By: Daniel Trecroci
There are an estimated 15,000 to 20,000 young people who attend diabetes camps each summer. Summer camps provide young people, ages 6 to 18, an opportunity to effectively manage their diabetes in an environment that is educational, safe and fun.
A Normal Part of Life
Alicia McAulisfe, program director for Circle of Life Camp in North Greenbush, New York, has type 1 diabetes and is the author of the book “Growing Up With Diabetes: What Children Want Their Parents to Know.” According to McAulisfe, diabetes is a “normal part of life,” and her camp strives to teach just that.
“[Diabetes] is not something you should be embarrassed about,” she says. “You can easily assimilate it into your life, but you first need to become educated.”
Suzanne Apsey, program director for Triangle D Camp of Northern Illinois, feels summer camps help nurture the self-esteem and self-reliance of children with diabetes.
“Camps offer a support system that isn’t available in other places because [kids] are meeting other kids with diabetes,” says Apsey.
“The youngest kids, when they are diagnosed, often have feelings of, ‘Why did this happen to me? Did I do something bad?'” says Rosalie Bandyopadhyay, executive director for Florida Diabetes Camps. “By coming to a camp and seeing hundreds of other children like them, they realize that they are not alone and they didn’t do anything wrong. “
For the 6- to 8-year-olds with diabetes, Bandyopadhyay says, art classes teach them how to express their feelings about diabetes. She adds that for middle school children, the focus is on psychology and medical education. Children in their early teenage years are taught that they can still do everything that any other teenager can do.
“I’m sure everybody can relate to those middle school years,” says Bandyopadhyay. “You never want to be different from other kids your age, but all of a sudden you have to eat differently, take snacks at different times, and check your blood sugars before engaging in sporting activities.”
Camps for high school kids are structured differently. Bandyopadhyay says that at this age, most kids are drawing up their own insulin and giving themselves their own shots. Therefore, the education has a different focus.
“We work a lot with the older kids on carbohydrate counting,” she says. “If they are playing soccer or swimming that afternoon, we’ll ask them what they think they should eat for lunch to avoid going too low. The camp physicians and educators work a lot more individually with each kid to try to get them to think about how this is a part of their lifestyle.”
Lowering Insulin Doses
Most camps have found it advisable to decrease the home insulin dosage by 10 to 20 percent or more, especially in those who were not active before the camp session.
“When they arrive at camp, insulin levels are lowered because their activity levels will be increasing throughout the summer,” says McAulisfe. “With the amount of hiking and swimming that they will be doing, they will not need as much insulin.”
Hypoglycemia is common at the beginning of camp because of increased physical activity. The American Diabetes Association (ADA) recommends that a daily record of a camper’s progress be made and then all blood glucose levels and insulin dosages be recorded in a format that allows for review and analysis.
“Self-management of diabetes is dependent upon two things: knowledge and motivation,” says Zula Walters, executive director for the Diabetes Camping Association (DCA). “Camps have an excellent record for educating campers through many types of experiences. Many people in many different ways teach diabetes education. It may come from a formal lecture from a doctor, educator or peer. It may also come from a cabin mate describing an insulin reaction he or she experienced, and how he or she managed. It may be from having a counselor or another staff member answering any questions they have.”
Games, competitions, skits, programs led by fellow campers or just listening to others who describe their fears and frustrations, are all informal techniques used to educate children on diabetes self-management.
Bandyopadhyay says her campers are taught in discussion groups, where every cabin has an education session scheduled into each day. One day, the kids will meet with a nutritionist, and on another day, they will meet with a certified diabetes educator to learn about insulin dosages and how to adjust insulin.
“It’s more of a discussion around the table,” she says. “The kids can swap stories, and the educator or physician can talk with them.”
Children are taught how to check blood glucose levels at summer camps. They are also taught how to give insulin injections on their own. According to Bandyopadhyay, most kids, by their middle school years, can test their own blood sugars, while the youngest children have it done for them.
“Many parents send their kids to us with the single goal of having their kids learn how to give their own insulin shots,” says Bandyopadhyay.
Children are never forced to administer their own insulin shot at camp. Most of the time, however, if they see peers or cabin mates giving themselves a shot, they are inspired to do the same thing.
“Most first-time shot givers are in the 8- to 10-year-old range,” says Apsey. “It is certainly not something that is required of the children, but we will encourage them to try it.”
Apsey adds that prevention of hypoglycemia and hyperglycemia are also taught at summer camps, as well as adjusting insulin dosages, diet and levels of exercise.
“Nutrition is the first thing we teach on the first day of camp,” she says. “We have dietitians who work out all of the meal planning. The camp provides the food, which they make according to the dietitians’ specifications. It is served family style, and we then train the counselors and medical staff to help the kids make choices from what is available.”
The ADA recommends that each camp’s medical staff be led by someone who is an expert in managing type 1 diabetes. The nursing staff should include diabetes educators and diabetes clinical nurse specialists.
In the event of an emergency, children are sent to the nearest medical facility. If the camp is located in a rural area, the ADA recommends that arrangements be made with a medical helicopter or fixed-wing airplane to provide rapid transport.
According to Bandyopadhyay, most counselors are nursing or medical students, and they are taught how to handle diabetes emergencies. Additionally, there are testing areas throughout the camp at ball fields and arts and crafts rooms, where there will be meters, snacks and juice.
For more information on the Diabetes Camping Association, you can contact Zula Walters via fax at (256) 882-0372, or her at email firstname.lastname@example.org.
For more information on finding a camp in your area, log on to www.childrenwithdiabetes.com.