Establishing the incidence and timing of hypoglycemia at a residential diabetes camp

Elizabeth A. Mann; Scott Lunos; Elijah Carrel; Trevor Omann; Alyssa Halper; Anne Kogler; Bradley S. Miller; Muna Sunni; Melena D. Bellin; Brandon M. Nathan

doi:10.1016/j.diabres.2019.04.003

Establishing the incidence and timing of hypoglycemia at a residential diabetes camp

Elizabeth A. Mann, Scott Lunos, Elijah Carrel, Trevor Omann, Alyssa Halper, Anne Kogler, Bradley S. Miller, Muna Sunni, Melena D. Bellin, Brandon M. Nathan

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1 Scopus citations

Abstract

AIMS: To establish the incidence and timing of hypoglycemia at a week-long residential diabetes camp for children. We hypothesized that hypoglycemia would occur more frequently during the first two days of camp and following evening all-camp games.

METHODS: 225 children (mean age 12.0 ± 2.3 years, 56% female, mean hemoglobin A1c 8.4% [71.6 mmol/mol]) had blood glucose (BG) levels obtained before meals, at bedtime, and as needed to detect hypoglycemia. Insulin adjustments were made by medical staff according to camp protocol and at the discretion of medical staff during camper check-in.

RESULTS: Mild hypoglycemia (BG 50-69 mg/dL [3.9 mmol/L]) occurred ≥ 1 time in 90% of campers while 43% had ≥ 1 episode of BG < 50 mg/dL (2.8 mmol/L). No episodes of hypoglycemia requiring glucagon occurred. More campers experienced ≥ 1 overnight hypoglycemia event during the first 48 hours of camp compared to later in the week (p = 0.01). Evening all-camp games did not impact hypoglycemia rates overnight.

CONCLUSIONS: Nocturnal hypoglycemia occurred more frequently during the first two nights, establishing this period as high risk and supporting implementation of a standard protocol to lower insulin doses. Rates of hypoglycemia were unaffected by all-camp games, indicating current practices are effective at minimizing hypoglycemia.

Original language	English (US)
Pages (from-to)	146-151
Number of pages	6
Journal	Diabetes Research and Clinical Practice
Volume	151
DOIs	https://doi.org/10.1016/j.diabres.2019.04.003
State	Published - May 2019

Bibliographical note

Funding Information:
This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award ( UL1TR002494 ).

Funding Information:
The authors would like to acknowledge Carol Holten, associate manager at the American Diabetes Association of Minneapolis-St. Paul for her assistance at Camp Needlepoint and in gathering camper records. This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award (UL1TR002494).

Publisher Copyright:
© 2019 Elsevier B.V.

Keywords

Diabetes camp
Hypoglycemia
Protocols
Quality improvement
Type 1 diabetes mellitus
Hypoglycemia/diagnosis
Humans
Male
Incidence
Time Factors
Female
Camping
Child

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.diabres.2019.04.003

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@article{993673058c484ae0b41351f99125cc40,

title = "Establishing the incidence and timing of hypoglycemia at a residential diabetes camp",

abstract = "AIMS: To establish the incidence and timing of hypoglycemia at a week-long residential diabetes camp for children. We hypothesized that hypoglycemia would occur more frequently during the first two days of camp and following evening all-camp games.METHODS: 225 children (mean age 12.0 ± 2.3 years, 56% female, mean hemoglobin A1c 8.4% [71.6 mmol/mol]) had blood glucose (BG) levels obtained before meals, at bedtime, and as needed to detect hypoglycemia. Insulin adjustments were made by medical staff according to camp protocol and at the discretion of medical staff during camper check-in.RESULTS: Mild hypoglycemia (BG 50-69 mg/dL [3.9 mmol/L]) occurred ≥ 1 time in 90% of campers while 43% had ≥ 1 episode of BG < 50 mg/dL (2.8 mmol/L). No episodes of hypoglycemia requiring glucagon occurred. More campers experienced ≥ 1 overnight hypoglycemia event during the first 48 hours of camp compared to later in the week (p = 0.01). Evening all-camp games did not impact hypoglycemia rates overnight.CONCLUSIONS: Nocturnal hypoglycemia occurred more frequently during the first two nights, establishing this period as high risk and supporting implementation of a standard protocol to lower insulin doses. Rates of hypoglycemia were unaffected by all-camp games, indicating current practices are effective at minimizing hypoglycemia.",

keywords = "Diabetes camp, Hypoglycemia, Protocols, Quality improvement, Type 1 diabetes mellitus, Hypoglycemia/diagnosis, Humans, Male, Incidence, Time Factors, Female, Camping, Child",

author = "Mann, {Elizabeth A.} and Scott Lunos and Elijah Carrel and Trevor Omann and Alyssa Halper and Anne Kogler and Miller, {Bradley S.} and Muna Sunni and Bellin, {Melena D.} and Nathan, {Brandon M.}",

note = "Funding Information: This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award ( UL1TR002494 ). Funding Information: The authors would like to acknowledge Carol Holten, associate manager at the American Diabetes Association of Minneapolis-St. Paul for her assistance at Camp Needlepoint and in gathering camper records. This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award (UL1TR002494). Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = may,

doi = "10.1016/j.diabres.2019.04.003",

language = "English (US)",

volume = "151",

pages = "146--151",

journal = "Diabetes Research and Clinical Practice",

issn = "0168-8227",

publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Establishing the incidence and timing of hypoglycemia at a residential diabetes camp

AU - Mann, Elizabeth A.

AU - Lunos, Scott

AU - Carrel, Elijah

AU - Omann, Trevor

AU - Halper, Alyssa

AU - Kogler, Anne

AU - Miller, Bradley S.

AU - Sunni, Muna

AU - Bellin, Melena D.

AU - Nathan, Brandon M.

N1 - Funding Information: This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award ( UL1TR002494 ). Funding Information: The authors would like to acknowledge Carol Holten, associate manager at the American Diabetes Association of Minneapolis-St. Paul for her assistance at Camp Needlepoint and in gathering camper records. This work was supported by the Biostatistical Design and Analysis center, part of the University of Minnesota Clinical and Translational Science Institute, and funded by a National Institutes of Health Clinical and Translational Science Award (UL1TR002494). Publisher Copyright: © 2019 Elsevier B.V.

PY - 2019/5

Y1 - 2019/5

N2 - AIMS: To establish the incidence and timing of hypoglycemia at a week-long residential diabetes camp for children. We hypothesized that hypoglycemia would occur more frequently during the first two days of camp and following evening all-camp games.METHODS: 225 children (mean age 12.0 ± 2.3 years, 56% female, mean hemoglobin A1c 8.4% [71.6 mmol/mol]) had blood glucose (BG) levels obtained before meals, at bedtime, and as needed to detect hypoglycemia. Insulin adjustments were made by medical staff according to camp protocol and at the discretion of medical staff during camper check-in.RESULTS: Mild hypoglycemia (BG 50-69 mg/dL [3.9 mmol/L]) occurred ≥ 1 time in 90% of campers while 43% had ≥ 1 episode of BG < 50 mg/dL (2.8 mmol/L). No episodes of hypoglycemia requiring glucagon occurred. More campers experienced ≥ 1 overnight hypoglycemia event during the first 48 hours of camp compared to later in the week (p = 0.01). Evening all-camp games did not impact hypoglycemia rates overnight.CONCLUSIONS: Nocturnal hypoglycemia occurred more frequently during the first two nights, establishing this period as high risk and supporting implementation of a standard protocol to lower insulin doses. Rates of hypoglycemia were unaffected by all-camp games, indicating current practices are effective at minimizing hypoglycemia.

AB - AIMS: To establish the incidence and timing of hypoglycemia at a week-long residential diabetes camp for children. We hypothesized that hypoglycemia would occur more frequently during the first two days of camp and following evening all-camp games.METHODS: 225 children (mean age 12.0 ± 2.3 years, 56% female, mean hemoglobin A1c 8.4% [71.6 mmol/mol]) had blood glucose (BG) levels obtained before meals, at bedtime, and as needed to detect hypoglycemia. Insulin adjustments were made by medical staff according to camp protocol and at the discretion of medical staff during camper check-in.RESULTS: Mild hypoglycemia (BG 50-69 mg/dL [3.9 mmol/L]) occurred ≥ 1 time in 90% of campers while 43% had ≥ 1 episode of BG < 50 mg/dL (2.8 mmol/L). No episodes of hypoglycemia requiring glucagon occurred. More campers experienced ≥ 1 overnight hypoglycemia event during the first 48 hours of camp compared to later in the week (p = 0.01). Evening all-camp games did not impact hypoglycemia rates overnight.CONCLUSIONS: Nocturnal hypoglycemia occurred more frequently during the first two nights, establishing this period as high risk and supporting implementation of a standard protocol to lower insulin doses. Rates of hypoglycemia were unaffected by all-camp games, indicating current practices are effective at minimizing hypoglycemia.

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KW - Protocols

KW - Quality improvement

KW - Type 1 diabetes mellitus

KW - Hypoglycemia/diagnosis

KW - Humans

KW - Male

KW - Incidence

KW - Time Factors

KW - Female

KW - Camping

KW - Child

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SN - 0168-8227

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JO - Diabetes Research and Clinical Practice

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ER -

Establishing the incidence and timing of hypoglycemia at a residential diabetes camp

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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