How I Spent My Summer Vacation
Being a counselor at diabetes camp can be an eye-opening-and heartwarming-experience
By Geoff Drake
Like thousands of other kids at summer camps across the country, James, 10, is making his first attempt on a climbing wall. Wearing a harness, and roped up to an experienced belayer, it takes him about two minutes to scramble to the top. He's exuberant about the feat, and rappels down quickly, ready for another attempt.
But first, he rushes over to a nearby counselor: that would be me. "I think I might be low," he says. James has diabetes, and wants to check his blood glucose level before his next climb. I hand him an alcohol wipe, a lancet, strip and a OneTouch® Ultra®2 Meter. Displaying the ease that most people would use to brush their teeth, he pricks his finger, inserts a strip, gets a reading from the meter, and pronounces the result: 120 mg/dL.
"Good enough!" he says, and heads back to the climbing wall, happy with his result and ready for the next ascent.
Welcome to diabetes camp, where young people have fun outdoors, learn independence, meet others who share their challenges and-hopefully-improve their diabetes management. I had an opportunity to be a part-time counselor and experience the phenomenon first hand, attending a session of Camp De Los Ninos, held in the Santa Cruz Mountains in Northern California. It's one of 13 such camps run by the Diabetes Society (formerly the Diabetes Society of Santa Clara Valley). It is the largest such statewide program in the country, according to the Society. There are a variety of programs to choose from, including overnight camps, day camps, family camps, teen camps and even a boat cruise in Baja, Mexico.
Diabetes camps are a growing phenomenon nationally; The American Diabetes Association helps fund or oversee such programs, and says that more than 10,000 children now benefit each year.
"Camp can be a life-changing experience for kids and caregivers," says David Price, M.D., Executive Director of Clinical Research at LifeScan. "Kids gain tremendous knowledge, confidence and acceptance of their disease. For those of us who work in the diabetes field, it changes your entire perspective of what you can do. It reminds you of why you come to work every day."
In many ways, it's a camp like any other. There's a boys' side and a girls' side, with the predictable mix of affection and warfare passing between. The YMCA-owned cabins and dining hall are cozy but display glacial amounts of wear, with deep gouges and a weathered look that comes from 70 years of energetic kids contained within their walls. The diversions are also like those at thousands of other camps across the country: There is a climbing rock, a cable slide, an arts and crafts studio, archery, a swimming pool and plentiful woods for hiking. There is a nightly campfire. The atmosphere is mostly casual, but sometimes military, with age-old rules like the buddy system and a strict separation of boys and girls at night, aimed particularly at the ages where passion and testosterone are most inflamed.
But there is clearly something different here, and it's palpable. For amidst the laughter, the noise, the skinned knees and the sunburns, there is the very real possibility of a medical emergency, and there isn't one staff person who doesn't know it and feel it every minute of the day.
People with diabetes may occasionally feel like a minority in general society, but at camp a liberating reversal takes place. Almost everyone-from campers, to counselors, to medical staff-has the disease. Here among the redwoods, a pancreas is almost a liability. Those without the disease are saddled with the playful moniker, "Pancreas!" as in: "Hey Pancreas-throw the ball over here!" Pumps are displayed proudly outside of cargo shorts, insulin syringes are unabashedly tucked behind ears like pencils. "Lows" and "highs" are discussed with the candor that others would use to talk about the weather. It is a place of refuge.
"Many feel that they are ostracized by having diabetes, and now they are in an environment where everyone else has diabetes," says Price. "So for a lot of these kids, it's an opportunity to unfold their wings and soar."
Scenarios that would normally capture our attention are played out hundreds of times each day and barely noticed. During a game of capture the flag, a girl is off to the side, discussing a blood glucose level of 515 mg/dL with a nurse, trying to determine a path forward. Everywhere you look, kids are huddled over meters or insulin pumps, pressing buttons and manipulating dosages on a small screen as if it were a video game.
It's 2 am on the night of the campout. Eighty sleeping bags are spread across a dusty field, and a low-hanging fog covers the broad expanse. Of these 80, 30 campers are on the infamous 2 am list, and must be roused from bed for blood glucose testing and treatment if needed.
By 2:05 the field looks like a MASH unit, with medical staff roaming about with headlamps, shaking campers out of their bags. Drowsy children offer their arms reluctantly to groggy counselors and nurses. Four are hypoglycemic and need to be treated. They quickly recover and just as quickly fall asleep again. Two are hyperglycemic, and need their ketones checked. They, too, are fine.
"It's a major challenge to adjust insulin for all the variables, prevent hypoglycemia and keep kids safe," says Price. "The goal is to send as many kids home on the bus as arrived on the bus."
In the space of an hour the madness has subsided, and it once again becomes a campout like any other, the giggles and taunts echoing through the redwoods well into the night. These are just kids, after all. Kids with one special asset: diabetes.
Each counselor is issued a fanny pack, which is carried at all times and contains a OneTouch® Ultra2 Meter, disposable lancets, alcohol wipes, tissues, a reclosable refuse bag-and the all-important glucose tablets, contained in their round dispensers. The latter are so important that at times camp seems to run on glucose tabs. Counselors, nurses, and doctors dispense them with finesse that borders on artistry, raising the blood glucose levels-and often, the spirits-of campers with these easily digested grams of carbohydrate.
The vast majority of campers (99%, according to the camp director) are Type 1, which means they must take insulin. About half are on insulin pumps, and the other half use multiple daily injections. Dosing regimens are a constant topic at camp, and the typical conversation involves enough math to challenge an accountant, as nurses and campers calculate correction factors, activity levels, carbohydrate content of meals, and anything else-like stress-that might figure into dosing and help keep blood glucose levels in range. Formulas are written on scratch paper, records are summoned from file boxes, and months of blood glucose histories are reviewed in making daily decisions.
"So," says a nurse. "How much are you planning to eat for dinner?" She hands the camper a plasticized menu of tonight's items, with the exact carbohydrate content listed for each.
"Let's see," says the camper, eyeing the list of spaghetti, a vegetable, a roll, milk and other items. "I think I'll have one of everything, so that's a total of 60 grams. I take one unit of insulin for every 12 grams. So that's 5 units."
"OK," says the nurse. "Now what was your blood glucose?"
"180. And my correction factor is one unit for every 50, so that's at least another unit to get within range. Plus, we're playing capture the flag tonight, so that's a lot of activity. And I've been running a little high at night anyway. So I'm thinking 7 units total."
The nurse nods in agreement. The camper draws up the syringe, presents it for her approval, and starts aiming for the back of his arm.
"Wait!" says the nurse. "Dinner isn't for 40 minutes, and if you take it now you'll go low. So take the syringe with you and wait 20 minutes."
The kid nods, tucks the syringe behind his ear, and is off like a shot. It's a scene that is repeated at least four times a day-a blur of numbers, calculations, and educated guesses that hopefully hone in on a healthy blood glucose range of 70-110 mg/dL, helping to ensure a long life and decrease the likelihood of complications.
But even the best and most carefully calculated plans can go awry-a child forgets a bolus that had been discussed and agreed upon. His eyes go big at the breakfast table and he eats six pancakes instead of the agreed-upon two, or has an extra half of a grilled cheese sandwich at lunch, sending glucose levels through the roof. The meter doesn't lie, and the effects are obvious. This sets off a new process of calculations and compensations-and so it goes, day after day. It's a combination of art and science, but it's one of the most important things a camper can learn.
"Camp makes me realize that you can control diabetes, it doesn't have to control you," said one camper.
It's 9 pm, and darkness has lowered over camp like a blanket. Everyone-campers, counselors, and medical personnel-are gathered around a roaring campfire, singing the usual songs, the stars blinking overhead. As I lean back and listen, I hear a quiet voice, almost disembodied, above the noise: "Where is my counselor? I think I'm low."
I look to my right and a small boy, towheaded and 10 years old, is looking up at me. His eyes are tired, and he's moving slowly, with effort.
I lean down toward him. "What did you say?"
"I think I'm low." The voice is even quieter than before.
Without asking, I reach into my fanny pack. We test. He's at 47 mg/dL: hypoglycemic and heading south. I give him the requisite glucose tablets, and we watch the fire for another 15 minutes. I eye him carefully, looking for other signs. When the time has passed, we test again: 126. Even better than this, his demeanor has been transformed; he is standing and laughing at every corny joke, yelling out the words to every song, whereas before he was quiet and withdrawn. When the campfire ends, he goes off jauntily to his cabin, pushing and ribbing his pals along the way, nearly falling with laughter.
I am no medical professional, but it seems to me I have performed a kind of minor miracle amidst the smoke and din of that campfire. It is, in fact, the closest thing to a cure that I will ever experience. But such things are the staples of diabetes camp: minor miracles, in the form of glucose tablets, advice, and a sympathetic ear, administered dozens of times each day to kids of every shape and size.
But the true miracle is that, in the end, both parties experience miraculous results-the giver, and the receiver. For these are special kids-not only for the disease they carry, but for all the reasons that make any kid special. They astonish us with their resilience, and their very presence.
Geoff Drake is the U.S. Web Manager for LifeScan, Inc., and oversees the Web site www.OneTouchGold.com.
Last Updated: Thursday February 05, 2009 17:44:52
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