Vivian Murray, RD, a type I for 32 years, is a camp director for children with diabetes. She was recently anticipating the possible problems she might encounter this summer supervising 230 enthusiastic kids.
As any parent of a child with diabetes knows, being responsible for the metabolic control of just one child is extremely stressful. Imagine watching over 230!
Every night at 3 a.m., Murray, armed with a flashlight, begins her nightly patrol from tent to tent searching for signs of hypoglycemia.
Her biggest concern about the upcoming camp sessions is scheduling insulin injections. In the past all the kids took their mealtime injections in the main building, then hiked a half-mile up a hill to the dining hall. This schedule worked because the walk made the recommended 20 minute wait before eating a necessity. However, with the introduction of lispro, all that is changed. Now the kids on lispro will need to take their insulin right before they eat. For Murray, a lispro user herself, this means an organizational nightmare.
Should she have the camp doctor put the kids back on R while at camp? Or will this create chaos when the children return home and switch back to lispro?
A diabetes educator from Walnut Creek, Calif., who wishes to remain anonymous, has encountered all kinds of trouble with her patients going on lispro. She says she spends hours on the phone helping her clients adjust to the new insulin. Patients’ blood sugars go high between meals and in the morning, and in some cases their basal dosage has been increased to as much as 70 to 80 percent of their total daily insulin requirements.
Another educator, Evelyn Fleury-Milfort, RN, MSN, FNP, CDE, of Los Angeles, has seen similar experiences in her patients. She points out that in addition to the problems mentioned above, many people on lispro need to be more attuned to covering mid-day and bedtime snacks. The fast-acting lispro doesn’t have the same tail-end action that they were previously accustomed to on R. These reactions could cause havoc in a camp environment.
Ultimately, Murray decided to keep the children on the insulins they had been taking before they came to camp. The camp has already begun readying itself for the new influx of lispro users. “An auxiliary health lodge will be added next to the dining hall so that kids on lispro will be able to inject right before mealtime,” she says.
Murray feels that in the long run, lispro will have a positive effect. It will decrease the number of nighttime lows, plus it will provide her with a good educational opportunity. One camper might wonder why she has to inject a half-an-hour before mealtime while another injects right before he eats. Answering this sort of question will give counselors an opportunity to emphasize what campers need to consider when timing their injections in relation to meals.
And finally, lispro might mean less stressful 3 a.m. patrols for Murray – and a better night’s sleep.