Thursday, August 16, 2007

So... Camp

For a moment, I look out across grass and trees and paths that lead to one-story camp buildings and cabins, and -- turning upward -- at a sky so perfectly blue that it doesn't seem real.

Then I walk forward and hand my "receipt" to the young blonde woman sitting at the check-in table just inside the campground.

"I'm here to pick-up my son," I say-- feeling both excited that I'm finally going to see him and nervous that something might have gone wrong.

"Terrific! Here you go," she says, handing back a piece of paper. "Just give this to his camp counselor, and you'll be all set."

I thank her, walk forward a few steps, and notice half a dozen tables set up in the grass just beyond the entrance.

Tables covered with swag.

Brightly-colored toys, bracelets, and bags; shiny-new One-Touch Mini glucose meters (in three new colors!), and stacks of white boxes containing Accu-Chek Multiclix lancet devices.


Without hesitation, I make a beeline to the Accu-Chek table and snag a free Multiclix before making my way to the far side of the camp-- to Joseph's cabin.

Strange... I don't see any other parents roaming around... hmmm... I know it said checkout was at 9am.

When I reach Joseph's cabin, I hear loud voices, whooping and laughter, but immediately after I open the door-- nothing.

"And the crowd... goes silent," I say with a grin, as I step into the room.

And then I notice the slightly disappointed look on my son's face.

"Ahh... hey, I can come back in a little while. I haven't even looked at the lake ye- "

"No, no, Mom-- that's okay, you can come in," Joseph tells me with a smile that says he's glad to see me.

"Yeah, yeah," say a number of boys, who are now smiling too, "c'mon in."

And then everyone is talking at once.

"We got the award for catching the most fish!" yells a dark-haired boy with large blue eyes, before dropping to the floor -- into a perfect lotus position -- and proceeding to "walk" around the cabin on his knee caps.

"Mom, I got the comedy award," Joseph says at the same time, "And I swam every day- oh, and you should have seen me in the mud pit-- I was completely covered in mud! And Tommy lost his shoes in there-- Mom, it was awesome!"

"Yeah, the mud pit was so cool," adds a tall, curly-haired boy, "I popped my knee caps like three times!"

Then several boys shout in unison: "Listen to this!"

Suddenly, I'm surrounded by eight adolescent boys -- my son included -- cracking knuckles, toes, elbows-- and God knows what else.

"Impressive..." I say, nodding and smiling at them all.

"Look- look at this," a boy with shaggy brown hair calls out, as he holds up his right hand and bends his finger tips so that they're perpendicular to his fingers.

"Ah yes, that is cool-- no doubt," I tell him, "but can you do this?"

And then I show them all my trick left thumb-- spinning and bending the thing at impossible angles.

"Wow... " they all cry, eyes wide.

"Excuse me," the boy's counselor interrupts -- my thumb in mid-spin -- "if you'd like to speak with the cabin nurse, she's ready for you in the common room."

I'd almost forgotten.


And so I return to the big comfy chair-- again sitting across from that kindly grandmother, her blue eyes bright and shining.

"Oh, Joseph had a wonderful week, just wonderful. And he was such a good friend to Tommy."

"Terrific. I'm so glad," I say.

Silently praying that his sugars were just as wonderful.

"Now, Joseph had some highs," the nurse begins, "and last night he was very high," she continues, sliding his log sheet across the table.


That's the first thing I see.

I swallow down hard, then look at the rest of it.

478 at 9pm, and 1.85 units of insulin; then HI at 11pm-- when he got a set change and 3 units of insulin via syringe.

Dang, that's a lot of insulin!

An hour later his blood sugar was 289.

He'd dropped over 300 points, and his 11 o'clock correction had not even peaked.

They didn't check him again until 8am.

No 2:30 check.

I quickly scan the rest of the log.

Not one check after midnight during the whole week.

Not one.

And immediately I see the pattern-- meal boluses, snack boluses, corrections-- all stacking before bedtime.

Midnight blood sugars that alone seem fine, but if looked at alongside the highs at bedtime show a dramatic downward trend.

And then, morning highs-- rebound highs from overnight lows.

The Somogyi Effect.


"But why wasn't he checked at 2:30-- like we talked about on Sunday?"

"Oh dear--well, the camp doctor felt that it wasn't necessary-- and you see, Joseph did just fine."

Yes, he did, but my God-- what could have happened?

I keep it together-- resolving to speak with the camp doctor before next year.

To make this work.

And then I rejoin the boys.

Just in time to referee a game of "hot potato."


Judy said...

How do you get a job at a diabetes camp if you don't have a clue about Somogyi effect? That's really scary.

I'm glad he's OK.

Anonymous said...

What are you supposed to do to get these people to listen! And why do professionals have the arrogance to assume they know more about a child they've never met before than his parents? I'm so sorry, I admire the fact you didn't lose your temper with them there on the spot. I'm glad Joseph enjoyed himself.

Bernard said...

Sorry to hear about that. I would have been steamed.

I'm glad he made it through OK and it does sound like he had fun.

Maybe next year Joseph will have a CGM and that'll remove the issue.

Sarah said...

Not that this is any excuse for not testing, but an explanation: When I worked at a diabetes camp we were the ones responsible for checking kids at night as counselors. Most of us were diabetic, so we knew what to do with lows at night, but with more than one low per child per night, sleep became a very precious and coveted commodity. Testing kids who tended to go high rather than low didn't always get the attention it deserved. More importantly, kids generally had to wake us up if they were low - if Joseph weren't waking up when low, it would be very unlikely that a staff person who wasn't informed by the med staff as per your instructions would wake up to test a camper who might be going low. If the doctor had chosen to treat the situation appropriately, this would have been less of a problem.
At the diabetes camp I worked at, med students got a chance to work with our kids - but only when it came to calculating doses. I can recall one point when one of our campers, a pumper, kept getting inadequately small doses assigned from med students. She felt really frustrated that the care she was getting kept sending her up to 400. In essence, it's not just you. Doctors at camps don't always have the background necessary for intensive control. If it's really a problem, I can tell you where I worked as I think they did a pretty good job for the most part when it came to control for our kids - it's not TOO far away from the NE.
Sounds like he had fun in either case - the swag sounds spiffy too.

Sarah said...

Oops, I meant to say it's not too far from the southern half of Wisconsin. It's about seven hours from Milwaukee. (although that's probably on the far end...)

Bad Decision Maker said...

That's unfortunate, that's one of the more intricate higher-level diabetes management thoughts, but one that I would hope the diabetes doctor and/or nurse at diabetes camp would have a handle on. Especially after very active days at camp (for me, active days cause even more lows at night than any other time).

When I went to diabetes camp (11-12 years ago), they did nighttime checks frequently, but there was still another camper in the cabin I was in had a severe low requiring glucagon (seizures) both years I was there. The first one woke me and other campers up before the counselor, and the counselors decided I could run faster so I had to run the half mile to where the nurses were. Clearly that was too far away.

Glad he is OK and had a good time though! I know I really used to love going .

mel said...

I don't think I would have "kept it together" at all!! I'm glad that he's ok, but it really rubs me the wrong way that this happens at DIABETES camp.

Nicole P said...

Ugh. Sandra, that had to have been so hard... I'm sorry. I love your resolve to address it next year... Your commitment to try to make things right is astounding.

Did you know I can do the perpendicular thing with my fingers? I can also turn my eyelids inside out and keep them that way...

Kassie said...

First, you are a way cool mom :)

Second, I think it might be a good idea to drop a note to the camp director now rather than next year. Having been a diabetes camp director, I'd want to know if that was going on. It could help shape policy for next year, and that kind of thing gets hammered out over the off-season.

Penny said...


I admire you for keeping your cool. I know I would have lost it and demanded to speak to the Dr. right then. Maybe not the best way to handle it, but it's probably what I would have done.

I am just in awe of these "medical professionals". I have only been dealing with diabetes for the last 22 months and I know that sometimes morning highs are the result of nighttime lows. And, the only way to know what's going on with a sugar is to check.

And, as far as what Sarah said about not testing because sleep is precious, why don't diabetes camp hire a "night counsler" whose job it is to test sugars at night? Wouldn't that make sense?

I know some parents don't test at night and that's their perogative. But, for the parents that do, these camp need to be a little more accomodating.

Ok, that said, I'm so glad Joseph enjoyed his time there. I know at the end of the day that's what is really important.

As you were telling the story I was picturing all those boys talking at once, and all I could think was "and, every last one of them has D". It gave me chills. What an awesome experience for Joseph. And, it sounds like he enjoyed the mud pit once again this year.

Christine-Megan said...

Penny, I like your night counselor idea.

Sanda, I can't believe how frustrating this must be for you.

Anonymous said...

Sandra, if the school nurse had made such an arbitrary decision without consulting you how would you feel? I think the decision was bad enough but to tell you one thing and then do another without even consulting and getting agreement from you is unacceptable!

Carey said...

Oh, man. Completely unacceptable to make such a decision without consulting you first. They're not watering your plants for a week, deciding to skip watering here and there. It's your child. Man, that makes me mad.

Anyway, that's great that he had such a blast. This experience of yours will certainly help prepare us down the road if we choose to send Charlie to camp.

Sarah S. said...

Re: night counselor - we did take turns and also had the night med staff to come in for that if we had more than one kid to check. Funny story though, the roasty toasty summer nights led to me saying "sure" to my kids sleeping in undies and tank tops (and doing the same myself) when it was our MALE pre-med student's turn to do rounds. Policy here demanded that one of the girl counselors be there for the checks for legal reasons. I woke up to a rather red-faced fellow staffer poking me to wake up so that I could help him with BG-checking rounds. After a bug-eyed moment and a quick dive under the covers to rediscover my boxer shorts, we were doing checks on sleeping campers no trouble. I did get dubbed "most likely to be found in only their underwear," though :)
I would definitely bring the inadequacy of night testing there up with the camp director and possibly the local ADA if the camp is run by them. If they're not hiring adequately trained personnel for this, then something needs to be done and not just for Joseph's sake.