off to camp!

the third week of june was spent working as a nutritionist/counselor for a week-long summer camp for kids with diabetes. the week served as as sort of extracurricular week within the context of my internship, so i was able to receive credit for being a camp counselor. awesome.

the main qualifications for working as a “camp nutritionist” were to be a registered dietitian (RD) or be on your way to receiving your master’s degree in nutrition/RD status, have experience in diabetes management or education, have past experience working with children, have a readiness to adapt to camp life/work as a team member, and willingness to donate a week of your life to living at camp. done!

i didn’t have much prior experience with diabetes education per se, but i did have a solid grasp of the biochemistry involved in an insulin-dependent system. i also knew a bit about diabetes nutrition management/the consistent carbohydrate diet from my coursework and hospital/food service experience.

before camp, my main role was to familiarize myself with the campers’ past medical, activity, and dietary histories so that i could assist in their nutritional care during camp. in plain english: i had to assess what campers were eating and how much they were exercising at home to correctly adjust their meal plans at camp.

while there may have been some campers in attendance with type II diabetes, the majority of them had type I, or insulin-dependent, diabetes. i was assigned one age group (the youngest group: 8-9-year olds) to follow throughout the week and help them eat the correct number of carbohydrates and bolus the correct amount of insulin.

people with diabetes focus mainly on controlling their carbohydrate intake since it is the nutrient with the biggest impact on blood sugar levels. it’s a delicate balance to give someone with diabetes just enough carbohydrate to sustain them throughout the day without pushing them into hyperglycemia (high blood sugar).

a little background: type I diabetes is a disease in which a person’s pancreas does not produce enough insulin. this type of diabetes is an autoimmune disease, which is why it usually shows up in childhood – it’s not a disease that you “do” something to get. type II diabetes, on the other hand is showing up in more children than ever, which is, unfortunately, due to the fact that kids are “doing” something, or more appropriately “not doing” something – eating well, exercising, etc.

an autoimmune disease (AID) is a disease in which a person’s immune system mounts an attack against it’s own body. type I diabetes is an AID in which a person’s immune system destroys the beta cells of the pancreas, which are the cells that produce the hormone insulin.

normally, the pancreas senses the levels of sugar, or glucose/carbohydrate, in a person’s bloodstream and releases just enough insulin to usher the sugar into muscles, fat cells and other tissues for use as energy or for storage.

in someone with type I diabetes, when carbohydrate is eaten it is absorbed into the bloodstream and the pancreas isn’t able to respond by releasing insulin, thus the glucose isn’t able to enter a person’s cells and blood glucose levels rise.

this is a huge problem as cells depend on glucose/sugar for energy. if glucose can’t enter the cell, the body has no choice but to break down other materials for energy. these “other materials” are usually fats.

while this may sound like a good idea to use fats for energy, burning only fat leads to ketoacidosis, or the acidification of a person’s blood due to the accumulation of ketones (an acid byproduct of fat breakdown). confusing? just know that the accumulation of ketones is a life-threatening situation.

people with diabetes routinely check their urine for ketones with ketone strips, as do some people on carbohydrate-free diets, like the atkins diet. these diets force the body into ketoacidosis. not good. thankfully, these diets are next to impossible for patients to maintain.

to sum it up: working with the camp nurses, medical staff and campers was really an amazing learning experience. i was exposed to the day-to-day maintenance of living with type I diabetes and i came away with an excellent understanding of how to educate kids about the nutritional maintenance of their disease.