Well, Texas Lions Camp for Children with Diabetes is now officially over. I can happily report that NONE of our 411 diabetic campers experienced either severe hypoglycemia or diabetic ketoacidosis during their collective two week camp experience. The latter is now pretty routine, but the former makes me extremely happy to report since over the past few years we’ve been plagued with campers experiencing severe hypoglycemia. The problems with maintaining insulin pump infusion site integrity during camp resulted in several campers with early stage ketosis, but that was as far as it got. Frankly we are always overly prepared for these problems and conduct extensive training on how to best manage and prevent it.

Regarding prevention of severe hypoglycemia, I attribute our diligence with screening for “mystery boluses” as one reason for why we had no severe hypos this year. Before screening bolus histories a few years ago, a mystery boluser managed to induce severe hypoglycemia (as she later said, for “not being asked out to the dance”) by bolusing 20 units right after lights out. Had we screened her pump memory, we would have seen similar events in the past few weeks. Today, by aggressively reviewing insulin pump bolus histories, we seem to be preventing some (hopefully most) of these events. Years ago, we identified campers on injections who were probably insulin omitting and made changes to their doses to prevent these kinds of problems.

Parent’s day was packed. I had a lot of good questions afterwards. We were also able to distribute complimentary DVD’s with over 2000+ digital photos, 60 current songs, and over an hour of camp video. This was done once again by Mr. Mike Koch, a camper parent-volunteer who defines the meaning of dedication, perseverance and ingenuity as it relates to supporting the Texas Lions Camp Diabetes Camp program.

To a person, our camp med staff has learned a lot. Mystery bolusing is only one of the things they’ve learned. These hard working folks are dead tired, as I can directly testify based on how exhausted my two adult daughters are today, plus myself. I had to pull over to nap on the ride back home, in spite of a good 10 hours of sleep last evening.

I know we accomplished our three goals of camp. First, the campers had fun. Second, they were safe (as described above). Third, they did learn more about their diabetes. I heard it during check out when some campers came back with their parents to tell us good bye. My unofficial “fourth” goal was also achieved: that the professionals in the med staff learned more about managing type 1 diabetes.

Med staff has lived in a bubble the past couple of weeks. We’ve also been chronically sleep deprived and put to our collective physical limits. In spite of this, the main topic of discussion yesterday seemed to be about who is coming back next year and who will be telling colleagues and friends about what they learned and how they plan on being back next year. After 27 years, I’ve learned that about 25% will make good on these promises. Still, returning med staff is key to the success of our diabetes program. Still, I deeply appreciate the fact they have been here this week (or two) and gave all they could for the kids. To me, next year is another matter and is best left for next year.

Finally, is diabetes camping still relevant? After all, children with diabetes are not barred from participating in activities once barred to them simply because they had a chronic disease. Societal barriers to having diabetes are fewer than ever before. Does it make a difference to have camps like these? I have my own opinions about this, but I would invite yours. I hope you will let me know what you think.

In the meantime, after floating down the Medina River today, I plan on getting another good night’s sleep. A few years ago, I learned to take off the Monday after camp. The older I get, the smarter that decision seems. Yet camp is in my blood and I’m already looking forward to next year. But… don’t tell my staff!

Camp is in its final couple of days. Two weeks has gone by like a month to everyone working on the med staff. Everyone is very ready to return to whatever routine they had before, or better yet just a good night’s sleep. Med staff is also busy making final recommendations for “going home” insulin dose adjustments and what they’ll be saying to camper’s parents at check-out. I will address the parents from 10:30-12:30 on Saturday morning at “Parents Day”. We usually have a full house at the Rec Hall. It’s my chance to share how camp went the past week, and also provide some insight much as I have in this blog over the past couple of weeks. I also try and answer any and all questions parents have about diabetes care and technology. Basically, a diabetes update from a doctor who treats children with diabetes for a living and who has also lived with the condition for 43 years.

We must acknowledge our gracious host and sponsor, the Texas Lions League. Their vision over 40 years ago made this diabetes camp not only possible, but also unique as the first such camp that never asked for, or accepted, fees for children with diabetes to attend the camping program. Others emulate them now, but this camp was the first.

The running joke at Parents Day is that campers check out is between 12:45 and 12:46 PM! We have enjoyed caring for campers, but we are very ready to return them. Just like last week, everyone on my med staff has made the transition from novice to pro over the past week, as I assured them they would. We’ve had our challenges along the way as we always do, but we always persevere.

To a person, every volunteer on med staff has learned something about diabetes they didn’t know when they arrived here. Many have learned a great deal; and they work in the diabetes field already. I tell anyone who will read or listen, that this camp is the single greatest learning experience about type 1 (juvenile) diabetes that I have ever had. More so than any book, lecture, course or symposium I’ve ever participated in. I would hope these posts will serve to identify future med staff.

Our hosts, the Texas Lions League, hold their semi-annual board of directors meeting starting Saturday. Check out is nothing short of a circus environment, as hundreds of Lions and their families co-mingle on campus with 208 campers, 50 medical staff and 100 camp counselors and their core leadership staff. It’s amazing that any of us don’t get run over by all the cars!

In closing, I can only say that I’m fighting the good fight, I’m running the race, and I’m keeping the faith. But it’s not over for me yet, nor any of these children that we come here to serve every year. This camp will remain forever part of my life, and part of the lives of tens of thousands of children and young adults with diabetes. Besides my family, it’s one of the best things to have ever happened to me.

As a follow up to the last post, we have continued to uncover many campers with Mystery Boluses. Some are rather startling. In one case, as much as 50 units bolused through a pump, or repeated boluses totaling 50 units or more at odd times of the day, even during the middle of the night. Not surprisingly, lots of lows. When the pump history was reviewed for the past few weeks, I found several days where NO bolus was given. This camper’s pre-camp A1C was in the double digits.

The reasons for this phenomenon are undoubtedly complex. I wish there was more study behind the drivers of these behaviors, or what characteristics these folks have in common. Given the fact that more and more kids are going on insulin pumps, this will only continue to be a serious problem with potential life-threatening consequences. In my practice, I require patients considering pump therapy to go through pre-pump training that spans several visits. It’s not my intent to slow down getting a pump, but simply acknowledging the fact that these are sophisticated machines with potential for great good, or great “bad” if not started properly and educationally “maintained”.

I ask kids to sign a behavioral contract regarding their pumps. That allows me the chance to re-visit promises almost all insulin pump patients make before starting a pump. These vows are often kept as long as a New Year’s resolution by January 15th.

At camp this week, my Mystery Bolusers come from every corner of the great state of Texas. All are teens and “tweens”. I don’t typically see this behavior in the pre-teen age groups since most parents still play such active roles in their day to day pump management. I’ve contacted these camper’s diabetes doctors and shared our findings to determine the best course of action in each case.

My advice to parents of teen insulin pumpers is simple: don’t back off from your involvement in their diabetes care. Dr. Barbara Anderson has clearly defined the age of 16 years as the earliest age where greater diabetes self care independence is justified. To do otherwise invites problems like the Mystery Bolus and their cousins, the Omitted Boluses.