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Diabetes at the RCH

Request a School Camp Plan

  • Hello, 

    This form will submit a request for a diabetes school camp plan.   

    Going on school camp can be an exciting adventure for children. Sometimes parents are worried that the school will not know how to look after their child's diabetes care needs. A dedicated school camp plan prepared by your diabetes team will help the teachers plan how best to support your child.  


    Preparing a plan takes time so requests must be made at least 4 weeks before your school needs it.  

    Please take the time to answer all of the the following questions, missing information can mean there are delays in getting the plan to you. 

    Details 

     Child's name: 

     Date of birth:

    Hospital record number (if known)

     Last HbA1c and date of collection:

     Current year level at school:

     

     Name of school: 


    Diagnosis of coealiac disease?

    Parent/carer name and relationship to child: 

    Parent/carer phone number: 

    Parent/carer 2 name ad relationship to child: 

    Parent/carer 2 phone number:

    What is the best contact email to return the completed plan to you? 

    Do you give permission for us to email the plan to the above email provided?

    Camp dates: 

    Camp duration: 

     

    Is the camp location more than 30 minutes away from emergency services? 

    If yes, we recommend that staff learn how to administer glucagon.

      Names of buddy teachers attending camp:


     

    Will a parent/carer be attending camp?

     

    Camp activity level: 

     Other: 

     

    Hypoglycaemia treatment on camp: 

    What type of fast acting carbohydrates are used (sugar serve)?

    List the type and quantity. E.g. 2 x GlucoHit glucose tablets OR 3 jelly beans


    What type of slow acting carbohydrates are used as follow up treatment? 

    List the type and quantity. E.g. 6 x crackers or 1 packet of rice crackers 


     

    Insulin modality and doses:

    An insulin dose reduction will likely be recommended for the duration of camp.  

    PLEASE NOTE:

    Insulin regimen currently using: 

     If your child currently uses flexible dosing, either via a dosing card or the MyLife app, indicate if you would like them to continue with the flexible dosing on camp or if you prefer set doses for meal time insulin. 

     

    Fixed doses are a good idea for camp if they currently need assistance with carbohydrate counting.

    Based on their current doses/settings in the app (information requested below) we will provide adjusted doses/settings for camp and these will be on the camp plan. 

     

    Insulin injections: 

    What time of the day is the long acting insulin given i.e. glargine, Ryzodeg or Levemir? 


    If using injections or pens complete these questions.

    If using an insulin pump, skip through this section and complete the next section on insulin pumps.  

     

    Insulin administration type: 

    Blood glucose level (BGL) checking: 

    Does your child independently check BGLs?

    If no, who will support your child with BGL monitoring on camp? 

     

    Names and doses of current insulin: 
    All doses are required here for current fixed doses, dosing card ratios or MyLife settings. 
    It is helpful if you can give a range of how much insulin your child has per meal for flexible dosing 
    e.g. dosing card ratios for breakfast: 2 units for 15 grams of carbohydrate and 1 unit will lower the glucose by 4 mmol/L. My child usually has 4-6 units NovoRapid pre breakfast. 
    OR 
    MyLife app: current settings: carb ratio is 1 unit for every 5 grams of carbohydrate and a correction factor of 3 mmol/L - my child usually has 10-13 units NovoRapid before breakfast, lunch and dinner  

    Insulin pumps: 

    Complete this section if using an insulin pump.

    Insulin pump brand: 

     Other type of pump not listed above: 

    Date of last pump upload:

    To complete a camp plan we must have a current pump upload within 2 weeks of your child leaving to camp. 
    Without a pump upload, we cannot complete the plan and there will be delays in providing you with the plan. 


    What type of insulin cannula does your child use? 
    Other type of line: 

    Student pump skills: 
    Can your child change their own pump cannula and reservoirs? 
    Can your child give an insulin injection in case of line failure, pump failure or if ketones are 0.6 mmol/L or higher? 
    Can your child independently count carbohydrates? 
    If you answered no to any of the pump skills questions, indicate the plan for management on camp:

    Continuous glucose monitoring (CGM) or flash glucose monitoring (FlashGM)

    On camp, will your child be using CGM/FGM? 
     If yes using CGM or FGM, what brand are they using? 

     Other type of CGM/FGM: 

     


    Can your child change a CGM/FGM sensor if needed? 

     For CGM and insulin pumps, does your child use any of these features:

         Other: 



    International trips 

    A trip overseas requires a camp plan (this form) and travel letters and those using insulin injections require a flight plan if there is significant time zone changes e.g. more than 3-4 hours. Please see the travel information on the RCH Diabetes website. 
    A travel plan helps with making sure there is insulin working in the body at all times when there are time zone changes. 
    For a travel letter and/or travel plan email diabetesadmin@rch.org.au 
    For a travel plan, email your official flight itinerary in this email as well (required 4-6 weeks prior to camp) 

     

     

    Copy and paste any information you feel is needed to prepare your child's camp plan or add any additional information:

    Additional information and equipment: 

    A list of supplies will be included in the camp plan. Your child needs to take twice the amount of equipment and insulin they might expect to use, including ketone strips and a spear BGL meter. 

    When clicking submit, please wait for the page to load. We are finding it is taking time to process and multiple pushes of the submit button creates multiple requests. A confirmation page will come up when the form has been emailed to diabetes@rch.org.au

    If you are unsure if the form has been processed contact diabetesadmin@rch.org.au