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P O S I T I O N

S T A T E M E N T

Diabetes Care at Diabetes Camps
AMERICAN DIABETES ASSOCIATION

S

ince Leonard F.C. Wendt, MD opened the doors of the first diabetes camp in Michigan in 1925, the concept of specialized residential and day camps for children with diabetes has become widespread throughout the U.S. and many other parts of the world. It is estimated that worldwide campsserve 15,000 –20,000 campers with diabetes each summer (1). The mission of camps specialized for children and youth with diabetes is to allow for a camping experience in a safe environment. An equally important goal is to enable children with diabetes to meet and share their experiences with one another while they learn to be more personally responsible for their disease. For this to occur, askilled medical and camping staff must be available to ensure optimal safety and an integrated camping/educational experience. DIABETES MANAGEMENT AT CAMP — The recommendations for diabetes management of children at a diabetes camp are not significantly different than what has been outlined by the American Diabetes Association as the standards of care for people with type 1 diabetes (2,3) or for childrenwith diabetes in the school or day care setting (3). In general, the diabetes camping experience is short term and is most often associated with increased physical activity relative to that experienced while at home. Thus, goals of glycemic control are more related to the avoidance of hypoglycemia than to the optimization of overall glycemic control (4) while away at camp. The management protocolaims to balance insulin dosage with activity level and food intake so that blood glucose levels stay within a safe target range, especially with respect

to the prevention and management of hypoglycemia (4). Each camper should have a standardized medical form completed by his/her family and the physician managing the diabetes that details the camper’s past medical history, immunization record,and diabetes regimen. The home insulin dosage should be recorded for each camper, including number and timing of injections or basal and bolus dosages given by continuous subcutaneous insulin infusion (CSII) and type(s) of insulin used. Records for insulin dosages and blood glucose values for the week immediately prior to camp should be provided. Additional medical information, such as priordiabetes-related illnesses and hospitalizations, history of severe hypoglycemia, previous A1C levels, other medications, significant medical conditions, and psychological issues, in addition to pertinent school information provided via a teacher information form, should also be available to camp personnel and be reviewed with diligence by those responsible for the health and wellbeing of the individualcamper. During camp, a daily record of the camper’s progress should be made. All blood glucose levels and insulin dosages should be recorded in a format that allows for review and analysis to determine if alterations in the diabetes regimen are required. Recording degree of activity and food intake may also be helpful in determining subsequent alterations in the diabetes regimen. It is imperativethat the medical staff have knowledge about the exercise schedule and the meal plan so that they can make appropriate insulin dosage adjustments. To ensure safety and optimal diabetes management, multiple blood glucose determinations should be made throughout

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The recommendations in this paperare partially based on the evidence reviewed in the following publications: Weir GC, Nathan DM, Singer DE: Standards of care for diabetes (Technical Review). Diabetes Care 17:1514 –1522, 1994. The initial draft of this paper was prepared by Francine Kaufman, MD, Desmond Schatz, MD, and Janet Silverstein, MD. The paper was peer-reviewed, modified, and approved by the Professional Practice Committee...