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Food Safety: Before, During, and After a Power Outage

Being prepared for a natural disaster or power outage is vital, especially when it comes to food safety for people with diabetes. Learn how to keep your food safe and avoid potential foodborne illnesses.

Hurricanes, floods, tornadoes, and power outages can occur with little or no warning. These disasters can threaten lives, especially if you have diabetes. Even a simple power outage can be dangerous, potentially spoiling refrigerated or frozen foods.

If refrigerated or frozen foods are not kept at the proper temperature, they can cause foodborne illness, also known as food poisoning. For someone with a chronic disease like diabetes, foodborne illness can be very serious.

Why are people with diabetes at higher risk for foodborne illness?

While anyone who eats food contaminated by bacteria, viruses, parasites, toxins, or other substances can suffer ill effects, people with diabetes are more likely to get sicker for longer, require hospitalization, or even die from foodborne diseases.

This is because diabetes often has associated complications that may affect things like your immune system or digestive tract, preventing them from optimal functioning.

For example, the primary role of the immune system is to fight off viruses and harmful bacteria. High blood glucose can weaken your body's immune response by impairing your immune cells’ ability to come to the site of an infection and fight off viruses and bacteria. This delayed and lower response allows bacteria to grow and can increase your risk of foodborne illness.

Gastroparesis is a condition that causes the stomach to hold its contents too long and can be a diabetes-related complication. Damage to the vagus nerve that controls the stomach muscles can cause this delay. Ordinarily, when you eat food, the vagus nerve triggers a spontaneous movement of the muscles in your stomach. This movement propels food through your digestive tract. However, diabetes can damage the vagus nerve, which may slow digestion and give harmful bacteria more time to multiply and grow.

In addition, people with diabetes face additional risks if they do contract a foodborne illness. There is an increased risk of dehydration, hyperglycemia resulting from added stress to the body, and diabetic ketoacidosis or hyperosmolar hyperglycemic states (two very deadly conditions resulting from very high glucose levels).

Keeping your glucose within your target range is the best way to lower your risk.

Preparing for a power outage with food safety and diabetes in mind

The thought of being in a hurricane or without electricity for hours or days can be very stressful. However, with proper planning, you can reduce this stress, keep your food safe, and take care of your diabetes.

Bacteria can multiply rapidly in warm, moist conditions, when temperatures are between 40°F and 140°F. This temperature range is known as the “Danger Zone.” The following steps will help keep your perishable food out of the danger zone during a power outage:

  • Keep appliance thermometers in your refrigerator and freezer. The refrigerator should be at 40°F or below. The freezer should be at 0°F or below.

  • Have a cooler, frozen containers of water, and gel packs available if you must remove your food from the refrigerator during an emergency to keep it cold. The melting ice in the containers of water will also supply safe drinking water.

  • If you know your power will be out for a long time, buy dry ice or block ice to keep your food cold in the refrigerator. However, be sure you don’t store dry ice in your freezer if the power is still on as it will make your freezer too cold, and the freezer may shut off.

You will also need a supply of non-perishable food if your refrigerated food is not safe to eat or you must relocate. The Diabetes Disaster Response Coalition (DDRC) recommends you have a two-day supply of non-perishable food (including foods to treat low glucose levels) on hand for an emergency.

Toby Smithson, a diabetes lifestyle expert with DiabetesEveryDay, who has lived with type 1 diabetes for 53 years, considers being prepared for an emergency part of her diabetes management.

"I aim always to be prepared for a power outage or any emergency that would require food to be available," Smithson said.  “I always have a supply of non-perishable food in the house that includes a source of protein and carbohydrate (both fast-acting carbs and complex carbs).”

The DDRC suggests having fast-acting carbohydrates like fruit juice, regular soda, hard candy, glucose tablets or honey available to treat low glucose levels. In addition, Smithson keeps lifesavers and Smarties candies in her emergency kit in the event of low glucose levels.

A power outage doesn’t have to derail your diabetes meal plan. There are plenty of healthy, high protein, low carbohydrate, non-perishable options available. Smithson's healthy protein options include nuts, nut butter, and tear-open tuna packs. In place of fresh fruit, she uses dehydrated fruit and canned fruit in natural juice with flip-top cans. Smithson's kit also includes whole-grain crackers.

Gabriela Rivera Martínez, 26,  has been living with type 1 diabetes for the past 21 years and is currently a Spanish Medical Interpreter in Children's National Hospital in Washington, D.C.. Though she lives in College Park, MD, now, she was in San Juan, Puerto Rico, in 2017 when Hurricane Maria struck. In preparation for the hurricane, Martínez’s mother designed a meal plan for her. “My mom created a menu with foods that everyone likes and bought the items according to the menu,” Martínez said. The family loaded up on, “salted crackers, dried fruit, nuts, canned chicken, and a little more fresh food than usual.”

With carbohydrate counting in mind, Martínez prepared snacks in advance. “Placing snacks in reusable plastic bags was key to carb counting and knowing what I needed to go buy again,” she said. “For example, I would place 1/4 cup dried fruits and 1/2 cup nuts in one bag, cereal bars already individually wrapped in another, and 1/2 turkey and cheese sandwich in another bag. I tried to portion each snack to be 15-20 g carbs.”

Marina Chaparro, founder of Miami-based Nutrichicos Family Nutrition, has been living with type 1 diabetes for 20 years. Chaparro says during hurricane season, she makes sure to have plenty of "high-quality" canned products available to feed her entire family.

"Living in Florida, you automatically assume you won't have power, so you need to create a plan B for meal preparation,” Chaparro said. "This includes canned beans and garbanzos, tuna, and salmon in a can, canned veggies like corn and peas, and plenty of fruit in dehydrated forms and canned in natural juices."

Knowing which fruits and veggies have a longer shelf life is also helpful when preparing for a power outage. “For example, sweet potatoes, apples, Brussel sprouts, squash, oranges, and beets will be great to have on hand when disaster hits,” she said.

How to keep food safe during a power outage

During a power outage, only open your refrigerator or freezer when necessary. If the doors stay closed, food can remain safe for up to four hours in a refrigerator and 48 hours in a full freezer. If the freezer is half-full, food will stay cold for 24 hours.

If you have been without power for four hours, transfer your refrigerated perishable food to a cooler. Keep enough ice in the cooler to keep food at 40°F or below. Be sure to add more ice to the cooler as it begins to melt.

You should only use dry ice if your power is going to be out for a long time. According to the Centers for Disease Control (CDC), 50 pounds of dry ice should hold an 18-cubic-foot freezer for two days. Do not touch dry ice with your bare hands or place it in direct contact with food. You can learn more about dry ice safety here.

During a snowstorm, it may be tempting to place perishable food out in the snow; however, this is not recommended for several reasons. Outside temperatures can vary, and food may be exposed to unsanitary conditions or animals. Instead, fill buckets, empty milk containers, or cans with water and leave them outside to freeze. Then use these homemade ice blocks in your refrigerator, freezer, or coolers.

Martínez’s family was fortunate enough to have a generator, two refrigerators, and several coolers to help keep their food cold during hurricane Maria. They would turn the generator on at night to sleep and turn it off in the morning.

“When the generator was off, we avoided opening our main refrigerator to keep our food as cold as possible. And that’s where the beach coolers came in,” Martínez said. “When the ice melted, the water would stay cold for hours. Foods like meat, cheese, and fresh milk when available were placed in the coolers."

How to determine if food is safe after a power outage

After a power outage, throw out perishable food like meat, fish, cut fruits and vegetables, eggs, milk, and leftovers that have been at temperatures above 40° F for two hours or more (or one hour if temperatures are above 90º F). If you notice an unusual odor, color, or texture on any food, throw it out. If you are in doubt, throw it out.

If you kept a thermometer in your freezer, check the temperature. If the thermometer reads 40° F or below, the food is safe and may be refrozen. If you did not keep a thermometer in your freezer, check each package to determine its safety. If ice crystals are on the food or the temperature is 40° F or below, it is safe to refreeze or cook that item.

Use this chart to determine when to keep different refrigerated foods and when to throw them out. And this chart can help you determine if thawed or partially thawed food in the freezer is safe to eat.

Upon returning home after a mandatory evacuation, Smithson found her power restored and wasn’t sure whether her food was safe to eat.

"We had to do a little research to determine that the power outage had been too long to have possibly kept our food safe," she said. Since then, she found an easy way to determine food safety when power is restored before you return home.

"If you need to evacuate for a storm or experience a power outage, a food safety assurance trick is to place a small Dixie cup filled with frozen water in your freezer and place a coin on the ice. If, when you return to a home with power, finding the coin at the bottom of the cup shows that your frozen food did not remain frozen,” Smithson said.

What are the symptoms of foodborne illness?

Eating food contaminated by bacteria will usually cause illness within one to three days. You could also get sick within 20 minutes or up to 6 weeks later. Symptoms of foodborne illness include vomiting, diarrhea, abdominal pain, and flu-like symptoms (such as fever, headache, and body ache).

When you have diabetes, it is extra important to reduce your risk of foodborne illness. Even a minor infection can make diabetes harder to control and put you at risk for diabetic ketoacidosis (DKA). If you think you have a foodborne illness, contact your healthcare provider immediately.

Having a sick day plan before getting sick will help you manage your diabetes and reduce your chances of complications. To learn more about managing diabetes when sick, click here.

For more information about weathering a natural disaster with diabetes, read diaTribe’s article, “Be Prepared: Surviving Natural Disasters with Diabetes.”