [(calories, the patients had no choice. Some patients showed severe postprandial hyperglycemia after consuming the meals )] TJ ET
BT 26.250 520.443 Td /F1 9.8 Tf  [(supplied in the refuges. Common comments included, �Nobody knows when the next aftershocks will come. I may not be able to )] TJ ET
BT 26.250 508.539 Td /F1 9.8 Tf  [(get a meal then. I want to eat while I can.� �I think I�ve been eating too much, but I can�t leave this because it is wasteful.� or �I�m )] TJ ET
BT 26.250 496.634 Td /F1 9.8 Tf  [(afraid other people will see my leftovers and may think that I�m ungrateful.� One piece of advice we were able to give these )] TJ ET
BT 26.250 484.729 Td /F1 9.8 Tf  [(patients was to share their meals with their families.)] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(Dehydration increases the risk of DVT and aggravates diabetic control. Despite our suggestions regarding the consumption of )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(sufficient amounts of liquid to avoid dehydration, elderly people tended to limit their liquid intake to reduce the number of times )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(that they needed to use the lavatory, which was often far away, cold, and not sanitized.)] TJ ET
BT 26.250 404.912 Td /F4 12.0 Tf  [(Mental Health Care)] TJ ET
BT 26.250 384.958 Td /F1 9.8 Tf  [(As reinforced by the World Trade Center disaster on September 11, 2001)] TJ ET
0.267 0.267 0.267 rg
BT 342.725 386.465 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 347.544 384.958 Td /F1 9.8 Tf  [(, mental health care is one of the most important )] TJ ET
BT 26.250 373.053 Td /F1 9.8 Tf  [(issues in disaster-stricken areas)] TJ ET
0.267 0.267 0.267 rg
BT 164.953 374.561 Td /F4 8.7 Tf  [(6)] TJ ET
BT 169.772 374.561 Td /F4 8.7 Tf  [(7)] TJ ET
BT 174.591 374.561 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 179.410 373.053 Td /F1 9.8 Tf  [(. The acute memory of the disaster and associated fears are deeply engraved in the mind, )] TJ ET
BT 26.250 361.149 Td /F1 9.8 Tf  [(causing mental trauma. In addition to emotional responses such as grief, loss, and anger, a person may be beset by a sense of )] TJ ET
BT 26.250 349.244 Td /F1 9.8 Tf  [(heavy obligation for being the one who survived \(survivor�s guilt\). Most survivors, living in refuges experience social and lifestyle )] TJ ET
BT 26.250 337.339 Td /F1 9.8 Tf  [(stress with regard to privacy, food, lavatory use, duty assignments, and care for others who need help. Therefore, mental )] TJ ET
BT 26.250 325.434 Td /F1 9.8 Tf  [(support is critical to patients with any disease or irrespective of the existence of a disease, and acute mental care, such as )] TJ ET
BT 26.250 313.530 Td /F1 9.8 Tf  [(counseling by a specialist, is sometimes necessary. Especially for diabetic patients, mental stress may aggravate diabetic )] TJ ET
BT 26.250 301.625 Td /F1 9.8 Tf  [(control)] TJ ET
0.267 0.267 0.267 rg
BT 55.510 303.132 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 60.328 301.625 Td /F1 9.8 Tf  [( and special care is needed. Patients should be advised not to endure their worries or anxieties alone but to attempt to )] TJ ET
BT 26.250 289.720 Td /F1 9.8 Tf  [(find someone with whom they can consult.)] TJ ET
BT 26.250 253.118 Td /F4 12.0 Tf  [(Conclusions and Recommendations)] TJ ET
BT 26.250 233.163 Td /F1 9.8 Tf  [(As diabetologists, and based on our experiences of the Great East Japan Earthquake, we offer the following suggestions to )] TJ ET
BT 26.250 221.259 Td /F1 9.8 Tf  [(cope with a disaster situation; \(1\) Maintaining daily stocks of necessary supplies and being mentally prepared for emergencies )] TJ ET
BT 26.250 209.354 Td /F1 9.8 Tf  [(is crucial. Diabetic patients should keep stocks of their medication with them and record their medication and dosage regimens )] TJ ET
BT 26.250 197.449 Td /F1 9.8 Tf  [(in a notebook, card, or media device. In addition, not only medical materials, optimal glycemic control in pre-disaster is )] TJ ET
BT 26.250 185.544 Td /F1 9.8 Tf  [(important. \(2\) There are virtually no guidelines regarding the management of chronic medical conditions after natural disasters)] TJ ET
0.267 0.267 0.267 rg
BT 569.218 187.052 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 173.640 Td /F1 9.8 Tf  [(. Basic guidelines need to be created to allow practical prescription of medication for diabetic patients under various situations in )] TJ ET
BT 26.250 161.735 Td /F1 9.8 Tf  [(the event of a natural disaster. Self-monitoring of blood glucose may be helpful in determining the prescription. \(3\) Diet )] TJ ET
BT 26.250 149.830 Td /F1 9.8 Tf  [(management after a disaster is very difficult; therefore, under the assumption of various cases, educating patients beforehand to )] TJ ET
BT 26.250 137.925 Td /F1 9.8 Tf  [(enable them to make proper decisions based on their situation is important. \(4\) For diabetes management, a multidisciplinary )] TJ ET
BT 26.250 126.021 Td /F1 9.8 Tf  [(medical team is indispensable. Our medical support team for the disaster in the Tohoku district kept close contact with each )] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(other, shared information, and worked with a single purpose. In the follow-up to this disaster, the provision of not only good )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(immediate care to diabetic patients, but also long-term, continuous, and comprehensive care for these patients, including mental )] TJ ET
BT 26.250 90.306 Td /F1 9.8 Tf  [(health support, will be necessary.)] TJ ET
BT 26.250 53.704 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
Q
q
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0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(the medications to maintain the patient�s blood glucose at relatively high levels and to avoid hypoglycemia, rather than )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(maintaining optimal blood glucose levels with strict control, because grief due to the loss of family and property reduced appetite.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(Realistic Diets)] TJ ET
BT 26.250 699.015 Td /F1 9.8 Tf  [(Diet is a fundamental element of diabetes management. Living in refuges, however, made it very difficult for patients with )] TJ ET
BT 26.250 687.110 Td /F1 9.8 Tf  [(diabetes to eat properly, because some refuges could not even provide basic healthy meals, let alone diets appropriate for )] TJ ET
BT 26.250 675.205 Td /F1 9.8 Tf  [(patients with diabetes. The Japan Dietetic Association reported that even by the end of April 2011, almost a month and a half )] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(after the disaster, most of the refuges in Ishinomaki City and Onagawa-cho in Miyagi prefecture could provide only two meals )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(per day: breakfast with bread and a cooked supper. In early April, 90% of the refuges in Kesennuma City provided three meals )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(per day, but 40% of them could not provide meat and eggs, whereas 30% of them could not provide vegetables. In the cases of )] TJ ET
BT 26.250 627.586 Td /F1 9.8 Tf  [(the Great Hanshin-Awaji Earthquake in 1995 and the Niigata Chuetsu Earthquake in 2004, people could receive packed )] TJ ET
BT 26.250 615.681 Td /F1 9.8 Tf  [(lunches from the surrounding cities at a relatively early stage. However, in the case of the earthquake in Tohoku, the dietary )] TJ ET
BT 26.250 603.777 Td /F1 9.8 Tf  [(circumstances did not rapidly improve for several possible reasons: the extremely vast size of the affected area, difficulty in )] TJ ET
BT 26.250 591.872 Td /F1 9.8 Tf  [(transporting relief supplies due to the destruction of roads, railways, and airports, and relatively old age of the people living in )] TJ ET
BT 26.250 579.967 Td /F1 9.8 Tf  [(the refuges \(i.e. few people in the refuges were healthy enough to prepare meals\). Some refuges had plenty of sweet buns, )] TJ ET
BT 26.250 568.062 Td /F1 9.8 Tf  [(snacks, and rice balls that were high in carbohydrates; however, fresh vegetables and fruits from all over Japan remained )] TJ ET
BT 26.250 556.158 Td /F1 9.8 Tf  [(packed in cardboard boxes and rotted because no one could cook and serve them. Unfortunately, precious food was not )] TJ ET
BT 26.250 544.253 Td /F1 9.8 Tf  [(handled properly. Although the supplied meals were not always healthy for patients with diabetes and were often high in )] TJ ET
BT 26.250 532.348 Td /F1 9.8 Tf  [(calories, the patients had no choice. Some patients showed severe postprandial hyperglycemia after consuming the meals )] TJ ET
BT 26.250 520.443 Td /F1 9.8 Tf  [(supplied in the refuges. Common comments included, �Nobody knows when the next aftershocks will come. I may not be able to )] TJ ET
BT 26.250 508.539 Td /F1 9.8 Tf  [(get a meal then. I want to eat while I can.� �I think I�ve been eating too much, but I can�t leave this because it is wasteful.� or �I�m )] TJ ET
BT 26.250 496.634 Td /F1 9.8 Tf  [(afraid other people will see my leftovers and may think that I�m ungrateful.� One piece of advice we were able to give these )] TJ ET
BT 26.250 484.729 Td /F1 9.8 Tf  [(patients was to share their meals with their families.)] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(Dehydration increases the risk of DVT and aggravates diabetic control. Despite our suggestions regarding the consumption of )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(sufficient amounts of liquid to avoid dehydration, elderly people tended to limit their liquid intake to reduce the number of times )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(that they needed to use the lavatory, which was often far away, cold, and not sanitized.)] TJ ET
BT 26.250 404.912 Td /F4 12.0 Tf  [(Mental Health Care)] TJ ET
BT 26.250 384.958 Td /F1 9.8 Tf  [(As reinforced by the World Trade Center disaster on September 11, 2001)] TJ ET
0.267 0.267 0.267 rg
BT 342.725 386.465 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 347.544 384.958 Td /F1 9.8 Tf  [(, mental health care is one of the most important )] TJ ET
BT 26.250 373.053 Td /F1 9.8 Tf  [(issues in disaster-stricken areas)] TJ ET
0.267 0.267 0.267 rg
BT 164.953 374.561 Td /F4 8.7 Tf  [(6)] TJ ET
BT 169.772 374.561 Td /F4 8.7 Tf  [(7)] TJ ET
BT 174.591 374.561 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 179.410 373.053 Td /F1 9.8 Tf  [(. The acute memory of the disaster and associated fears are deeply engraved in the mind, )] TJ ET
BT 26.250 361.149 Td /F1 9.8 Tf  [(causing mental trauma. In addition to emotional responses such as grief, loss, and anger, a person may be beset by a sense of )] TJ ET
BT 26.250 349.244 Td /F1 9.8 Tf  [(heavy obligation for being the one who survived \(survivor�s guilt\). Most survivors, living in refuges experience social and lifestyle )] TJ ET
BT 26.250 337.339 Td /F1 9.8 Tf  [(stress with regard to privacy, food, lavatory use, duty assignments, and care for others who need help. Therefore, mental )] TJ ET
BT 26.250 325.434 Td /F1 9.8 Tf  [(support is critical to patients with any disease or irrespective of the existence of a disease, and acute mental care, such as )] TJ ET
BT 26.250 313.530 Td /F1 9.8 Tf  [(counseling by a specialist, is sometimes necessary. Especially for diabetic patients, mental stress may aggravate diabetic )] TJ ET
BT 26.250 301.625 Td /F1 9.8 Tf  [(control)] TJ ET
0.267 0.267 0.267 rg
BT 55.510 303.132 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 60.328 301.625 Td /F1 9.8 Tf  [( and special care is needed. Patients should be advised not to endure their worries or anxieties alone but to attempt to )] TJ ET
BT 26.250 289.720 Td /F1 9.8 Tf  [(find someone with whom they can consult.)] TJ ET
BT 26.250 253.118 Td /F4 12.0 Tf  [(Conclusions and Recommendations)] TJ ET
BT 26.250 233.163 Td /F1 9.8 Tf  [(As diabetologists, and based on our experiences of the Great East Japan Earthquake, we offer the following suggestions to )] TJ ET
BT 26.250 221.259 Td /F1 9.8 Tf  [(cope with a disaster situation; \(1\) Maintaining daily stocks of necessary supplies and being mentally prepared for emergencies )] TJ ET
BT 26.250 209.354 Td /F1 9.8 Tf  [(is crucial. Diabetic patients should keep stocks of their medication with them and record their medication and dosage regimens )] TJ ET
BT 26.250 197.449 Td /F1 9.8 Tf  [(in a notebook, card, or media device. In addition, not only medical materials, optimal glycemic control in pre-disaster is )] TJ ET
BT 26.250 185.544 Td /F1 9.8 Tf  [(important. \(2\) There are virtually no guidelines regarding the management of chronic medical conditions after natural disasters)] TJ ET
0.267 0.267 0.267 rg
BT 569.218 187.052 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 173.640 Td /F1 9.8 Tf  [(. Basic guidelines need to be created to allow practical prescription of medication for diabetic patients under various situations in )] TJ ET
BT 26.250 161.735 Td /F1 9.8 Tf  [(the event of a natural disaster. Self-monitoring of blood glucose may be helpful in determining the prescription. \(3\) Diet )] TJ ET
BT 26.250 149.830 Td /F1 9.8 Tf  [(management after a disaster is very difficult; therefore, under the assumption of various cases, educating patients beforehand to )] TJ ET
BT 26.250 137.925 Td /F1 9.8 Tf  [(enable them to make proper decisions based on their situation is important. \(4\) For diabetes management, a multidisciplinary )] TJ ET
BT 26.250 126.021 Td /F1 9.8 Tf  [(medical team is indispensable. Our medical support team for the disaster in the Tohoku district kept close contact with each )] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(other, shared information, and worked with a single purpose. In the follow-up to this disaster, the provision of not only good )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(immediate care to diabetic patients, but also long-term, continuous, and comprehensive care for these patients, including mental )] TJ ET
BT 26.250 90.306 Td /F1 9.8 Tf  [(health support, will be necessary.)] TJ ET
BT 26.250 53.704 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
Q
q
15.000 43.273 577.500 733.727 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(the medications to maintain the patient�s blood glucose at relatively high levels and to avoid hypoglycemia, rather than )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(maintaining optimal blood glucose levels with strict control, because grief due to the loss of family and property reduced appetite.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(Realistic Diets)] TJ ET
BT 26.250 699.015 Td /F1 9.8 Tf  [(Diet is a fundamental element of diabetes management. Living in refuges, however, made it very difficult for patients with )] TJ ET
BT 26.250 687.110 Td /F1 9.8 Tf  [(diabetes to eat properly, because some refuges could not even provide basic healthy meals, let alone diets appropriate for )] TJ ET
BT 26.250 675.205 Td /F1 9.8 Tf  [(patients with diabetes. The Japan Dietetic Association reported that even by the end of April 2011, almost a month and a half )] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(after the disaster, most of the refuges in Ishinomaki City and Onagawa-cho in Miyagi prefecture could provide only two meals )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(per day: breakfast with bread and a cooked supper. In early April, 90% of the refuges in Kesennuma City provided three meals )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(per day, but 40% of them could not provide meat and eggs, whereas 30% of them could not provide vegetables. In the cases of )] TJ ET
BT 26.250 627.586 Td /F1 9.8 Tf  [(the Great Hanshin-Awaji Earthquake in 1995 and the Niigata Chuetsu Earthquake in 2004, people could receive packed )] TJ ET
BT 26.250 615.681 Td /F1 9.8 Tf  [(lunches from the surrounding cities at a relatively early stage. However, in the case of the earthquake in Tohoku, the dietary )] TJ ET
BT 26.250 603.777 Td /F1 9.8 Tf  [(circumstances did not rapidly improve for several possible reasons: the extremely vast size of the affected area, difficulty in )] TJ ET
BT 26.250 591.872 Td /F1 9.8 Tf  [(transporting relief supplies due to the destruction of roads, railways, and airports, and relatively old age of the people living in )] TJ ET
BT 26.250 579.967 Td /F1 9.8 Tf  [(the refuges \(i.e. few people in the refuges were healthy enough to prepare meals\). Some refuges had plenty of sweet buns, )] TJ ET
BT 26.250 568.062 Td /F1 9.8 Tf  [(snacks, and rice balls that were high in carbohydrates; however, fresh vegetables and fruits from all over Japan remained )] TJ ET
BT 26.250 556.158 Td /F1 9.8 Tf  [(packed in cardboard boxes and rotted because no one could cook and serve them. Unfortunately, precious food was not )] TJ ET
BT 26.250 544.253 Td /F1 9.8 Tf  [(handled properly. Although the supplied meals were not always healthy for patients with diabetes and were often high in )] TJ ET
BT 26.250 532.348 Td /F1 9.8 Tf  [(calories, the patients had no choice. Some patients showed severe postprandial hyperglycemia after consuming the meals )] TJ ET
BT 26.250 520.443 Td /F1 9.8 Tf  [(supplied in the refuges. Common comments included, �Nobody knows when the next aftershocks will come. I may not be able to )] TJ ET
BT 26.250 508.539 Td /F1 9.8 Tf  [(get a meal then. I want to eat while I can.� �I think I�ve been eating too much, but I can�t leave this because it is wasteful.� or �I�m )] TJ ET
BT 26.250 496.634 Td /F1 9.8 Tf  [(afraid other people will see my leftovers and may think that I�m ungrateful.� One piece of advice we were able to give these )] TJ ET
BT 26.250 484.729 Td /F1 9.8 Tf  [(patients was to share their meals with their families.)] TJ ET
BT 26.250 465.324 Td /F1 9.8 Tf  [(Dehydration increases the risk of DVT and aggravates diabetic control. Despite our suggestions regarding the consumption of )] TJ ET
BT 26.250 453.420 Td /F1 9.8 Tf  [(sufficient amounts of liquid to avoid dehydration, elderly people tended to limit their liquid intake to reduce the number of times )] TJ ET
BT 26.250 441.515 Td /F1 9.8 Tf  [(that they needed to use the lavatory, which was often far away, cold, and not sanitized.)] TJ ET
BT 26.250 404.912 Td /F4 12.0 Tf  [(Mental Health Care)] TJ ET
BT 26.250 384.958 Td /F1 9.8 Tf  [(As reinforced by the World Trade Center disaster on September 11, 2001)] TJ ET
0.267 0.267 0.267 rg
BT 342.725 386.465 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 347.544 384.958 Td /F1 9.8 Tf  [(, mental health care is one of the most important )] TJ ET
BT 26.250 373.053 Td /F1 9.8 Tf  [(issues in disaster-stricken areas)] TJ ET
0.267 0.267 0.267 rg
BT 164.953 374.561 Td /F4 8.7 Tf  [(6)] TJ ET
BT 169.772 374.561 Td /F4 8.7 Tf  [(7)] TJ ET
BT 174.591 374.561 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 179.410 373.053 Td /F1 9.8 Tf  [(. The acute memory of the disaster and associated fears are deeply engraved in the mind, )] TJ ET
BT 26.250 361.149 Td /F1 9.8 Tf  [(causing mental trauma. In addition to emotional responses such as grief, loss, and anger, a person may be beset by a sense of )] TJ ET
BT 26.250 349.244 Td /F1 9.8 Tf  [(heavy obligation for being the one who survived \(survivor�s guilt\). Most survivors, living in refuges experience social and lifestyle )] TJ ET
BT 26.250 337.339 Td /F1 9.8 Tf  [(stress with regard to privacy, food, lavatory use, duty assignments, and care for others who need help. Therefore, mental )] TJ ET
BT 26.250 325.434 Td /F1 9.8 Tf  [(support is critical to patients with any disease or irrespective of the existence of a disease, and acute mental care, such as )] TJ ET
BT 26.250 313.530 Td /F1 9.8 Tf  [(counseling by a specialist, is sometimes necessary. Especially for diabetic patients, mental stress may aggravate diabetic )] TJ ET
BT 26.250 301.625 Td /F1 9.8 Tf  [(control)] TJ ET
0.267 0.267 0.267 rg
BT 55.510 303.132 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 60.328 301.625 Td /F1 9.8 Tf  [( and special care is needed. Patients should be advised not to endure their worries or anxieties alone but to attempt to )] TJ ET
BT 26.250 289.720 Td /F1 9.8 Tf  [(find someone with whom they can consult.)] TJ ET
BT 26.250 253.118 Td /F4 12.0 Tf  [(Conclusions and Recommendations)] TJ ET
BT 26.250 233.163 Td /F1 9.8 Tf  [(As diabetologists, and based on our experiences of the Great East Japan Earthquake, we offer the following suggestions to )] TJ ET
BT 26.250 221.259 Td /F1 9.8 Tf  [(cope with a disaster situation; \(1\) Maintaining daily stocks of necessary supplies and being mentally prepared for emergencies )] TJ ET
BT 26.250 209.354 Td /F1 9.8 Tf  [(is crucial. Diabetic patients should keep stocks of their medication with them and record their medication and dosage regimens )] TJ ET
BT 26.250 197.449 Td /F1 9.8 Tf  [(in a notebook, card, or media device. In addition, not only medical materials, optimal glycemic control in pre-disaster is )] TJ ET
BT 26.250 185.544 Td /F1 9.8 Tf  [(important. \(2\) There are virtually no guidelines regarding the management of chronic medical conditions after natural disasters)] TJ ET
0.267 0.267 0.267 rg
BT 569.218 187.052 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 173.640 Td /F1 9.8 Tf  [(. Basic guidelines need to be created to allow practical prescription of medication for diabetic patients under various situations in )] TJ ET
BT 26.250 161.735 Td /F1 9.8 Tf  [(the event of a natural disaster. Self-monitoring of blood glucose may be helpful in determining the prescription. \(3\) Diet )] TJ ET
BT 26.250 149.830 Td /F1 9.8 Tf  [(management after a disaster is very difficult; therefore, under the assumption of various cases, educating patients beforehand to )] TJ ET
BT 26.250 137.925 Td /F1 9.8 Tf  [(enable them to make proper decisions based on their situation is important. \(4\) For diabetes management, a multidisciplinary )] TJ ET
BT 26.250 126.021 Td /F1 9.8 Tf  [(medical team is indispensable. Our medical support team for the disaster in the Tohoku district kept close contact with each )] TJ ET
BT 26.250 114.116 Td /F1 9.8 Tf  [(other, shared information, and worked with a single purpose. In the follow-up to this disaster, the provision of not only good )] TJ ET
BT 26.250 102.211 Td /F1 9.8 Tf  [(immediate care to diabetic patients, but also long-term, continuous, and comprehensive care for these patients, including mental )] TJ ET
BT 26.250 90.306 Td /F1 9.8 Tf  [(health support, will be necessary.)] TJ ET
BT 26.250 53.704 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
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trailer
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/Info 5 0 R
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