Final camp post

This is the last full day of camp. It’s been a busy 2 weeks. We’ve been fortunate to avoid any need for intravenous dextrose to treat severe hypoglycemia (at least as of this writing). That is always one benchmark I’m proud of. I want to once again thank the Texas Lions League for making this camp possible since 1953, plus all the counselors, med staff, core staff, dining hall staff, maintenance staff and senior leadership that make it possible. If I had to list each person by name, it would look like the credits from a Star Wars movie. Camp is a team effort in every way. It also “takes a village” to serve a child at diabetes camp. Ultimately, parents are the most important members of this team. You made the choice to share your son or daughter with us for the past 6 days.

I urge parents to call or write the Lion who sponsored your camper to come here (at no cost as you know). It means a lot to them to hear this feedback. I also suggest you send your comments to Mr. Stephen Mabry, the CEO of the Texas Lions Camp and one heck of a human being. His e-mail is smabry@lionscamp.com. I’ve had the honor of knowing this man for the past 20 years. I could not think of a finer, more dedicated and sincere individual as Stephen. He is also supported by a staff of equally committed professionals that make your camper’s experience a truly memorable one.

So today’s final Diabetes Challenge Question of the Day asks: Did diabetes camp make a difference for your child? I realize your responses won’t come until later. But I want you to think about this as you head home with your son or daughter and discuss their camp experience with them. But also reflect upon your own experience: for many of you this may have been the “first time”. For others, this may be old hat. Ultimately, your vote of confidence in us will be by entrusting us again with your camper sometime in the future.

Personally, it’s been an honor to be involved with this camp. I’m now in my 28th year. I’ve been directing it for 20 years. It has been (and hopefully will continue to be, God willing) an experience I’ll appreciate for many years to come. I’m also surrounded with people on our medical staffs that are of the highest integrity and moral character. I just hope a little bit of it will rub off on me!

Is NPH insulin dead? Of the 211 8 to 15 year olds attending diabetes camp this week, a mere 12 (5%) of them used an insulin regimen that included some form of NPH insulin (i.e., the cloudy one). Basal-bolus insulin regimens (e.g., Lantus-Humalog or Levemir-Novolog) have all but killed the older split-mixed insulin schedules (NPH-Novolog/Humalog in AM, Novolog/Humalog in PM and NPH at dinner or bedtime).

But there is more to this story. NPH never really had many strong advocates (or funding) over the last couple of decades. It was considered to be too unpredictable (and this is somewhat true). With the emergence of analog insulin preparations in the late 1990’s such as Lantus and later Levemir, the die was cast. These new insulins were empowered by large amounts of money in their respective pipelines; NPH had about a snowball’s chance in west Texas on a summer day. Numerous studies, many funded by the parent companies of Lantus and Levemir, dealt blow after blow to NPH’s clinical usefulness (at least compared to these new kids on the block). Armies of sales representatives descended in mass on physicians’ offices across the country armed with samples and literature on these agents, or through medical conferences for doctors that highlighted the incredible virtues of these new and improved insulins over the old and obsolete NPH.

But by my direct observations at diabetes camp this year and over the past several years, there may still be a role for NPH to play. I could not help but notice that many NPH using campers actually as a group had better control than did groups of campers on pumps or basal-bolus insulin schedules, at least based on the A1c levels. It begs a big question as to whether this insulin should really be put out to pasture. I use NPH in my practice as one of several tools in my diabetes armamentarium. To exclude it altogether is, in my opinion unwise.

Today’s Diabetes Challenge Question of the Day asks: What role (if any) should NPH insulin play in the management of persons with type 1 diabetes? Should NPH insulin be discontinued altogether? Cite any examples to support your position one way or the other. How many of you don’t even know what NPH insulin is?

Wrapping up

Camp will be over in about 24 hours. The webinar was a success last night. I look forward to meeting with Parents over dinner on Friday evening at 5:15 PM in the dining hall. It has been a pleasure leading the team that cared for your most precious family assets. I hope you will consider the Texas Lions Camp in the future, and refer others to our program so we might serve them.

Webinar Tonight! - see below to get more info on how to attend.

Like it or not, diabetes care involves numbers. Some might say too many numbers. But one number that anyone with diabetes should know is their own hemoglobin A1C number, plus what it means.

I continue to meet patients from other practices that don’t know their last A1C value. It might be because the doctor draws the test after the visit and doesn’t get back to the patient about results. It could be that the doctor doesn’t order the test at all. That still happens. Worse yet, the doctor may draw the test and have the value at hand, yet not know how or when to act on the results.

A hemoglobin A1C test looks back several months and is an indicator of the average level of blood sugar control. It is expressed as a percentage. Recently, there has been an emphasis on converting the value to a number the patient can better relate to: the average blood sugar level in mg/dl, which are the units displayed on glucose meters in the US.

The A1C can be measured with a simple finger poke, or may be drawn from the arm. Some devices can report the result in minutes; others are handled like any other laboratory study and take a day or two to result. The ADA recommends that A1C values be targeted for 7% or lower. Anything higher should be evaluated for possible changes in management or discussion of existing diabetes self care practices with the patient. Other organizations suggest A1C be under 6.5%. There is already a major report that suggests the A1C test be formally accepted as one way to diagnose diabetes. The results are working their way through the diabetes medical establishment for final adoption.

Therefore, today’s Diabetes Challenge Question of the Day is about the A1C: YOURS: how often each year do you get your hemoglobin A1C measured; and if so do you know the most recent result? What kind of advice do you get from your diabetes doctor about your A1C levels? Is it supportive, critical or dismissive? Is your most recent value 9% or higher? If so, do you have a plan for getting it lower? And when do you get your next A1c to see how you’re making progress?

Webinar Tonight

I will not be posting an informational blog today due to the scheduled Diabetes Webinar tonight. The Webinar is scheduled to start at 8 PM CST and end at 9PM (Central Time). Updated links are posted to the site http://lionscamp.com/webinar.htm. Attendees from last Wednesday night are invited to rejoin the webinar next week if you had to leave early. During the day, join me at my twitter site for more one liners and candid photos of your kids being kids at http://twitter.com/Dr_Steve_Ponder . If you have any questions or comments about camp, please let me know anytime at Stephen.Ponder@dchstx.org.

Photo Gallery - check back later in the day and I’ll have a few posted.