Standards of Diabetes Camp Dr Elaine Kwan QMH 16 September 2004.
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Transcript of Standards of Diabetes Camp Dr Elaine Kwan QMH 16 September 2004.
![Page 1: Standards of Diabetes Camp Dr Elaine Kwan QMH 16 September 2004.](https://reader030.fdocuments.in/reader030/viewer/2022032802/56649e015503460f94aebca2/html5/thumbnails/1.jpg)
Standards of Diabetes Camp
Dr Elaine KwanQMH
16 September 2004
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Mission of diabetes camps for children and adolescents
• To allow for a camping experience in a safe environment
• To enable children with diabetes to meet and share their experiences with one another
• To learn to be more personally responsible for their disease
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Mission - for patients and families
• To be enjoyable
• To increase the confidence in both physical and social activities
• To promote diabetes education in a more relaxed and non-structural setting
• To review their management skill in daily life
• To impart a more positive attitude in coping with chronic illness
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Mission - for patients and families
• To promote communication / understanding with staff and sharing of difficulties and feelings in coping with disease
• To allow parents a ‘vacation’ off diabetes care
• To allow campers to gain perspective on their own family dynamics
• To establish ongoing peer support networks
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Mission - for medical staff
• To have better understanding of the struggles and difficulties that patients face in their daily living
• To build a good rapport and relationship with the patients and families
• To provide an opportunity to work as a team in running an educational camp
• To encourage sharing of responsibilities in diabetes care
• To gain practical experience in diabetes care
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Diabetes camps for children and adolescents• Should be an integral component of overall
care and support
• Organised using an agreed set of standards and protocols specifying responsibilities, staff ratios etc
• Skilled medical and camping staff to ensure optimal safety and an integrated camping /educational experience
• A standardised medical information form should be completed for each campers
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Diabetes camps for children and adolescents• Often associated with increased physical
activity
• Goals of glycaemic control more related to avoidance of hypoglycaemia than optimization of overall control
• Balance insulin dosage with activity level and food intake
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Standardised Information before camp
• Past medical history
• Immunisation record
• Diabetes regimen including home insulin dosage
• Blood glucose record for the week before camp
• History of poor control and severe hypoglycaemia
• Previous HbA1c levels
• Other medications
• Psychological issues
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Written camp management plan• Include camp policies and medical
management procedures
• General diabetes management
• Insulin injections/ pump therapy and BS monitoring
• Nutrition, timing, and content of meals & snacks
• Routine and special activities
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Written camp management plan• Hypoglycaemia and treatment
• Hyperglycaemia/ketosis and treatment
• Medical forms
• Assessment and treatment of intercurrent illness
• Psychological issues at camp
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Written camp management plan• When to notify parents and chief care
physicians
• Risk management plan
• Universal precautions and policies for needle sticks
• Handling of infectious wastes
• Monitoring of medical equipment
• Incident/ accident reporting
• Policies for camp closure and returning home
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Written camp management plan
• Emergency procedures (including natural disasters)
• Prevention of physical, sexual and psychological abuse
• Risk management plan
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Standardised record during camp and feedback• All blood glucose levels and insulin
dosages
• Degree of activity
• Food intake
• Any major alterations during the camp
• Copy of camp record sent to health care team of patient
• To return to their pre-camp regiment
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Camp Leader• Led by someone with expertise in diabetes
care, in paediatric care and in camping– Appropriateness in working with children
• Be responsible for daily reviewing of blood glucose results, insulin logs and other medications to make appropriate adjustments
• Overseeing all medical emergencies
• To ensure that the medical program is integrated into the overall camping experience
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Camp Staff Composition
• Diabetes educators
• Dietitians
• Students
• Volunteers
• Camping experts
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Training of staff• All staff should undergo testing to ensure
appropriateness of working with children
• All staff should receive training concerning routine diabetes management issues and the treatment of diabetes-related emergencies before camp (hypoglycaemia and DKA)
• Familiar with signs and symptoms of hypo/ hyperglycaemia, indications for blood glucose testing, and treatment of hypoglycaemia including administration of glucagon
• Camp policies and job descriptions available before camp
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Facilities
• Routine first aid
• For treatment of intercurrent illnesses (allergies, asthma, sore throats, diarrhoea/ vomiting, minor trauma)
• Diabetes supplies (insulin, pen, pump, battery, catheters, glucose monitoring machine, stripes, lancets, syringes, alcohol swabs, gauze, glucagon, intravenous glucose solutions, simple sugar, urine ketone stripes, stethoscopes, thermometer)
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Management protocol at camps - insulin• To balance insulin dosage with activity
level and food intake to ensure stable blood glucose
• 20% or more reduction of insulin dosage
• Extra reduction for extreme physical activity, prolonged hikes or water sports
• Pre- and post-camp insulin dose advice – Small reduction of 10% for immediate
pre-camp dose
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Management protocol at camps - monitoring
• Multiple BS determinations made throughout 24 hour period – Before meals, at bedtime, after or during
prolonged and strenuous activity and in the middle of the night (for BS < 5.6 before bed), after extra doses of insulin or with symptoms of hypoglycaemia
• Daily record of camper’s progress – Insulin dosages, BS levels, degree of
activity and food intake
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Management protocol at camps - diet• 3 meals and 3 snacks should be given at set
times each day
• Meals balanced, with composition, carbohydrate component, exchange value, and/or calorie count taught to campers
• Enable campers to learn how to balance food and activity
• Supervision of food intake of younger children
• Give extra snacks for BS < 6.7 mmol/L
• Signs of eating disorders
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Management protocol - others
• Universal precautions (appropriate containers for disposal of sharps)
• Formal relationship with a nearby medical facilities for emergencies
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Hypoglycaemia
• No clear definition, usually defined as PG < 4 mmol/L
• Varies with metabolic control (threshold at higher BG level for poor control)
• Result of a mismatch between insulin, food and exercise
• Symptomatic/ asymptomatic• Mild/ moderate/ severe
– Moderate - requires help from someone else– Severe - semi-conscious/ unconscious/
coma/ convulsion
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Hypoglycaemia related to exercise
• Hypo can occur – During exercise – Immediately after exercise or – 6-8 hours after exercise
• The BS lowering effect is extremely variable and severity depends on many factors
• Recommendations for individuals can only be made on the basis of their age, size, individual experience and ‘trial and error’
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Prevent exercise induced hypoglycaemia
• Extra snacks before and after exercise– Small rapidly absorbed carbohydrate for
light exercise– Slowly absorbed carbohydrate for strenuous
and prolonged exercise– Extra snack before bed for strenuous
exercise in the afternoon or evening
• Reduce insulin dose• Change injection site• Monitor BG before exercise
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High-risk sport when hypoglycaemia would be potentially dangerous
• Water sports, climbing, skiing, diving, riding bicycle etc
• Must do BS monitoring before , during and after exercise
• BS targets may be temporarily relaxed• Extra rapidly absorbed carbohydrate must be
available throughout the period • Young people should perform strenuous exercise
in the presence of a companion/ supervisor familiar with the recognition and treatment of hypo
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Treatment of hypoglycaemia
• All measures to avert severe hypoglycaemia (give extra snacks for BS < 6.7 mmol/L)
• A set protocol for treatment of mild-to-moderate hypoglycaemia so that hypoglycaemia is consistently managed
• Repeat BS testing performed within 30 min to ensure resolution of hypoglycaemia
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Guideline for management of hypoglycaemia in camp
• Check dextrostix if condition not critical• Dextrostix 3-3.9: give 10 gm simple sugar, repeat
after 3-5 min if necessary• Dextrostix < 2.2: give 20 gm simple sugar, give
another 10-20 gm if still symptomatic after 3-5 mins
• Give extra 10 gm CHO if no meal within 1 hour• Unconscious: give glucagon imi (0.5 mg for < 6
years, 1 mg for > 6 years)• Keep record of BS reading and inform i/c medical
staff before next injections
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Extra carbohydrate before and during exercise
Exercise BS before (mmol/ L) Extra CHO< 7 10 gLow intensity
or < 30 min > 7 No extra CHOModerate < 7 10-15 g before
10 g f or every 30 min< 7 20 g before
10 g f or every 30 min7-12 10 g before> 12 No extra CHO
Strenuous
> 15 Exercise should be avoided
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Treatment of ketoacidosis• Measure urine/serum ketone if BS persistently >
15 mmol/L (2 consecutive readings if asymptomatic) or if there is intercurrent illness
• Oral or intravenous hydration (oral: 2 L water/day)
• Extra insulin (10-20% of total daily dose as fast acting/ ultra-fast acting insulin bolus) if BS and ketone +ve
• Avoid exercise
• Dextrostix and urine/serum ketone every 4 hours
• Flow sheet for documentation of progress
• To medical facilities if vomiting or if ketosis does not resolve within 8 hours
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Diabetes Education and Psychological issues at camp• Camp setting an ideal place for teaching
diabetes self management skills
• Education programs should be developmentally appropriate
• Improve psychological well-being of campers
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Diabetes Education - topics• Insulin injection techniques/ insulin pumps
• Blood glucose monitoring
• Recognition and management of hypo/hyperglycaemia and ketosis
• Insulin dosage adjustment
• Carbohydrate counting
• Diabetes complications
• Importance of diabetes control
• Lifestyle issues (especially weight control and exercise)
• Sexual activity and preconception issues
• New therapies
• Problem solving skills
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Research at camp
• Must not interfere with integrity of camping program
• Parents and campers should have a copy of the research protocol
• Informed consent
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Thank you !See you at the camp !