I'll never forget walking into the infirmary for my week as a camp nurse and hearing one of the outgoing nurses say, "I got the kid with diabetes again. Don't worry, you don't have one this week." In my six years as a camp nurse at this non-diabetes camp, I always hoped I'd get "the kid with diabetes." That's because I happen to specialize in diabetes — and I have diabetes myself! My hope is that camp nurses and camp staff everywhere will feel comfortable including and accepting children and adolescents with diabetes in their programs, without fear or dread.

I spent many, many summers at diabetes camp, where blood glucose monitoring, insulin pumps, and carbohydrate counting are a way of life. Everyone fits in and no one freaks out about low (or high) blood glucose levels. Then when my kids were camp-ready, I decided to be a nurse at a non-diabetes camp so they could have the full camper experience and not be "staff kids" at diabetes camp.

It wasn't until my sixth summer at non-diabetes camp that I got the opportunity to work with someone who had diabetes — and he was in the leadership program (not a camper). He did an amazing job taking care of himself and integrating into the camp program. The other nurses, while still freaked out about his blood glucose numbers, were happy to let me worry about him. One thing I emphasized to this young man and to the other nurses and staff was to give him responsibility (and space) and respect his ability to manage his diabetes. One of the hardest things for adolescents with diabetes is managing their diabetes pretty much independently at home and then going to camp and having people breathing down their necks. This can actually create a tense and stressful situation where nurses, staff, and campers can get kind of cranky. Campers/leaders in training can be expected to check in periodically and staff/nurses can back off in the meantime. Creating an atmosphere of trust goes a long way toward open communication and success.

A child or adolescent who feels comfortable going to camp should be encouraged to do so. We all know how much good camp does for kids. Kids with diabetes just have to think more. And the camp staff needs to be prepared and knowledgeable, and do a little extra thinking too. Kids with diabetes may want to attend a non-diabetes camp for many reasons. Perhaps they had been going to a particular camp for years before they were diagnosed with diabetes and they want to continue going to that camp. Maybe they want to try a sports camp, science camp, music camp, theater camp, or other specialty camp because they have an interest or talent in one of those areas. The thing about kids with diabetes is that they are kids first, and they just happen to have diabetes. Their camp preferences are not necessarily limited to diabetes camp. Some kids even attend both diabetes camp and other camps because they love camp that much.

When I was eight years old, my parents sent me to diabetes camp to learn how to administer my own insulin injections. I attended diabetes camp for two summers, had a great time, and learned a lot (including how to inject myself). Unfortunately, the cost of diabetes camp doubled prior to my third summer, and my parents were not eligible for scholarship and could not afford the high price of a medical specialty camp. They decided to send me to the camp where my siblings were going (and my cousins, aunts, and parents had gone). I ended up spending two summers at that camp, followed by four summers at various music camps. When I was 17 years old, I returned to diabetes camp as a staff member. Thinking back, I realize that had I not been accepted at the non-diabetes camp when I was ten, I would have missed out on all those camp experiences and likely not have pursued becoming camp staff. My experiences at all of the camps I attended shaped my life.

The American Diabetes Association has created a fact sheet on The Rights of Children with Diabetes in Summer Camp (2016). The purpose of this document is to lay out the resources and protections available to children and adolescents with diabetes. The bottom line is that they deserve to enjoy and benefit from camp just like any other child. Camps can make "reasonable modifications" to include children with diabetes who wish to participate in their programs. This may include providing carbohydrate counts for menu items, learning the signs and symptoms of low blood glucose and watching for them, and carrying supplies to treat low blood glucose. With planning and preparation, diabetes is very manageable.

Some families may decide not to send their child to a particular camp if, for example, there is no health care professional available, or the program takes place in a remote location. However, many teens with diabetes are self-sufficient in their care and would have no problem taking part in these programs.

Communication, as always, is key. Open communication between camp administration / health care staff and parents/ campers is crucial to a successful camp experience. Asking questions and gathering information is part of that communication process. Camp staff should be familiar with the child's needs and the parents' expectations, and parents and campers need to understand what will be expected of the camper while at camp. Families will need to provide enough diabetes supplies for twice the amount of time the camper will attend, as well as options for treating low blood glucose. A plan can be set in place for where the treatment will be stored and who will carry it.

Diabetes is frightening for those who don't have enough information about it. With the right tools and understanding — and an attitude of support and inclusion — kids with diabetes can succeed in the non-diabetes camp setting.

For More Information
Review the ADA's fact sheet, The Rights of Children with Diabetes in Camp. If you have questions regarding the rights of children with diabetes at camp or your camp's diabetes care responsibilities, you can contact the American Diabetes Association at 1-800-DIABETES or askada@diabetes.org. The Diabetes Education and Camping Association is another great resource: https://diabetescamps.org.

Top Ten Things Camps Can Do to Successfully Include Campers with Diabetes

  1. Ensure open communication with parents and camper prior to camp season/session.
  2. Provide a list of unusual or sometimes-served food items so parents/ camper can plan ahead.
  3. Work with parents/camper to establish carbohydrate counts for typical menu items.
  4. Create a plan for when and where blood glucose monitoring and insulin administration will take place.
  5. Provide a list of essential camper functions for your program so parents and campers are fully informed and can decide if your camp is a good fit for them.
  6. Identify staff members who will be taught how to detect and treat low blood glucose in the event of an emergency situation.
  7. Create a plan for who will carry low blood glucose treatment supplies and/or where they will be stored.
  8. Work with parents, camper, and/or health care professionals to gain a basic understanding of diabetes and what you might expect in the camp environment.
  9. Partner with the family and ask questions until you all feel comfortable and prepared.
  10. Treat campers with diabetes like any other camper and focus on their strengths.
American Diabetes Association. (2016). The rights of children with diabetes in camp. Retrieved from diabetes.org/living-with-diabetes/know-yourrights/ discrimination/public-accommodations/ daycare-camps-and-recreational-programs/rightsof- children-with-diabetes-in-camp.html

Jane K. Dickinson, RN, PhD, CDE, has been living with type 1 diabetes since 1975, and helping others live well with diabetes since 1995. She has spent many years as a camper, counselor, and camp nurse. Jane stays connected with diabetes camping by helping out with special projects for the Diabetes Education and Camping Association (DECA). She is on the planning committee for the Medical Camping Track at ACA. Her full-time job is program director and faculty for the online Master of Science in Diabetes Education and Management Program at Teachers College Columbia University. She lives in Steamboat Springs, Colorado, with her husband and two teenagers.