Diabetes Care at Diabetes Camps
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MEDICAL STAFF COMPOSITION AND STAFF TRAINING
It is imperative that each camp have a medical director who is a physician with expertise in managing type 1 and type 2 diabetes. The medical director or their on-site licensed designee is ultimately responsible for the daily reviewing of blood glucose results, insulin logs, and other prescribed medications of all campers and staff with diabetes to make appropriate adjustments. The medical director or the on-site licensed designee is also responsible for providing guidance in all medical emergencies and should ensure that the medical program is integrated into the overall camping experience. One licensed physician must be on-site at all times for resident camp programs and available on call at all times for a day camp program.
Nursing staff should include diabetes educators and advanced practice diabetes nurses. Licensed physicians and medical residents should also be encouraged to participate in the medical staff. Registered dietitians with expertise in diabetes should also have input into the design of the menu and the education program. It is beneficial to include some medical, nursing, pharmacy, physician assistant, and dietetic students as volunteer counselors or junior medical staff to learn not only about diabetes but also the needs of children with a chronic disease.
All camp staff, including medical, nursing, nutrition, and other volunteer or paid staff, should undergo background testing to ensure the appropriateness of their working with children. Medical staff should receive training concerning routine diabetes management, issues related to lifestyle modification for type 2 diabetes, and the treatment of diabetes-related emergencies (hypoglycemia or ketosis) before camp begins. Camp policies and job descriptions for the medical staff should be understood and available in print before the start of camp. All camp staff should be familiar with the signs and symptoms of hypo-/hyperglycemia, indications for blood glucose testing, and treatment of hypoglycemia, including the administration of glucagon to treat severe hypoglycemia. Diabetes supplies should be monitored and given out by responsible medical staff.
Supplies for routine first aid and for the treatment of intercurrent illnesses, such as allergies, asthma, sore throats, diarrhea/vomiting, and minor trauma, should be available. All medical treatment should be recorded in both the camper’s file and in the yearly camp medical log.
TREATMENT OF DIABETES-RELATED EMERGENCIES
Hypoglycemia
Glucagon or intravenous glucose solutions must be available for administration by trained camp personnel for treatment of severe hypoglycemia. All possible measures should be taken to avert severe hypoglycemia. These may include nighttime blood glucose testing, decreasing insulin dosages for extreme activity, and altering insulin regimens for campers with prior severe hypoglycemia. Extra snacks should be provided to children not on basal-bolus therapy with blood glucose levels <100 mg/dl at bedtime. Additional snacks or modifications of insulin for those on Lantus or pump therapy with blood glucose levels <80 mg/dl should also be considered.
A set protocol for the treatment of mild-to-moderate hypoglycemia with oral glucose at other times should be followed so that hypoglycemia is consistently managed. Repeat blood glucose testing should be performed within 15–20 min to ensure resolution of hypoglycemia.
Ketosis
It may be possible to treat mild-to-moderate diabetic ketosis at camp. Urine or blood should be measured for the presence of ketones if a camper has persistent hyperglycemia (blood glucose level >240 mg/dl [13.3 mmol/l]) or if a camper has an intercurrent illness, regardless of blood glucose level. Oral or intravenous hydration (if vomiting) should be administered, and adequate insulin should be given to reverse ketosis, with a flow sheet produced to document the progress of the treatment regimen. Referral to an appropriate medical facility is required if vomiting and ketosis do not resolve promptly.
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