February 12, 2002
Question from Costa Mesa, California, USA:
My 11 year old son (diagnosed two months ago with type�1 diabetes) will be attending an outdoor school science camp for four days and three nights soon. Parents are not allowed to attend so I am in the process of coordinating what supplies he'll need. I've obtained a menu so we can carbohydrate count what he'll eat ahead of time, and we're having a meeting soon with our Certified Diabetes Educator to understand the effects of exercise and a higher altitude (we're at sea level, the camp is at 5,500 foot elevation). We have called the school principal and nurse at this outdoor science school. I conveyed to the principal and nurse that if his nighttime read is low (120 mg/dl [mmol/L] or less) before bed that we double his snack and check him at 12:00 am and 2:00 am and I requested that they do the same. They're very resistant to potential nighttime checks, and I'm concerned as to how to handle this situation if it should occur. I've heard about the bars to prevent nighttime hypoglycemia. Would that be a way to work around a nighttime hypo since it's pretty clear my son will be "on his own" at night? Just as a side note, we could request a medical aide but my son said he doesn't want to stand out any more than he will with blood testing, etc. Also, the nurse is on site at this camp 24 hours a day, and she figured he was giving himself his own shots. I said "no", and she did agree to give him his shots (two a day) when I asked "Can't you give him his shots?"
There may be times when a nighttime check is necessary. I would make arrangements with the school to make sure someone is able to help him with his diabetes if necessary including nighttime checks as needed. Having diabetes for just two months is tough, especially if he is going on a prolonged outing and will need to have some measure of independence. A good diabetes educator may be a good resource for helping you plan this trip and find school personnel who can assist you. In addition, in this era of cell phones, good communication with you at home may also be necessary in this case.
Additional comments from Stephanie Schwartz, diabetes nurse specialist:
It is very important that camp staff be familiar with the symptoms and treatment of hypoglycemia. The cornstarch bars (or simple a peanut butter sandwich) are fine, but there is no guarantee that your son will not have a low at night. Whoever is supervising his sleeping quarters, needs to have instruction and be directed to do as you ask. That person should also know how to use your son’s meter, glucose gel, and a Glucagon Emergency Kit.
I fail to understand why the nurse cannot be more accommodating. It seems that your son’s care is part of her role, and this issue needs to brought to someone’s attention. If you cannot get camp staff to agree, your alternative would be a medical aide. While I agree with your son’s desire to not “stand out”, this might be a compromise should all else fail.
Also make sure he has plenty of glucose tabs and snacks available at all times, including nighttime.
[Editor’s comment: You might want to send Extend Bars for a nighttime snack. These have been shown to reduce the risk of nighttime hypoglycemia. See Evaluation of a snack bar containing uncooked cornstarch in subjects with diabetes.