Camp Too Sweet gives one medical student insight into diabetes
A clinical rotation at a summer camp for children with diabetes provides a new understanding of patients' challenges to a medical student.
Jacqueline Urdang, a third-year student at the Virginia Tech Carilion School of Medicine, writes about her clinical experience at Camp Too Sweet, a Carilion Clinic-hosted summer camp for children with diabetes.
“Will you prick your finger?” The question came from one my campers at Camp Too Sweet, where I spent the first week of my pediatrics clinical rotation as a third-year medical student at the Virginia Tech Carilion School of Medicine. Our traditional rotations, unsurprisingly, include a combination of up to six weeks of work and observation at in-patient and out-patient settings in a variety of medical specialties. When I heard there was a chance to spend a week as a member of the medical staff at the Carilion Clinic camp that is held at Camp Bethel in Fincastle, Virginia, specifically for children with Type 1 diabetes, I jumped at the chance to do something different. The question from the camper who wanted me to experience a little part of what it was like to live with diabetes demonstrated why.
At Camp Too Sweet, I had the rare opportunity to spend an extended period of time with campers/patients as they went about their lives. I monitored their blood sugars as they kayaked, rock climbed, and rode horses, among many other things. I was with them from roughly 6 a.m. until they went to sleep at 10 p.m. with a night nurse keeping watch for the times in between. I oversaw seven campers aged 12-14 who made sure I was participating with them in all activities. I got to know these kids inside out, listening to their stories, laughing at their jokes, and learning their idiosyncrasies, which play such a big part in their diabetes treatment. I learned their dietary preferences, how they felt when their blood sugar was high or low, and how much monitoring they either wanted or needed.
Diabetes is a disease that fluctuates over time and requires consistent attention to calorie intake. With children who depend on external insulin to deal with their blood sugar, mealtimes were especially busy. Every camper wore a continuous glucose monitor that checked their sugar level throughout the day. New injections of insulin depended on this number, on how many lows or highs they had had that day, what activity they were going to be doing after lunch, and how they were feeling in general. “Would you like to pre-bolus some insulin before lunch?” I would ask. This was my attempt to get some insulin into their bodies before they ate so it could ward off an episode of elevated blood sugar once the sugar was ingested. “Well what’s for lunch?” many campers asked. I looked at the menu for the day. “Tacos, green grapes, and cooked carrots.” After telling me they wouldn’t “eat any of that,” I dosed them for the bagel I knew they would eat. “Let’s put in for 15g of carbs at least,” I would say. “Ugh, fine!” and on to the next camper.
A particularly revealing moment in my oversight and intervention with the campers came when they told me at some random moment long before or after lunch that they “felt low.” This might mean something slightly different for each camper, but I learned how important it is to trust the patient. They know their bodies better than we ever will. I would usually offer advice, but I tried to let the campers make their own decisions about their own insulin requirements in these instances.
One of the best things about Camp Too Sweet is that it gives campers the tools to make healthy decisions for themselves in a safe environment instead of having the medical staff do everything for them. The parents feel a sense of relief and joy that their child can safely enjoy a traditional summer camp experience while learning about their health. Erica Reynolds, the pediatric endocrinologist who oversees the camp; Kate Jones, the camp director; and all the volunteer dieticians and health care providers helped me see that medicine is often more of an art than a science. For all the technology that exists to help patients manage their diabetes, there is so much nuance required to properly manage a blood glucose level. Managing type 1 diabetes, like many other diseases, depends significantly on the individual involved.
I knew that I would never truly understand the challenges these campers faced every day of their lives, but when I picked up the lancet, the camper who asked me to prick my finger gathered her friends around. We all understood that pricking my finger was a limited gesture, but it showed the campers that I was doing my best to know what living with diabetes was like for them. “Will you come back to camp next summer?” they asked. “If you don’t have time you could just get diabetes.” A joke, but one packed with meaning and emotion.
One thought filled my head after my return to regular clinical rotations: I wish there was a summer camp that I could work at for every disease state!
