Session 2 is fully underway. Midnight checks are about to happen. We had our 10 PM med staff team meeting. There were lots of questions for me about the wide range of insulin regimens campers came in with. Like last week, there were too many basal-bolus-”like” regimens which lacked the complete core elements that make this approach to insulin therapy the best method to use based on much of the recent literature.

Bottom line: kids and basal bolus regimens don’t mix well. You need a parent (or an incredibly talented and emotionally mature child) to be actively involved in multiple decision making points and quality-control steps if you ever hope to achieve optimal glycemic control. What I see are fragmented basal bolus regimens (like what I saw last week: Frankenstein returns!), consisting of 1) a basal insulin only with occasional rapid-acting insulin per a “sliding scale”, 2) basal insulin (typically Lantus, but also equal doses of NPH at times, plus rapid-acting insulin with meals at a fixed dose (no option to adjust for carb intake or to correct a high BG, 3) basal-bolus without the ISF and 4) basal-bolus without the insulin to carbohydrate ratio. Not surprisingly, A1C levels were not that great. Many were in the 8% or higher range with several in the double-digit range.

When any insulin regimen is started on a child during the honeymoon phase (where they still make insulin), you can use a wide range of atypical regimens and still get a great A1C. This is in most cases due to the residual insulin capacity inherent with the honeymoon phase itself, not the regimen. As insulin production fades, the luster of the regimen quickly disappears and the control goes south. Also, several of the pre-teen campers are self-dosing insulin without adequate parental supervision. The pre-camp BG sheet in one case was replete with normal looking readings which had such a low variance that the most logical conclusion was she was fabricating data. There were no significant variances in the data, which is not in keeping with the normal flux seen in any patient with type 1 diabetes. I advised my staff to get to know the child and family as the best approach to deciphering the control problems these children are exhibiting.

Today was great day by any measure. We’ll be able to serve many campers by teaching them the skills and knowledge to best apply their regimens. For others, I expect we will do them the best favor by simplifying their regimens which, for now, have set them up to fail. More tomorrow….

Last 5 posts by Steve

• Halloween and Diabetes CAN mix! - October 5th, 2009
• Introducing Healthy Families of South Texas - October 5th, 2009
• Complications 101 - About Kidney Failure - August 23rd, 2009
• The Sleep Bolus - August 18th, 2009
• The Dirty Truth Behind DCCT - August 16th, 2009

This entry was posted on Sunday, July 27th, 2008 at 11:51 pm and is filed under Camp. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.