A Camper With Diabetes…

Is first and foremost a camper

By Beth Morrow
Photos Courtesy of Central Ohio Diabetes Association

In 1964, five central-Ohio physicians collaborated in educating the community due to the increasing number of diabetic patients in their care. The doctors created the Central Ohio Diabetes Association, a nonprofit agency that continues to offer education and resources to people with diabetes in and around Columbus, Ohio. Three years later, in 1967, these same physicians discovered their pediatric diabetic patients were being refused access to summer camp, solely based on their Type 1 diabetes.

Following a visit to Camp Ho Mita Koda in Newbury, Ohio , the first and oldest diabetes camp in the United States , these doctors decided to replicate the camp’s routines for their own patients. In 1968, they held to their vision and created Camp Spill-A-Little, housed at the Judson Hills campgrounds in Loudonville, Ohio . Staffed by the campers’ older siblings and their friends, Camp Spill-A-Little (named for the body’s reaction of “spilling” ketones into urine when blood glucose levels run higher than average) hosted 37 campers over the course of one week. Following the death of Dr. George Hamwi, one of the founders of both the association and the camp, Spill-A-Little was renamed Camp Hamwi . The camp expanded to two weeks in 1969, and to three weeks in the late 1970s. Ever-increasing attendance in 1983 required a larger space, so the camp moved to its present location at Camp Mohaven in Danville, Ohio.

Currently, Camp Hamwi hosts two weeks of campers: a junior week (ages 7 to 12) and a senior week (ages 13 to 17). The camp provides all diabetes-related supplies through donations. While the one-week supply cost per camper averages $1,751, the cost for parents is $425, and scholarships are available. The majority of Hamwi staff is homegrown, rising from the ranks of camper, counselor-in-training, counselor, to program staff. In July, 90 percent of the senior-week counseling staff was camp alumni or counselors with at least three years’ experience.

Hamwi staff members believe diabetes should not preclude a child from the camp experience. If anything, the autonomy and responsibility required for youth with diabetes to thrive in a camp setting helps foster independence and self-awareness in coping with the disease in daily life. As a camp director, medical director, kitchen or dietary staff member, counseling or support staff, each person is a conduit for the camper to have a phenomenal experience, despite his or her chronic condition.

Best Practices For Camp Staff
If you are the director of a camp for diabetic children or are running a camp with a diabetic child, consider the following advice. In advance of camp, invite parents and campers to compile information for a unique diabetes profile to share with pertinent staff. Include:

▪ Insulin dosages and carbohydrate-to-insulin ratios

▪ Camper behavioral responses to both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar)

▪ Preferred treatments to specific blood-sugar readings

Consider sending parents a menu if no one on staff is able to calculate appropriate carb-insulin ratios for mealtimes. This allows for pre-planning and notation of insulin dosages for camp staff. Day campers often bring a packed lunch, but if lunch is provided, share details with parents in advance to adjust insulin according to the level of activity and meal plan.

To ensure the camper has a safe and memorable experience, schedule “Diabetes 101” staff training during the health portion of orientation. This training can be led by a licensed medical professional or a Certified Diabetes Educator (CDE). Include details on hyperglycemic and hypoglycemic behaviors and treatments, the camp emergency plan, and training on the administration of glucagon. Diabetes management is reliant upon maintaining the proper carbohydrate-to-insulin balance, so ensuring proper portion control at mealtime is crucial. Offer alternatives for high-sugar foods and other dietary issues and camper allergies, such as Celiac disease. Provide access to individual snacks that the camper can take on extended activities.

Planning For An Emergency
Every camp should have an emergency response/crisis communication plan, with the following practices and considerations to be reviewed and discussed:

Notify paramedics, hospitals, and law-enforcement departments in the immediate vicinity of camp that a camper (or campers) with diabetes will be in your care.

Implement a written policy for notifying parents of treatments their child has received. At Camp Hamwi , parents are notified when a child is transported to the hospital, or a child receives a glucagon injection.

Be aware of how monitoring equipment will be readily available to a camper.

High blood sugars result in ketones, which increase with physical activity and require hydration to remedy. At what blood-sugar level will physical activity require rest and rehydration? Can that be done under the supervision of trained staff, or is a trip to the medical center required?

Understand the action steps for hypoglycemic and hyperglycemic readings, and when a reaction requires outside emergency assistance. For example, if the camp health facility is not equipped with IVs necessary for treating diabetic ketoacidosis (DKA) arising from high blood sugars, at what point is a child transported to the local hospital?

If a camper is not old enough to administer his or her own insulin and monitor blood glucose readings, which staff member is responsible? How will detailed records be maintained? Similarly, who is responsible for administering glucagons, and how will they be accessible at all times?

A Camper With Diabetes
Most campers with diabetes have some experience and knowledge in managing their condition in a school setting. Simply asking a camper his or her needs is often sufficient in determining the comfort level in sharing with others. Counselors and cabin mates of a diabetic camper must recognize which behaviors are exhibited in reaction to high and low blood sugars. For example, anger and irritability are often signs of low blood sugar, and require quick checking and treatment. If a camper is too young or inexperienced to be able to explain these details to a counselor, parents or guardians can make a list of needs and behaviors. A good practice is to make sure the diabetic camper has a buddy present at all times in case medical assistance is needed.

Before Leaving Camp
When parents arrive to pick up their camper, have them meet with the medical-staff member responsible for the child’s monitoring and treatment. Share with them interpretations of the blood-sugar readings in response to various activities, meals, and snacks over the course of camp. Offer parents a copy of the blood-sugar and insulin log to provide to the child’s endocrinologist. Invite parents to meet with cabin counselors and other staff members who spent significant time with the camper.

If parents have follow-up questions for staff members after the session is complete, camp directors should act as a liaison. Instruct parents to call the camp director, who will contact the counselor for a response. Likewise, if a counselor remembers an important detail for the parents, the camp director should be contacted to relay that information. This preserves the integrity of the conversations, as well as confidentiality.

Camp has the power to transform the life of every child. For campers with diabetes--who are campers first, and diabetics second--camp has the additional bonus of helping them become more aware and proactive in their management and knowledge of how diabetes affects them individually.

Beth Morrow is an educator, author, and co-program director for senior week at Camp Hamwi.