We’re very proud of our little Stevie as he is getting ready to present the inaugural Webinar to over 300 diabetes educators via the J&J Diabetes Institute. They initially had 200 slots and those were gone in less than 48 hours. So, they added 100 more. I just looked and those are all gone now, too.

From the JJDI site:

Tapping into the Social Side of Blood Glucose Monitoring
Friday, January 22, 2010
9:00 AM - 9:45 AM (Americas) Pacific Time (US & Canada)

In Tapping into the Social Side of Blood Glucose Monitoring, Dr. Stephen Ponder will lead an energetic discussion about the role of the diabetes provider in SMBG and will also cover innovative communication methods to encourage appropriate testing with your diabetes patients. In this Webinar, you will get the chance to learn and participate in the discussion about a variety of topics, including: how to navigate the challenges to effective SMBG and how Dr. Ponder and other diabetes healthcare professionals approach the challenge of identifying creative ways to help patients understand the value of testing.

Presenter: Stephen W. Ponder, MD, FAAP, CDE, Johnson & Johnson Diabetes Institute Faculty

There is no more space available in this event.

I really love that Steve gets this opportunity to share his experiences with others. Hopefully at least a few of those hundreds are there to actually learn and change the way they help patients.

Did you attend? What did you learn? How will this new knowledge affect the way you work with your patients?

Well, Kevin McMahon “outed” my new application of the extended bolus we used very successfully at diabetes camp this year. It was borne out of necessity. With over 200 campers, 50% of whom used insulin pumps, we would sometimes face the dilemma of what to do with an out of range high blood sugar level at the midnight check. Certainly, every parent out there with a pumper (or perhaps pumping themselves) gets a little anxious about taking a correction bolus and then going to sleep. Of course the best thing to do is to check a BG in 2-3 hours. That puts it right smack in the middle of the night. Many of us are more inclined to do this so that we avoid a trip into the “3 AM Club” (severe hypoglycemia) which I’ve written about before (http://challengediabetes.diabetech.net/2008/12/23/are-you-a-member-of-the-3-am-club/).

So, here is the solution that worked so well for us. Using the smart pump’s bolus calculator (i.e., “wizard”, “EZ BG”), we calculated the correction dose of insulin needed to reduce the blood sugar back into the camper’s target range. But instead of giving it all at once, we programmed it as a 6 hour extended bolus instead. In each case we had a smooth descent back into target range. For campers we were uncertain about, we delivered 2/3rd of the correction over 6 hours (midnight to 6AM) and validated the effect the next morning. If we “got close, but still a little higher than target”, we went with the full dose the next time. That’s called titrating to effect.

Anyway, it worked like a charm. I use it myself. Now, purists out there would understandably want to still set the alarm clock and check a 3AM reading just to make sure. I understand and respect that. But once you can assure yourself that a slow descent works for the overnight correction, you might allow you (and your child) a more complete night’s sleep. If this is being done or promoted by others I sure would like to know about it so we can compare notes and perfect the Sleep Bolus as commonplace and just one more reason why a pump should be considered over injection therapy. Please share this information with as many of us who need and would benefit from the knowledge.

How many more subtle applications of seldom used pump features are out there? How do you squeeze every ounce of utility out of the tools you use today? And lastly, of the tools available today, are you leveraging them to their fullest?

Here is the background for our Diabetes Challenge Question of the Day.

We had several family members of former diabetes campers on the medical staff this week. Several were siblings of persons with type 1 diabetes. Chances are very good that a child with type 1 diabetes has a non- diabetic brother or sister (over several). I saw lots of siblings waiting around at check in. I’m sure I’ll see more today at check out.

Non-diabetic siblings often experience a wide range of feelings surrounding their diabetic brother or sister. Some may state (like my sister did at one point), that I got all the attention and special privileges she never did. Some sibs may live in fear that they might develop diabetes too. Often, the only persons explaining anything to the siblings are the parents. And if the parents don’t have the necessary training, the information that they do share may be inconsistent or sometimes simply incorrect.

Some older siblings may get placed in the position of acting as a “junior parent” to their younger diabetic sibling. This might include giving or watching insulin injections and blood sugar checks, preparing proper meals, or even making self care choices for their diabetic brother or sister.

Over time, a chronic family focus on the diabetic child may make the non-diabetic sibs angry or even resentful. Many sibs may be severely conflicted by these feelings.

So, today’s Diabetes Challenge Question is the following: How did growing up with a diabetic sibling affect you as a child and later as an adult? Did it permanently affect your adult relationship with your diabetic brother or sister? If you overcame this challenge, what do you think contributed most to your success? Feel free to be specific in your comment below.

Dance Night

The dance was a big success as always. Campers were made up and dressed up as well as one could at camp. I have several great photos below. If you are looking for the youngest campers, they were on camp out so the Rec Hall was less crowded than usual, but nonetheless just as active. Our med staff BG check table saw steady business all evening.

Last Day of Camp

Friday is the last day of camp. It’s been a privilege to have the opportunity to provide a safe and enjoyable camping experience for 215 children from across the state of Texas. My staff has also enjoyed this challenge and all are prepared to hand over campers to their parents on Friday night (or Saturday morning at 8AM for the 42 campers staying over). I will not be able to meet with the parents of campers discharged on Saturday morning since I will be occupied with orienting incoming new medical staff for Session 2, which starts at 1PM on Sunday July 26th 2009.

Free Photo/Video DVD

We shot over 2000 photos and 1 hour of video (Night Court). Mike Koch is working to create complimentary DVD’s in time for check out. These have great music tracks as well. This is Mike’s 8th year volunteering his time for the diabetic camping sessions. He was also involved with the organization of the Webinar the other evening (and this coming Wednesday evening too).

Texas Lions Camp

My medical team is very appreciative of the Lions Club and the Texas Lions Camp. The people who established this camp had their diabetes camping program vision almost 40 years ago. I’ve been lucky to be part of it each year since 1981. I encourage families to consider making donation to the camp. Every donation is appreciated and put to good use to serve the children and families of Texans with diabetes. The medical staff applauds Mr. Stephen Mabry, the camp’s CEO, for the quality team of individuals who operate every facet of the camp and effectively interface with my volunteer medical staff. The camp’s website is http://www.lionscamp.com. Photos of campers from this session can be purchased on the Lions Camp site.

Webinar

We have corrected the sound feedback problem for next week’s Parent’s Day Webinar so there will be no “echo chamber” effect. Updated links are posted to the webinar site. Attendees from last Wednesday night are invited to rejoin the webinar next week if you had to leave early. Also, the twitter site http://twitter.com/Dr_Steve_Ponder and this blog site form part of the alternative approach I’ve tried to develop to replace the former 2 hour Parents Day program in the Rec Hall we used to have. I will also have the pleasure of visiting with parents over dinner on Friday evening July 24th at 5:15 PM. If you have any questions or comments about camp, please let me know anytime by sending me an email at Stephen.Ponder@dchstx.org.

Diabetes Housecall

About 2 years ago I created a revolutionary new approach to diabetes care for children. It’s called Diabetes HouseCall. I currently have patients with diabetes in this modern version of my practice who have been seen as far away as Iowa. Texas patients as far away as 600 miles are seen just as easily as if they were in town. I encourage you to check out my practice website for HouseCall that explains how this innovative care program operates (http://www.diabeteshousecall.com ) to allow me to see you in the comfort of your own home, also while having access to all your relevant diabetes self care information. The rules of participation in this exciting program are explained on the site. I received some exciting news today that Blue Cross Blue Shield of Texas is embracing this program as a covered service starting around the end of September 2009. This would be a first for home based telemedicine care for children with diabetes in Texas. Advantages of HouseCall include 30 minutes or more of direct face to face time with the diabetes specialist. No waiting rooms, no long car rides, no time out of work or school, to see the diabetes doctor. Does this sound pretty good to you? Let me know if you need more info or would like to talk to one of the families already enrolled in my HouseCall practice. There is also an online community forming around HouseCall at glucoKIDZ.com and I know at least one of our families there would be more than happy to tell you more about their experience.

See you at Parent’s Night!!!