1. Staff Training Presentation Diabetes Education & Camping Association

2. This presentation is intended to be a general guide that will help you create a thorough staff training tool for your camp. It is not intended to be a comprehensive resource or to fully cover the topic. We hope you will take this presentation and adapt it so that it fits your camp’s specific needs and meets the guidelines established for the safe and effective operation of your program. Each diabetes camp operates under detailed policies and procedures that follow Board of Health and national accreditation standards that ensure the health and safety of children with diabetes. It is essential that camp staff be trained according to your camp’s policies and procedures. Staff should be encouraged to carefully review materials before arriving at camp, participate fully in pre-camp training, ask questions and use good judgment as they provide diabetes management supervision and educate youth with diabetes at camp. While doing so, it is equally important that camp staff not lose focus – camp is a place for youth to have fun with peers – to feel supported and understood, and to feel part of a passionate community. Good luck!

3. Campers arrive at camps on all methods of insulin delivery: Injections Insulin pumps Insulin pens Campers are on many different insulin regimens. Accept each camper’s method and to help them better understand it, not to judge it. Insulin is good and all delivery devices are “cool” as long as you take your insulin.

4. Insulin needs may be different at camp than at home. Intensive activity may require less insulin. It is very important to become familiar with, and to follow, your own camp’s policies and procedures for monitoring blood glucose and adjusting insulin.

5. Insulin helps the body use carbohydrates (food) and is generally administered before, during or after meals, according to camp protocol. It is also administered whenever a “correction dose” for blood glucose outside the recommended range (on the high side) is needed (again according to protocol).

6. Campers arrive at camp on an insulin “regimen” determined by their physician at home. Sometimes, basal or long-acting insulin doses will need to be reduced when campers arrive at camps because activity levels tend to be higher. This will be done by the camp physician. On a daily basis, both at resident and day camps, insulin doses are adjusted based on blood sugar levels (checked before each meal and whenever there are symptoms), planned activity, and food intake. Insulin doses are typically prescribed and supervised by a health care team member as described in your camp’s policies. This will vary from camp-to-camp. Campers and counseling staff will take part in this process. It is an important educational component of every camp program. Documentation of insulin doses and blood sugars is essential in every camp. Following your camp’s policies in this regard is critical to the safety of everyone in the camp environment.

7. Injections Some campers are on multiple daily injections of “analog” or fast-acting insulin to “cover” meals (carbohydrates) and to correct blood glucose readings, combined with long-acting or “basal” insulin which have a long action time in the body. This mimics what the body’s own system does when it produces insulin in the pancreas.

8. Insulin Pumps Other campers use insulin pumps which infuse analog (fast- acting) insulin through tubing inserted in the body (back of the arms, tummy, upper buttocks, thighs) throughout the day in micro units according to pre-set infusion rate(s). In addition, the pump will give additional insulin (“bolus” dose) as needed to cover meals and for a correction dose. Campers should never give insulin without the supervision of a camp staff member as directed by camp policy/procedure.

9. At most diabetes camps a camp physician reviews all camper blood sugars and insulin doses and makes recommendations for the next insulin dose. Camp nurses, along with cabin counselors and the campers themselves, work as a team to discuss and administer insulin after blood glucose checks are complete. This is a perfect educational opportunity for all staff to interact with campers about insulin dosing and the effects of food, activity and insulin dose (and other variables like stress) on blood sugar levels. It is also a great time to show proper methods of care and to show campers new methods – like the use of insulin pumps for campers who may not be using them, or insulin pen devices. Camp is a great opportunity for campers to make informed decisions about their own care once they go home.

10. Camp is a good place to encourage campers to take the next step in independence – Whether it’s pushing buttons on the pump or giving their own shot for the first time. Peer and professional support in a relaxed and supportive environment can work wonders for even the most timid youngster. Another important teaching opportunity is site rotation - whether it is injection sites or pump sites. Tissue buildup can lead to absorption difficulties and encouraging campers to rotate sites when their peers are “rotating” too can be much easier than battling at home with parents.

11. Documentation of all blood sugar readings, insulin administration, hyper (high) and hypo (low) blood sugar and any treatment given needs to be recorded so that the health care team has adequate information on which to base the next insulin dose. Following camp procedure for documentation is essential.

12. If possible (depending on facility) unopened insulin should be stored in refrigeration. Opened insulin bottles and pens for current day’s use can be stored with health care supplies and in belt/backpacks as needed. In extremely hot environments it may be necessary to use a cool pack.

13. Diabetes supplies must always accompany campers whether they are in camp or out of camp on a field trip. Many camps have tackle boxes equipped with supplies and health care team members often carry backpacks fully equipped with all necessary supplies, including insulin. In very hot environments, care may be needed to keep insulin from getting too hot – especially in camp vans or cars. Staff should be equipped on and off-site “at the ready.” This means carrying insulin and having trained staff (health care team members) who can administer insulin when necessary even off-site. Insulin log sheets for documentation should accompany campers “on the go.” Campers on pumps should always have access to injectable insulin in the event of a pump malfunction as blood sugar can rise very rapidly.

14. TYPES OF INSULIN ANALOG INSULIN – resembles human insulin chemically altered through genetic engineering to change structure for desirable effects in absorption, distribution, metabolism, excretion HUMAN INSULIN – In "human insulin" which is man-made, parts of the chain of chemicals that make up insulin are replaced to make a sequence (the number, kind, and order) the same as the body's own insulin. In "NPH insulin", protamine is added to insulin to lengthen the insulin's action time. aspart (“Novolog”) glulisine (“Apidra”) lispro (“Humalog”) glargine (“Lantus”) detemir (“Levemir”) Human Regular Human NPH (protamine added to lengthen action)

15. InsulinOnset of ActionPeakDuration of Action Aspart (“Novolog”) glulisine (“Apidra”) lispro (“Humalog”) 5-15 minutes1–2 hours4–6 hours Human Regular (“Humulin R”) (“Novolin R”) 30–60 minutes2–4 hours6–8 hours Human NPH (“Humulin N”) (Novolin N”) 2–4 hours4–10 hours12–16 hours Detemir (“Levemir”) 1–2 hoursFlat24 hours Glargine (“Lantus”) 2–4 hoursFlat24 hours Action times may vary in clinical practice.

16. 01 25346789 1011 12131415161718192021222324 Insulin levels Human Regular 6–8 hours Human NPH 12–16 hours Hours Glargine (Lantus) 24 hrs Detemir (Levemir) 24 hrs Aspart (Novolog), glulisine( Apidra), lispro (Humalog) 4–6 hours