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Thread: Type 1 Diabetes

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    Senior Member Taeniura's Avatar
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    Type 1 Diabetes

    The Local Scout Group has an Explorer ESU with a partnership agreement and I have been asked to help with supervising their Bronze D of E expedition. The two Unit Leaders are very good and friendly but are totally new to Scouting and to D of E. One of the Explorers is type 1 Diabetic and I asked the question the other day do the others know what to do if something should happen especially in the lovely hot weather we have been enjoying. Oh yes said one of the Leaders whose child is the Diabetic. It turned out the advice that has been given is make her comfortable and call for an ambulance. Last weekend when they Explorers were out on a camp with the Cubs helping as YL her Insulin pump failed and Mother in child spent 4 hours trying to sort things out telling no one that she had a problem. The previous day the Explorers had done a day hike in preparation for their D of E practice hike this month and I was concerned that I was not told of the problems neither was the GSL who was also on the camp. I would hate for something to happen whilst they are our hiking and possibly out of mobile signal range. i would like all those taking part in the expedition to know what to do if case of a problem how to check her blood sugars and if needs be how to administer Insulin or sugar if needed. My son's best friend at 10 was type 1 Diabetic and he made sure that my son could deal with any problems when they were out. i know in the past 14 years technology has moved ob but it can fail as demonstrated last weekends. All the Explorers are sensible you people and I would hate for something to happen causing this young person a possible life changing result just because the Mother seems to think it is not necessary or she does not want her child to be embarrassed
    Cum catapultae proscriptae erunt tum soli proscript catapultas habebunt

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    Senior Member Bushfella's Avatar
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    This is important enough to comment on. There should be no stigma about this.

    If the insulin pump fails, then there is a possibility that blood sugars will rise, however, on an expedition where energy is being expended it is unlikely to be a risk. I'm T2 and have never had a hyper but I am told that a symptom is the sweet smell of ketones on the individual's breath. If they have a test meter, run a blood test, if the blood sugars are high, call the emergency services with your position, they will give guidance and send help. Do NOT administer glucose if sugars are high enough to cause symptoms. I'd be mightily upset of someone offered me glucose when I had high blood sugars.

    If the blood sugars are low, the individual will know, or should know - though if on an insulin pump they may not be familiar with the symptoms - Do a Blood sugar check, if low - Say below 4.5 heading towards 3 - give a glucose sweet but again, call emergency services and advise them of a patient with a potential hypo.

    Always play safe. I am not a medical professional but I have now lived with diabetes for 20 years, I remain active and I know how to manage my own symptoms. But, if I were in charge of someone else's child, I would always, but always play it safe. That might embarass them or disappoint them but, I'd rather hand back an unhappy child than a seriously ill one.
    Ewan Scott

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    Nawyecka Comanch'": "Means roundabout--man says he's going one way, means to go t'other" Ethan Edwards - The Searchers



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    As a Type 1, being too high should not result in an immediate call to emergency services. Blood glucose should be monitored, with insulin given if necessary. If the blood sugar remains high/ shows no sign of dropping 20mins after insulin, then emergency services *might* be called. It's a lot easier to survive high glucose than low glucose.

    Having said that, for the parent to not inform you, they are showing a distinct lack of regard for what could happen to either their child or the rest of the group if the child gets into difficulties. I'm assuming you don't know them well, but do they (to your knowledge) have a good working relationship with the ESLs?

    I would not encourage peers being advised to administer insulin, but for them to all have spare high-sugar food and know when it's needed is definitely not a bad thing.
    Last edited by Chillax; 01-07-2018 at 05:27 PM.

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    Explorers out on expeditions really need to have sufficient first aid training and be aware of potential issues within the group to deal with it until help arrives.

    In this case a review of how to deal with diabetes should be carried out, i wood.d suggest asking the explorer with the condition to lead the discussion and tell them if this happens this is what I want you to do.

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    GSL & AESL shiftypete's Avatar
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    One of my former collegues had type 1 diabetes, he was very good a managing it but one time he had a major hypo and it was a massive heath and safety risk (note I install solar panels on roofs for a living) as despite being given a sweet drink and food he went totally delirious (fortunately I had ordered him off the roof we were working on at the first sign he was in trouble) it took an emergency ambulance visit to sort him out. No way would I want to send kids out on a D of E style expedition with someone who had type 1 diabetes without being sure that those on the expedition with them knew what to do if it became necessary.

    Peter Andrews AESL of Headingley Pirates ESU, Group Scout Leader & Webmaster of Falkoner Scout Group
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    Wike, North Leeds District Campsite - www.wikecampsite.org.uk
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    Please note all views expressed are my own and not those of any organisation I'm associated with

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    Member jondimon's Avatar
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    I was diagnosed with Type 1 when I was 17 and a Venture Scout (yes, I know that ages me :-) ). I completed numerous overnight expeditions including a d of e gold.

    Diabetes should not be a barrier to anything.

    Like others have suggested, the key thing is that the YP makes people aware of their diabetes and warning signs. It is highly unlikely with a pump that a YP would have a significantly raised blood sugar on an expedition that would cause the nail varnish type smell on the breath (ketone acidosis), the opposite is more likely (hypoglycaemia) where the blood sugar level drops.

    Signs will be different for each person, but I get a tingly sensation in my finger tips, vision can become blurry, a shortness of temper, and their can be a delayed or odd response in conversation. These signs need to be communicated to their expedition group, and how to treat (glucose tablets, liquid glucose etc.) but the YP needs to take ownership and test at regular intervals, understand about eating small amounts regularly, understand about reducing insulin intake to cope with increased activity etc.

    I don’t know how long they have had diabetes for but the YP needs to take ownership and not be afraid to communicate to their peer group. When I was first diagnosed I did this by presenting to my VS unit about diabetes and how it was changing my life, not stopping it.

    If you are anywhere near Gloucestershire and I can offer any words of advice to the YP then happy to do so.

    Hope that helps


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    ASL and YLUL wealdbrook's Avatar
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    The safety of the young people has to be paramount and that requires them to discuss with their peers the issue and what to do if things begin to go pear shaped (which we hope they will not). I would not be comfortable being responsible for a group where I was not aware of the right diagnosis and treatments, and where the immediate group had not been briefed on what to do. Sounds a bit like a parent in denial.
    John Alexander,
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    Senior Member Taeniura's Avatar
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    Thank you to everyone for their input. Wealdbrook is right it is parental denial and when we have gently pushed her about it all she says is my child knows all about it and can deal with the situation and all the others have to do is call 999. I am type 2 diabetic and have made sure that everyone knows what to do if something happens to me. I have had some health issues in the past and all my medical details are on my iPhone and can be accessed by anyone without the need for a password or number. I also know about Insulin as at one time I was on Insulin. I don't know about Insulin pumps but what i do know is that anything mechanical can go wrong and will go wrong when you are miles from help. The peer group want to help but Mother and Young person don't want the help. My only concern is that if something went wrong and the peerr group could not help.
    Cum catapultae proscriptae erunt tum soli proscript catapultas habebunt

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    this is were your risk assessment will have to decide if it's safe to have them in the group. If they are walking in remote areas how long before help can get to them remembering it's likely they will need mountain rescue as an ordinary ambulance won't be able to get close.

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    Senior Member Bushfella's Avatar
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    Quote Originally Posted by Chillax View Post
    As a Type 1, being too high should not result in an immediate call to emergency services. Blood glucose should be monitored, with insulin given if necessary. If the blood sugar remains high/ shows no sign of dropping 20mins after insulin, then emergency services *might* be called. It's a lot easier to survive high glucose than low glucose.

    Having said that, for the parent to not inform you, they are showing a distinct lack of regard for what could happen to either their child or the rest of the group if the child gets into difficulties. I'm assuming you don't know them well, but do they (to your knowledge) have a good working relationship with the ESLs?

    I would not encourage peers being advised to administer insulin, but for them to all have spare high-sugar food and know when it's needed is definitely not a bad thing.


    In context, a hyper on an expedition with a group of teenage peers, there is no room for error. Call emergency services, they are not medical experts, I wouldn't have any discussion about it. If in doubt, call them out.

    Just to be clear - this is what NHS say about hyperglycaemia... And this is the one that could be a concern on an expedition...

    Very high blood sugar levels can cause life-threatening complications, such as:

    • diabetic ketoacidosis (DKA) – a condition caused by the body needing to break down fat as a source of energy, which can lead to a diabetic coma; this tends to affect people with type 1 diabetes


    When to get urgent medical attention

    Contact your diabetes care team immediately if you have a high blood sugar level and experience the following symptoms:


    These symptoms could be a sign of diabetic ketoacidosis or a hyperosmolar hyperglycaemic state (see above) and you may need to be looked after in hospital.

    NB - some of those symptoms could be mistaken by young people out on an expedition for something else, play safe.


    And from Diabetes UK...

    Diabetic coma at diagnosis of type 1 diabetes

    If the symptoms of type 1 diabetes are not spotted soon enough, ketoacidosis can develop leading to coma before a diagnosis is made.
    It is possible that doctors may not correctly diagnose diabetes at first presentation. Approximately 1 in 4 patients diagnosed with type 1 diabetes are recorded as demonstrating signs of ketoacidosis.

    My bold underline... so, if symptoms occur, then get help. If doctors can misdiagnose, then we should not expect teenagers out on a hike to be assessing without getting support... Yes they might get lucky and do everything right, but the stakes are too high because if they get it wrong then they have to live with the consequences ( as does their Leader). So, if in doubt, call them out.
    Last edited by Bushfella; 04-07-2018 at 07:08 AM.
    Ewan Scott

    It seems that there are a lot of Nawyecka Comanch around....





    Nawyecka Comanch'": "Means roundabout--man says he's going one way, means to go t'other" Ethan Edwards - The Searchers



    www.upperdearnevalleynavigators.org.uk

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    Quote Originally Posted by Bushfella View Post
    And from Diabetes UK...

    Diabetic coma at diagnosis of type 1 diabetes

    If the symptoms of type 1 diabetes are not spotted soon enough, ketoacidosis can develop leading to coma before a diagnosis is made.
    It is possible that doctors may not correctly diagnose diabetes at first presentation. Approximately 1 in 4 patients diagnosed with type 1 diabetes are recorded as demonstrating signs of ketoacidosis.

    My bold underline... so, if symptoms occur, then get help. If doctors can misdiagnose, then we should not expect teenagers out on a hike to be assessing without getting support... Yes they might get lucky and do everything right, but the stakes are too high because if they get it wrong then they have to live with the consequences ( as does their Leader). So, if in doubt, call them out.
    Just to clarify, I think the Diabetes UK advice is about undiagnosed type 1 diabetes, not an undiagnosed hyper in someone who knows they have type 1 diabetes.

    People who are unaware they have type 1 diabetes will likely have fairly long-term hyperglycaemia, hence the risk of ketoacidosis and coma. This is very different from the risks of a shorter-term hyper. I'm not an expert, but I don't think the risks should be overstated by taking that advice out of context.

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    Senior Member Bushfella's Avatar
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    Quote Originally Posted by KingstonCubber View Post
    Just to clarify, I think the Diabetes UK advice is about undiagnosed type 1 diabetes, not an undiagnosed hyper in someone who knows they have type 1 diabetes.

    People who are unaware they have type 1 diabetes will likely have fairly long-term hyperglycaemia, hence the risk of ketoacidosis and coma. This is very different from the risks of a shorter-term hyper. I'm not an expert, but I don't think the risks should be overstated by taking that advice out of context.
    The Diabetes UK advice does not specify whether diagnosed or not - and really, it is immaterial in the situation where this could be ocurring on an expedition. Hypers and Hypos are potentially medically serious, so, in my mind, the action to be taken by young people out on an expedition is not to second-guess what is happening but to play safe. I can't believe this is even being questioned. (We thought Smiffy might be going hyper but we weren't sure so we carried on till he collapsed...)

    A T1 on a pump requires the insulin to keep their blood sugars down. If the pump stops working, one presumes they are not getting any insulin, ( if it delivered by default that would be a design fault) so blood sugars will rise. I have seen it and I have seen it happen very quickly. Mum collected and the kid ended up in hospital as a result.

    It is perfectly okay for an adult with diabetes to say, I can deal with this, I don't need help at this stage, sort it and carry on ( we might think ourselves - my Doctor suggests otherwise...). It is quite another to expect young people to do the same where the illness of one may not only put their health at risk but that of others. It is basic safety procedure. You never take risks when there could be serious health consequences - yes, they may be rare consequnces but nonetheless, you do not put young people at risk by expecting them to diagnose something that may well confuse a doctor at first.

    The parent not wanting to tell you and saying it isn't serious is in denial, she needs a wake-up call before it is too late.
    Ewan Scott

    It seems that there are a lot of Nawyecka Comanch around....





    Nawyecka Comanch'": "Means roundabout--man says he's going one way, means to go t'other" Ethan Edwards - The Searchers



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    But if the child tested, and were above the official hyper borderline (11.0mg/dl) but not continuing to rise, then you'd be calling out mountain rescue for a manageable incident that would be fixed by insulin and a rest. if the child were dramatically high (20.0mg/dl or above) without reason, that would be a good time to call mountain rescue for a group of young people with limited to no experience of this disease.

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    Senior Member Bushfella's Avatar
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    Quote Originally Posted by Chillax View Post
    But if the child tested, and were above the official hyper borderline (11.0mg/dl) but not continuing to rise, then you'd be calling out mountain rescue for a manageable incident that would be fixed by insulin and a rest. if the child were dramatically high (20.0mg/dl or above) without reason, that would be a good time to call mountain rescue for a group of young people with limited to no experience of this disease.

    11 and not continuing... fix with insulin... that presupposes that there is an alternative supply if the pump is not working. The key here is a child, and a pump not working. You cannot rely on that pump for information. I'd lay odds that no alternative insulin would be available on the expedition.

    If a young person is at risk of becoming ill and you do not deal with it, or you deal with it incorrectly, then they may have to live with the consequences. Those with them may have to live with the guilt. I simply do not believe that any expedition is worth that sort of risk. Play safe. It is our duty of care to ensure, first and foremost, that the young people in our charge are safe - nothing takes priority over that requirement.


    Move the discussion. A young person on a hike gets cold and starts to suffer from hypothermia. Well, we all teach our kids how to deal with that, so it shouldn't be a problem. But, it is a problem and even though they know how to deal and they can get the patient warmed up again. They should get of the hill and getthat patient to hospital for a check-up. We play safe.
    Ewan Scott

    It seems that there are a lot of Nawyecka Comanch around....





    Nawyecka Comanch'": "Means roundabout--man says he's going one way, means to go t'other" Ethan Edwards - The Searchers



    www.upperdearnevalleynavigators.org.uk

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    That is still dealt with by packing an alternative supply of insulin, which is standard advice when using a pump, rather than calling mountain rescue. Day to day I don't carry my insulin pens around with me, but I make darn sure to pack them with spares when on a hike, expedition or camp. And I doubt a diabetic at 11.0 will be incapable of injecting themselves.

    Unless the parent is in denial that the pump could fail, at which point, expedition refused unless spare resources are carried, as with any meds such as inhalers or other prescribed drugs.

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