Gales Creek Camp Policy on Continuous Glucose Monitors
Please note: this policy is being updated for the 2022 camp season and will be posted when final approval is given by the Medical Committee. Below is the policy as of 2019, and much as changed.
Gales Creek Camp for Children with Diabetes welcomes and embraces the new technologies that are being developed to manage blood sugars. Continuous glucose monitoring provides for frequent estimates of blood sugar in between pre meal and bedtime blood sugar checks, assisting in blood sugar management and hypoglycemia detection. And in limited situations, continuous glucose monitoring results can be used in calculation of insulin dosing.
However, continuous glucose monitoring in a diabetes camp setting also poses challenges. Other than responding to hypoglycemia and hyperglycemic episodes with ketones, managing blood sugars in between the scheduled test and shots times at camp would be difficult with the number of campers in each session. And even though some CGM’s are FDA approved to be used in making treatment decisions, the extreme variability of camp activities makes it more difficult to use the CGM results and trends to make reliable treatment decisions without confirmation with a fingerstick blood sugar. After a thorough review of the capabilities of continuous glucose monitoring, the Gales Creek Camp medical committee has developed the following policy.
Campers will be allowed to come to camp wearing a continuous glucose monitor. If coming to camp with a CGM, the sensor should be changed and initial calibration completed on Sunday before coming to camp so that the sensor does not need to be changed while at camp. If the sensor fails or falls out during camp, it will not be replaced. CGM devices will be calibrated 3 times a day, before breakfast, dinner and at bedtime. The monitor will primarily be used for hypoglycemia detection and for review by the camp physician if the camp physician would like further information on the camper’s blood sugar trends beyond what is provided at routine testing times. Any hypoglycemic event detected by the CGM will be confirmed by a fingerstick blood sugar and hypoglycemia treatment will be started if low blood sugar confirmed per camp protocols. A high blood sugar threshold of 300 will be programmed into the receiver and the rapid rise and fall rate alarms turned off. If the camper has a high blood sugar alarm and doesn’t feel well, a fingerstick blood sugar will be performed and if confirmed, camper will be treated per GCC Hyperglycemia Protocol.
Please note that although Gales Creek Camp has procedures in place to check every camper’s blood sugar twice a night, and counselors sleep in the cabin with the campers, counselors may not be able to hear CGM alarms for a variety of reasons (CGM muffled by sleeping bag/pillow, counselors sleeping, distance from counselors, etc.). Per current protocol, campers that feel low at night can wake up a counselor and have their blood sugar checked and low blood sugar treated. This would include campers woken up by their CGM alarm.
In addition, the high activity level of a summer camp can create significant swings in blood sugar. It is expected that blood sugars will trend up and down fairly rapidly at times. Responses to blood sugar treatments based on trending is very likely to be different than responses based on trending at home. Therefore, trends in blood sugars based on real time CGM data will not be used by nurses and counselors in making decisions based on medical protocols. If a camper is trending down rapidly and feels hypoglycemic, they can ask a counselor or nurse to have their blood sugar checked. Treatment of hypoglycemia, however, will still fall under the camps current hypoglycemia protocol.
Campers with sensors that do not use a pump as the receiver (Dexcom G4 and G5), will need to use a CGM receiver and not a cell phone as the receiver. Gales Creek Camp does not have cell phone reception so remote monitoring of blood sugars is not possible. All CGM receivers need to be clearly labeled with the camper’s name to avoid getting it mixed up with another camper’s receiver. Gales Creek Camp will not be responsible for lost or damaged transmitters, receivers, pumps, or other electronic devices. If concerned about losing CGM equipment, the GCC Foundation encourages campers to leave CGM devices at home. The camp will continue the intensive monitoring of all campers including the two blood sugar checks overnight to help keep all of our campers safe from hypoglycemia.
Technology is rapidly advancing in Type 1 diabetes care. We anticipate that sensor augmented pumps will be worn by a number of our campers by the 2018 camp season. The medical committee will be preparing for integrating this new technology into the care of campers for next season with the development of new protocols and procedures in the off season. We look forward to these new advancements as diabetes care continues to improve.
If you have any questions regarding this policy or any other medical policies at camp, please do not hesitate to contact the camp office, the Director of Medical Services or the Camp Medical Director.