Sunday, August 13, 2006

The Lowdown on Camp



As Ryan and I enter Joseph's cabin, we're greeted with the sight of many boys talking, laughing, stuffing their clothes into duffles, and messing with funky colored balls, little electric fans, light-up necklaces, etc... All labeled with some diabetes-related sponsor's name -- camp swag.

And there is Joseph, his back to us, standing half a dozen bunks away. I watch him for a few moments-- joking around with two other campers, and checking out the trinkets he has spread on top of his bunk. I look for signs that things might not have gone well.

So far (thank God)-- nothing.

He finally turns around and sees us, runs across the room and throws his arms around me-- for a moment, we hold each other tight.

I'm trying hard not to lose it-- after all, I don't want to embarrass the kid.

He looks up at me and says, "I missed you," then walks the two of us over to his bunk and continues to pack. He looks as though he's anxious to tell us something, but for a while says nothing. He just keeps fiddling with a bright blue, purple and red ball that lights up every time he whacks it with his hand.

I watch him carefully, bracing myself. And then he lifts his head, looking from Ryan to me.

"Guess what?" he asks, with a huge grin.

"What?"

"I got asked out on a date."

The boy just cannot stop smiling.

"Reeeally." I say.

"Yeah, the girl who said I was cute last year-- she asked me to the dance."

More smiles.

"And we danced."

"Oh, reeally."

"Oh Yeah," he says, nodding and smiling even bigger than I thought possible.

"And Mom, I think she's 12."

"Oh. My. God."

I breathe a sigh of relief.

"Oh, and Mom-- " he says, giving me a meaningful look, then mouthing the words through yet another smile:

"I didn't have any accidents."

Thank. God.

"All righty then, let's get you packed."

As we pick up his clothes, and try to collect his booty (he keeps wanting to play with each thing before we put it in his bag), Joseph tells us about camp: about the paddleboat sponge fight and water dodgeball; about learning how to kayak ("it's a lot harder than it looks"); catching frogs (he caught several!); and of course, his time in the mud pit ("It was gross, Mom. It smelled really, really bad-- but it was awesome!").

Oh yes this was good for him-- very, very good.

But then, he says -- almost nonchalantly -- "And one night, I was really high-- like higher than I've ever been."

I stop packing.

"What do you mean, bud?"

"Well, I had them check me 'cause I didn't feel right and the meter said 'HI' -- and they said that meant I was like over 600!"

"What?!"

"But my set was bad," he says quickly, "I could tell because my cannula was sticking out."

"Did you have any ketones?" I ask, breath held.

"Nah."

Okay, he was fine. Just fine.

But as we continue packing, I struggle to keep a growing fear in check.

What if something awful happened again? But the 'HI' was just a bad set-- a fluke, really.

It had to be.


Just then, Joseph's very friendly and rather burly counselor comes over and says the nurse is ready for me.

Before I even sit down, she is telling me that things went very well.

"Joseph's sugars were really good this week, and he had no nighttime accidents," she says smiling brightly.

"Yes, Joseph told me-- that's wonderful. But he did mention that he'd had one very high blood sugar-- that the meter had said 'HI' -- we've never seen that before."

"Yes, we had to change his site that evening," she says, her smile beginning to fade. "Well, uh . . . let's have a look at the log."

She pulls a sheet of paper from Joseph's file, and slides it in front of me.

"Now we did several set changes-- we always like to do them when the kids have been in the mud pit, and then we had that bad set."

I'm listening to her, nodding-- while looking very carefully at the log. Those first two days were awesome. But it was on that second night that he went 'HI' and stayed that way for several hours . . .

I look at that for a long moment.

On the third night, he was 246 at bedtime-- they gave him a snack and a bolus (with a correction-- despite the fact that his combo bolus for his dinner had just finished). At midnight he was 120-- they never did the 2:30 AM check. At 10 AM, he was 367.

A rebound high.

The fourth night they'd given him a snack and over a unit of insulin at 9pm-- just three hours after a large meal bolus with a correction. There were no nighttime checks that night (though they did get him up to use the bathroom). And he was 356 by 10 AM the next morning.

Another rebound.

The fifth and final night saw a 425 at bedtime.

"He had no ketones throughout the week," she says-- obviously noting the concern on my face as I stare at the number.

And, as my finger moves from the "Blood Glucose" box down to the "Correction Bolus" box, the nurse tells me:

"Oh, and Doctor D overrode the pump's recommended correction that night because Joseph was so high." In the bolus box I see a .5 crossed out and a full unit written over it. I also see that Joseph clearly still had insulin on board from a very large dinner bolus.

He was 96 by midnight-- having dropped 329 points in three hours. When they checked him two and a half hours later, he was 135 and climbing -- by 7am he was 254.

Man.

"I'm really thinkin' that there were several rebound highs this week-- that he may have had a number of low blood sugars that were not picked up overnight. I mean, those morning highs are kind of unusual."

"You mean from the Somogyi effect?" she asks with a look of sudden understanding.

"Yes, that's exactly what I mean."

"Well, yes . . . you might be right . . . I'm sorry. There were a couple of nights in there when he wasn't checked as often-- when I wasn't on duty, and well, they just followed the usual protocol."

"I see," I respond quietly.

About 20 minutes later, Joseph is packed and we're ready to head home. We take one last look at the lake, still and shimmering under a perfect, clear sky. Then we make our way to the parking lot-- Joseph saying goodbyes and talking the whole time about the dance, the girl who asked him to it, and how much better camp was this year than last.

Despite the things that didn't go right, it's obvious this experience meant a great deal to him. And really, it's hard not to feel good about something that so clearly makes your child happy.

But still, as we drive away I'm thinking again about those rebound highs-- the lows they imply -- and how to avoid them next year.

15 comments:

Angie said...

well, I am so glad that you posted the "effect", I can't spell it much less say it. I never knew about it. My daughter has been diabetic for 4 years noe and I never knew about it. It explains alot. Thank you. I know you hate to hear about the high BS levels. Makes you want to never send him back, but he is gettig more out of camp than BS control and diabetes education. My daughter comes home every year with horror stories of her behaviour that she would never get away with at home, But I let her go back every year. She has one year left. Camp is always stressful for me, I dread it and yet when it is all over, I see something in Cassie that I don't usually get to see. A smile, more than a smile, an overwhelming joy that is just not there any other time. The joy of knowing that she is not alone, and that as hard as she has it someone else has it harder than she does. She comes home with a confidence that she has taught someone else who has it harder than she does something that will make their life a little more easy. So, as much as I hate camp, I am so glad for it.

Kathleen Weaver said...

Hey, you did good.

You really have to let him go, once in a while -- you do need the break, and it was for one week.


Yeah, they don't take care of him as well as you do, but maybe next year, he can do more self-care?

julia said...

I have to agree. Camp is an incredible experience. I can't begin to tell you how much Olivia has gotten out of it. She's like a new person each time she comes home from camp. She just glows. And her sugars are always, always, always all over the place and they don't check as often as I do and some of the things they do make me cringe, but I let her go anyway. Because it means the world to her and at some point, I have to give up a little control.

It was really hard at first, but each year, it gets a little easier. I just take the sheet of numbers they give me, go over it and put it away. Two weeks of all over the place is worth it, to me, for the incredible changes that camp has wrought in my formerly timid kid.

Vivian said...

Sandra,
Thank you for posting the camp stories, Daniel has not been to camp yet and it really helps prepare me for when he does. I am glad he had such a good time, you are doing a great job.
Vivian

Sandra Miller said...

Angie & Julia-

I really do look forward to Joseph's time at camp-- despite knowing that I'm gonna be totally stressed in the weeks leading up to it.

He just loves the place.

I gotta say, though-- it's comforting to know that he's not the only one experiencing those wild sugars at camp. Makes me feel a little less guilty about them :-)

Kathleen-

Thanks.

We're working on the self-care at camp-- Joseph actually did a lot more of that this year than last.

It's just really tough during the overnight. The boy could sleep through the sound of a freight train, let alone that of an alarm clock... sigh.

Vivian-

Thanks. I'm so glad you're planning to send Daniel to camp. I know that some of these posts probably make it sound scary. But I just keep telling myself-- it's only one week. And a week of amazing experiences with other diabetic kids is worth every one of those crazy blood sugars...

(That's not to say I won't keep trying to prevent those crazy blood sugars :-)

Jamie said...

I'm glad to hear he had a fabulous time at camp this year.

It's hard to give up that control when you send your kid off to camp. I know I'll be the SAME when Danielle is old enough to go - it'll be completely nerve wracking. But I know it's all worth it from the stories I hear from other parents.

Now you know what to work on for next year :) Also happy to hear he had no accidents :D

Shannon said...

My neighbor's daughter has gone to diabetes camp up here in NH and they had the same experience with crazy numbers....but she loved the experience nonetheless.

And the girl....nothing beats camp love :)

Kerri. said...

I had my first instance of "camp love" thwarted by none other than Kassie herself. It was mortifying. And wonderful. All at the same time.

If it's any consolation, I had my first and only bloodsugar of Epic Proportions at camp: They cut my insulin so drastically that my afternoon check clocked in at 600 mg/gl plus. But they took exquisite care of me and, after I had evened out a bit, everything was cool. It must be tough for the camp staff, as the exercise levels are so much higher at camp that sugars plummet sometimes. I saw a seizure once at camp that has haunted me to this day.

For that two week span, better to run higher than bottom out, I'd venture. It's easier to correct a high than to chase that low.

How is he doing now that he's home?

Kerri. said...

Shoot, I screwed up the link to Kassie: Kassie once again.

Sandra Miller said...

Kerri-

He's actually doing just fine.

We'd done a great deal of work in preparation for camp-- basal testing, re-reading portions of Pumping Insulin and Think Like a Pancreas. As a result (or it could just be the stars aligning), his bgs have been really, really good these past number of days.

On the issue of running high at camp-- I'm more concerned with the fact that some of those highs seem to be rebounds-- that he was actually low overnight.

Now that scares me.

Because you're right, running high at camp is kind of expected (to compensate for possible activity-induced hypos).

But the thought that he might experience a serious low while everyone is asleep is frightening.

In looking over the "Camp Re-cap" and Joseph's log, it looks like the times he was disconnected during the day probably kicked up his bgs before bedtime-- prompting some sizable corrections at a time when Joseph is usually very insulin sensitive.

It's these over-corrections, I believe, that sent him low overnight-- thus producing those rebound highs in the morning.

(Or maybe the stars were just not aligned ;-)

Regardless, I'm toying with the idea of having him do the untethered regimen next summer-- so that he has at least some insulin on board when doing the many activities (read: anything in the water) during which the camp requires him to disconnect from his pump.

BTW, You have me curious about this camp love triangle... care to elaborate :-)

Kerri. said...

Um ....

When I was about eleven or twelve years old, there was a boy at Camp Joslin that I had a fantastic crush on. The Camp Joslin boys and the Clara Barton girls would get together twice a session for dances. (They always played Def Leopard's "Pour Some Sugar (On Me)", which never failed to make me snicker. I mean, it's diabetes camp, for crying out loud.)

So at the first dance, I met This Boy and we danced. All puppy-love-ish. Second dance, we danced again. Cue puppies. That should have been the end of it, but This Boy circulated a petition bartering for another dance with CBC and, after most of the Joslin Camp boys signed it, we had a third dance.

Overcome with Puppy Love at its summer finest, This Boy and I were caught kissing on the dance floor by my camp director - Kassie. And because I was terrified of Kassie (she was The Authority Figure at CBC), the moment has been emblazoned into my very soul.

Sigh ... it was fun, though. ;)

Sandra Miller said...

Ahhh... so not a love triangle at all, but rather an interruption of a beautiful moment...

The Boy petitioned for a third dance? Now that is true Puppy Love!

Thanks for sharing a very sweet story (albeit one with a sad, sad ending).

Minnesota Nice said...

Sandra,
Just wanted to thank you for your kind comment to my recent post.
I don't know how all of you fabulous mothers do it with so many balls in the air.
Your kids are beautiful.

Kathy

Sandra Miller said...

Kathy-

Thanks.

And again, welcome to the OC.

Lori said...

I just found your blog. My son is Type 1 and was diagonosed at age 13, almost 3 years ago. I read about the morning high readings during his camp time and an additional reference you made to the possibility that he may be starting puberty. Because my son was 13 at the time of his diagnosis, puberty was a very real issue. We were told that the additional hormones usually are highest right before they wake. The hormones create additional sugar in their bodies, which of course causes a rise is the BG. Just something to keep in mind as you begin the journey into this next stage of maturity for your son. I look forward to reading your blog on a regular basis. It's always good to see what other mom's are doing.