Practical session of Diabetes Camp 2004

Lee Kar Bik

Diabetes Educator QMH (Paed) 16 September 2004

The objectives of Diabetes Camp 2004

To promote diabetes education in a more relaxed and non-structural setting.

(Main themes: food exchange and CHO counting, insulin dosage adjustment, exercise and diabetes)

To review their management skill in daily life. To encourage independence, build confidence and

self esteem. To impact a more positive attitude in coping with

the illness. To create a safe and fun environment.

Diabetes Camp 2004 Place: 西貢黃宜州青年營營地 Date: 22/10/04 --- 24/10/04 Participants: 95 DM children Hospitals: 12 Age groups: 8-10 (18) 11-12 (23) ≥13 (54) Sex: female – 51 male – 44 Years of diagnosis: From ~3 months to 17 years Groups: 12 (different ages and sex), 7-8 persons/group Room: 12 Female (7) Male (5) Workers: Doctors / DM nurses / Dietitians / MSW / Camp facilitators / volunteers from parents

Role of Diabetes educators/ DM nurses within a DM Camp To provide educational and recreational activities To provide knowledge in management of exercise

and hypoglycaemia To provide psychological and physical support to

younger patients To prevent and manage hypoglycaemia To ensure safety outdoors activities To co-ordinate dosage reduction To identify patients at risk of unstable blood

sugar To monitor patients daily diabetes care . Dextrostix monitoring . Insulin injection technique . Dietary intake

Role of leader within the camp

鼓勵營友積極地參與營內各種活動節目。

協助職員維持營內活動之秩序。

鼓勵其他營友遵守營內的規條。

協助指導年幼的營友做血糖測試和注射胰島素。

協助照顧較年幼的營友 , 肯定他們已跟進各人的食物表所訂的份量。

協助教導其他營友在日常生活中怎樣去調較胰島素量及食物 , 運動和胰島素 的關係。

Role of leader within the camp

協助教導其他營友怎樣去處理低血糖反應。

鼓勵營友們需積極地面對糖尿病 , 給予他們一個正面的榜樣適應由糖尿病所帶來的負面情緒反應。

鼓勵大家去分享和思考各人心中面對糖尿病的疑難和矛盾。

若有任何疑難或困擾問題 , 歡迎轉介職員去協助解決。

盡量鼓勵團隊精神。

DM camp programDay 1 (2004-10-22)09:15 Assembly09:30 -12:00 Depart SK Pier Settle and grounding Introduce facilitators Trust lean (partner/group) Group name & Slogan Find facilitator12:00 – 13:00 Lunch ( including check H’stix and injection)13:15 – 17:00 Small group activities (outdoor)18:00 – 19:00 Dinner (including check H’stix and injection)19:00 – 19:30 Sharing 19:30 – 20:00 Briefing for Field trip20:00 – 21:00 Basic Map Reading21:00 – 22:00 Preparation for Field trip22:00 End

DM camp program

Day 2 (2004-10-23)08:00 – 09:00 Breakfast

09:30 – 18:00 Field trips

18:00 – 19:00 Dinner (including check H’stix and injection)

19:00 – 20:00 Preparation for Camp Fire

20:00 – 22:00 Camp Fire

22:00 End

Dm camp program

Day 3 (2004-10-24) 親子日營08:00 – 09:00 Breakfast

09:30 – 12:00 Small group activities (parents to join)

12:00 – 13:00 Lunch (including check H’stix and injection)

13:00 – 1400 Packing

14:00 – 16:00 增進親子溝通工作坊 16:00 – 16:30 Closing Ceremony

16:30 End

Blood MonitoringBlood glucose monitoring Frequency: before breakfast

before lunch

before dinner

before bed

or 3 a.m.

& p.r.n. Blood sugar analyzer: Optium Recording

Record in camp record sheet and their own record book

Blood monitoringKetone monitoring Measuring serum ketone if BS persistently

> 15 mmol/L (2 consecutive readings if asymptomatic) or if there is intercurrent illness

Blood ketone level <0.6 mmol/l -------------- No action required0.6 – 1.5 mmol/l -------------- Retest blood glucose and blood ketones in 2 – 4 hours1.5 – 3 mmol/l ------------- May be at risk of developing DKA>3mmol/l ------------ Requires immediate emergency treatment

Hypokit Blood glucose analyser & strips Lancets Alcohol prep Gauze Ribena candy (10g/pack)/ Vitasoy 125ml/box (1

0g/box) / biscuit Glucagon I.M.I & 2.5ml syringe +/- Hypostop Bandaid/ Bandage Insect Repelient Record sheet & pen Small sharp box

Medical instrusment (1)

Items:1.Stethoscopes

2.Thermometer

3 .I.V. drip set/ Angiocath / heparin flush and heparin block/ Splint

4. Micropore/ Tagaderm/ Alcohol prep

5. I.V. fluid D5/ NS/ Water for injection

6. I.V. Glucose D20/D50

7. Blood glucose Analyzer/ blood glucose strips

8. Lancet

9. Blood ketone test strip

10. Urine ketone strip

Medical instrusment (2)

11. Syringe (2.5ml/ 10ml, 20ml)/ insulin pen12. Insulin syringe (30u/ 50u)13. Gauze/ bandaid/ Elastic Bandge/ Triangular bandage 14. Sharp box/ gloves15. Medication: Glucagon i.m.i Insulin ( different kinds of insulin) OHA Panadal / Piriton / Stemetil /Maxolon/ Gelusil / Holopon / Lomotil /Ventolin Puff / Hydrocortisone i.v. / Adrenaline i.v.16. Insect Repellent17. Antisan18. +/- Hypostop

Recording

DM camp medical form

Name _______________(Chinese)___________________(English) I.D. No_______________ Age ________ Sex _________ Hospital_________________ Year of Diagnosis________________ Paediatrician_______________ Nurse Educator_____________ DM medication_____________________________________ Other medication____________________________________ Allergy history ______________________________________ Medical history______________________________________ Latest HbA1c_________Blood sugar control range _______________ Diet (Cal / CHO portion)__________________________ Frequency / severity of hypo (recent 3 months)_____/week ______ Any severe hypo : ________require glucagon (Y / N) admission(Y / N)Episode of DKA (in last 12 months)_______________Psychological issue________________________________________Remarks_________________________________________________Emergency contact person________________ Relationship_______Emergency contact phone no________________________________

No. Hospital Name Sex/ Age

Dx /

Yr of Dx

Tel Medical History

Cal/ Cho Portion Diet / Food allergy

Insulin dosage / OHA/ other medication

Emergency Contact Person / Tel

RemarkS

Room no : _________ Team no : ________ Doctor I/C : ________ (Pager __________ ) Nurse Educator I/C ________

Recording

No. Hospital Name Sex/ Age

Dx /

Yr of Dx

Tel Medical History

Cal/ Cho Portion Diet / Food allergy

Insulin dosage / OHA/ other medication

‘E”

Contact Person / Tel

RemarkSCharacteristics

Aims

QMH XXX F/10 Type I DM

10 yrs

Nil 1200 Cal

40/ 0/ 50/ 0/ 50/ 20Lispro 6u BB

Lispro 7u BL

Lispro 7u BDGlargine 20u B bed

Easy to have hypo

Plan to teach injection over abdomen

Room no : _________ Team no : ________ Doctor I/C : ________ (Pager __________ ) Nurse Educator I/C ________

Recording

Blood sugar recording

22/10/2004 Breakfast Lunch Dinner Before bed Night

Day 1 Insulin

H’stix

Hypo

Extra food (simple

sugar/ CHO) Remarks

10月 23日遠足日誌 

姓名 : 性別 : 年齡 : _________  胰島素治療方案 :___________________________ 澱粉質分配 : _________________________

時間

H’stix

Ketone(p.r.n.)

胰島素劑量

胰島素劑量調較由 → 至

減胰島素之百分比(%)

食物種類

澱粉質分

量 (gm)

額外澱粉質

遠足里數

估計遠足所用時間

運動量評分

背囊重量

Rema

rk

Aftercare of DM camp

. Give advise to parents/ caretakers on insulin adjus

tment to prevent delayed hypoglycaemia

. Sent participants’ blood sugar record and special events within the camping to individual hospital.

. Follow up what they had learnt in the camp.