Part 1: Lessons Learned from Diabetes Camp: A Transformational Experience
I arrived home in one piece on Sunday evening after the immersion of four days and three nights at the first Diabetes Camp sponsored by Children's National Medical Center (Brainy Camps). I was extremely tired and totally worn out both physically and emotionally. My medical colleagues were right about one thing: the experience would totally change my perception of these kids (age 12-16) and who they are. I also learned first hand about the anxiety that caregivers feel on a daily basis multiplied by 21.
Thursday morning did not start well. One of my nurse educators and I were to meet 12 (out of a total of 30 campers) at a local high school, collect all medical forms and medications, and have the kids board the bus en route to camp in Harrisonburg, Virginia. Readers in the Washington, DC, area may recall that we were hit with a fierce thunderstorm (associated with tornado warnings) that flooded areas of the beltway and local thoroughfares on that particular day. I arrived at the school and campers gradually trickled in depending on the ability to traverse the flooded streets. My nurse educator arrived one hour late; requiring me to "register" all the kids and get their meds and forms in order. It was not an easy task. Clearly, it was necessary to ensure that we had all the information necessary to keep the kids safe: insulin regimes, timing of other medications, and all the diabetes paraphernalia including insulins, pump supplies, syringes, needles, meters, strips, glucagon, etc. The bus arrived 45 minutes late in the midst of all this mayhem. However, we eventually organized and sorted out everything and the bus was on its way.
We followed the bus to the camp without incident (or further storms). The kids were met by the activity counselors and settled in their bunks. These fabulous counselors (older teens/college students) had been "educated" about diabetes (blood sugar monitoring, recognition of low blood sugar symptoms and how to treat them, as well as understanding the interpretation of these blood sugars) in the morning prior to camper arrival by one of my CDE nurse educators. Clearly, these exceptional counselors paid attention to this diabetes survival crash course!
My next task was to finish registering the remaining campers. Eight simply did not show up. We were not amused because other kids could have enjoyed the camping experience. Another child was sent home due to contagious conjunctivitis as I did not want a "pink-eye" outbreak in camp. We were left with 21 kids, 3 diabetes nurse educators, 1 doc, 2 experienced guys from the pharmaceutical companies to assist, the camp counselors, camp facilitators, arts/crafts expert, the Camp overall director (a physical therapist with a social work degree), and a psychologist.
My staff and I quickly realized that we needed to get organized ... and fast.
Lunch was happening and dinner was next. After a bit of brainstorming, we arrived at a successful game plan.
1. A white board listed all the menu items with carbohydrate counts based on portion sizes.
2. All the kids were asked to test blood sugars BEFORE eating (we asked them to carry their meters with them at all times in backpacks)
3. All the kids were then asked to record the chosen menu items and to record the carbohydrates.
4. Those kids on basal/bolus therapy and insulin pumps were asked to calculate the insulin required based on the carbs and blood sugars using insulin/carb ratios and correction factors. One of the medical staff members checked the calculations, handed the insulin pens (syringes and vials) and insulin was administered prior to eating. Of course, there are always several kids that had to do it their way and bolused after they ate.
5. The kids on traditional split mixed insulin (NPH/Regular or rapid acting insulin 2 or 3 times/day) were not required to take insulin at lunch (but were required to take at breakfast/dinner and bedtime).
6. Kids were then asked to hand in their cheat sheets with calculations to the medical team so that we could record them on grids and follow blood sugar patterns carefully.
7. We cut all basal insulin (Lantus, NPH) and pump basal rates by 20 percent across the board on the first day in anticipation of lows due to increased activity.
And then the campers went to bed (END of Day 1- at least for them!). Next week: Part 2