How to Keep Kids With Diabetes Safe and Thriving All Summer, With Jennifer Sherr, M.D., Ph.D.

Jennifer Sherr, M.D., Ph.D.

Credit: Yale Medicine

Summer break should be a time of fun and freedom for kids — but for children with Type 1 diabetes, it also brings unique challenges. From unpredictable schedules to increased physical activity and changes in caregivers, the risk of diabetic complications like diabetic ketoacidosis (DKA) can quietly rise. Jennifer Sherr, M.D., Ph.D., a pediatric endocrinologist and person living with Type 1 diabetes herself, shares essential insights on how parents can prepare, what warning signs to never ignore, and how to equip caregivers for a safe, healthy summer.

Why is summer a particularly risky time for children with diabetes who are on insulin therapy?

Jennifer Sherr, M.D., Ph.D.: Summer can be a particularly risky time for children with diabetes who are on insulin therapy due to the flexibility of summer schedules as compared with the predictability afforded in the school setting. While these are treasured times for kids, the multitude of factors that can impact glucose levels rises exponentially.

Some youth may attend multiple camps, meaning new caregivers are involved in oversight each week. New activities can lead to inconsistent schedules, making it difficult to stay on top of sugar levels and insulin dosing.

During the summer there’s increased physical activity like swimming and extended outdoor play that can lead to sweating, potentially dislodging or kinking insulin pump infusion sets without immediate alerts. Additionally, summer fun can also bring dietary challenges at gatherings and vacations, where understanding the true carb content in meals can be more difficult.

Yet, we don’t want to limit a child with diabetes from partaking in treats! Inadequate insulin delivery and carb counting challenges can increase the risk of prolonged hyperglycemia, increasing the risk of elevated ketones and DKA — a potentially life-threatening complication.

What are some common diabetes management mistakes you see when kids’ schedules change — like at camp or on vacation?

JS: We wouldn’t call them mistakes, but changes in routine — like those that come with camp or vacation — can lead to unintentional oversights. New environments and shifts in adult supervision (e.g., school nurses, camp counselors, other parents, etc.) can make diabetes management more complex.

At camp, there may be lots of different activities with rotating schedules to make things fresh and fun. Overnight camps can pose a challenge as the ability of parents/guardians to “fix” things when the child comes home is not feasible. It’s easy to miscalculate insulin doses due to varied mealtimes and new schedules that impact opportunities to take breaks to monitor glucose, eat a snack and/or administer insulin. This can lead to unexpected highs or lows.

With the excitement and distractions of new environments, there needs to be an active effort to take a fresh look at your sugar levels and ketone monitoring plan — with particular focus on how to ensure frequent monitoring and intervention as early as possible, if needed.

What advice do you have for talking to new caregivers who may be responsible for your child’s care in the summer — like camp counselors or relatives — about their diabetes care plan?

JS: When talking to new caregivers about your child’s diabetes care plan, provide a clear plan that includes emergency contacts, medication details, and specific instructions for managing highs and lows. Highlight warning signs, knowing when to check sugar or ketone levels, how to administer insulin if necessary, and how to determine if a hypo- or hyperglycemic episode needs escalated medical intervention.

What are some of the warning signs of DKA that parents and caregivers might overlook?

JS: It’s possible to overlook signs of elevated ketones and DKA, mistaking them for common, less serious illnesses. Symptoms like nausea, abdominal pain or vomiting, for instance, are frequently attributed to a stomach bug or food poisoning, but when they occur in children with Type 1 diabetes, these can be early indicators of elevated ketones, which can lead to DKA if not treated quickly.

Since DKA can sometimes be mistaken for something as simple as a stomach bug, how can families tell the difference?

JS: It can be challenging to distinguish between the symptoms of elevated ketones or DKA from something as common as a stomach bug. The best way to tell the difference is through ketone testing. Even without typical stomach bug symptoms, a fever or general illness can trigger ketones due to the body’s stress response. Because even a single episode of DKA is serious and may require hospitalization, it’s important to take any vague or seemingly minor symptoms — like the stomach flu — seriously. When in doubt, the first step should always be to check for elevated ketones.

What should always be in a child’s diabetes travel or camp kit to stay safe over the summer?

JS: Outside of the usual supplies to check for low sugar, it’s important to include backup insulin to account for things like increased usage. Equally important are ketone testing supplies, whether by measuring a fingerstick blood or urine sample, as early detection of elevated ketones is vital. Be sure the testing strips are not expired.

Remember that diabetes management is a delicate balancing act and preparing for both high and low sugars is crucial for a fun and safe summer.

What’s one message you want every parent of a child with diabetes to hear before summer starts?

JS: One episode of DKA is one too many. It is preventable so long as you know how and when to check ketone levels. With the summer underway, every parent of a child with diabetes should prioritize educating their child’s new teachers, nurses, counselors and caregivers. They should be thoroughly informed about the child’s specific diabetes management plan, including medication schedules and dietary needs. Additionally, clearly communicate the signs of high sugar levels and elevated ketones and provide instructions on when to test for ketones and what actions to take in response to these readings. And this will be a summer to remember!