Get Your Child Ready for a Fun-Filled Summer
It was early on a summer morning in 2005 when Jim Zellmer, 7, arrived at camp, a backpack full of gear and a nervous mom in tow. Jim had been diagnosed with type 1 that past November, but still he was surprised to see another boy near the registration desk, sitting alone and checking his blood glucose. "Mom, I think that kid has diabetes!" Jim said.
"Jim," she replied, "all these kids do."
Most kids worry about things like bad food and mosquito bites when they're starting summer camp for the first time. But for kids with diabetes—and their parents—the concerns are far more serious. Even apart from the risk of life-threatening events, there's a complex array of management issues involved, like adjusting insulin as activity levels rise, making sure that a meter is working properly in the summer heat, or even counting carbs while eating s'mores. When children have diabetes, shipping them off to summer camp can feel like preparing for a polar trek.
For some families, the best choice is a camp that caters exclusively to kids with diabetes. In the Zellmers' case, it was the American Diabetes Association's Camp Discovery in Glen Ellyn, Ill., one of the more than 40 ADA camps around the country. "He was a little nervous … until he saw that he was not the only one with diabetes," says Jim's mother, Mary Agnes Zellmer. Not only did he make friends with other kids who understand what it's like to live with diabetes, but Jim also learned all about the insulin pump—something he'd previously shied away from. "After he went to the camp and all the boys in his group had a pump, and his counselor had a pump, he was ready then," says Zellmer. "That's something I couldn't decide for him and the endocrinologist couldn't instill in him—it was another 8-year-old boy who was able to talk to Jim on his own level."
Amie Miles, 15, has been attending ADA Camp Victory in Leesville, La., every summer since she was diagnosed with type 1 diabetes at age 9. For her, camp has been a kind of refuge: "I knew I wasn't the only kid going through the experiences I was having at school," she says.
These camps are unique in that they offer experienced medical staff: pediatric endocrinologists, nurses, dietitians, medical students, and other professionals with diabetes experience, many of whom volunteer their time and services. They also provide diabetes supplies for campers. "There are not a lot of camps where you can drop your kids off and know there's enough medical care," Zellmer says. "It's the first chance you get to have a moment when you're really not worried about them, and know they're safe."
Safety aside, the experience gives kids some much-needed independence with their diabetes self-care. "I think most parents who have children with diabetes—we do more than hover," says Amie Miles's mother, Eloise Keene. "We have to learn that they'll have to manage [their diabetes] by themselves when they're older."
Some families, of course, choose to send their kids to non-diabetes camps, for a variety of reasons. In addition to ADA Camp Discovery, Jim Zellmer will be going to an overnight Boy Scout camp for a week this summer. While "regular" camps are still responsible for keeping children safe, and providing diabetes care, their staffs are probably going to be less prepared to handle a child with diabetes. Some tips for preparing for non-diabetes camp:
Ready your child (and yourself)
Is your son or daughter going to an overnight camp? Whether it's a diabetes camp or not, leaving home can be overwhelming the first time. Try to prepare your child by arranging sleepovers at friends' houses well in advance of the summer. It'll help you get used to the idea, too.
Talk to the camp director
Meet with the person who runs the place—not just the administrative staff who work in the camp office, but the director who will actually be present when your child is at camp. Ask if anyone on staff is comfortable helping kids with carb counting, injections, even doing blood glucose checks in the night. Find out what medical equipment will be available at the camp, what sort of training the staff has, and what food will be served. Offer to help train camp staff about diabetes.
Investigate the area
If your child has a severe low or other emergency while at camp, the staff may not be equipped to provide adequate care. So it's important to look into the surrounding hospitals and medical facilities—is there anything nearby? How remote is the camp?
Check the setup
Is the camp accredited through the American Camp Association (ACA)? Some camps can't be considered for accreditation for reasons like session length, but they may still be perfectly safe. Just be sure to investigate how closely they adhere to ACA guidelines, available at http://find.acacamps.org/finding_a_camp.php. If you can, check out the camp in person ahead of time.
Packing for Non-Diabetes Camp
Here's what should go in that trunk (or backpack):
1. The blood glucose meter currently in use, plus a backup meter.
2. Twice as much insulin as normally necessary for this length of time.
3. Twice as many test strips as normally necessary.
4. Twice as many syringes.
5. Twice as many ketone test strips.
6. A glucagon kit, if necessary (ask your doctor).
7. Glucose tabs, candy, juice, or other items for treating low blood glucose.
8. A container for safe disposal of sharps.
Prepare for activity
When your child starts swimming, horseback riding, and participating in other such activities, he or she is bound to experience dips in blood glucose—and to need less insulin. "We typically start off by cutting [the children's] insulin by 20 percent or more based on baseline activity at home," says Henry Rodriguez, MD, director of the Diabetes Clinical Program at Riley Hospital for Children in Indianapolis, and a volunteer at ADA Camp John Warvel in Indiana. Teach your child to do frequent blood glucose checks, and if he or she is on an insulin pump, make sure your child knows the settings.
See if someone on staff would be able to help with the pump if your child has trouble adjusting it alone. Offer to help the staff with training. (The ADA recommends not starting insulin pump therapy sooner than 6 to 8 weeks before camp.)
Rodriguez says your child should bring twice as many supplies as he or she would typically need. (See box, p. 47.) You'll want to check the manual to make sure that your child's glucose meter can tolerate summer heat. Also, remember that insulin must be kept at a fairly constant temperature. Make sure there's somewhere your child can keep it cool.
And once you've handled all these preparations, relax. Kids' blood glucose levels won't be perfect during a week of intense physical activity at camp. And those mosquitos will probably still bite. But thanks to you, your child can have a terrific summer.
Did You Know?
The right of kids with diabetes to attend camp is legally protected under federal law. The Americans with Disabilities Act protects your child's right to attend camp, and to receive adequate medical care while there. As a "place of accommodation" that is covered by the law (unless the camp is run by a religious institution), most camps are required to make available the personnel and service to perform routine and emergency diabetes care. If you experience a problem acquiring the care your child needs at camp, call 1-800-DIABETES (1-800-342-2383) for help.
The Campfire Treatment
As rousing as a chorus of Kumbaya might be, is it possible that diabetes camp might really improve kids' health? Yes, according to a recent study, which linked camp to better blood glucose control. The findings, published in the February 2008 issue of the journal Pediatric Diabetes, are based on medical records of 12- to 18-year-olds with type 1 diabetes, 77 of whom went to a Dallas-area camp and 106 who did not. The researchers compared their A1Cs 3 months before, and 3 and 7 months after, 2005 summer camp sessions.
Three months after their session, the campers' A1Cs had decreased by 0.3 percent, whereas non-campers' A1Cs increased 0.5 percent over the same time period. Seven months later, campers' A1Cs continued to be lower than the non-campers' A1Cs by the same margin, indicating camp benefits may hold long term. But, the researchers note, camp A1C benefits were seen predominantly among the girl campers. Lead author Annie Wang, MD, assistant professor at the Children's Medical Center Dallas, guesses this may be because girls are more likely to form camp friendships that reinforce positive behavior. On the other hand, it was the male campers who fared better on treatment adherence, depression, and quality of life, according to questionnaires filled out by campers' parents.
Further studies are needed to determine if these findings apply to other diabetes camps.
—Erika Gebel, PhD