When it comes to dreams, Colleen McCarthy LaPierre had one big one: She wants kids and teens with diabetes to be able to do anything other kids can do.

In July of 2004, LaPierre’s dream came true when she organized and led a 19-day challenge-based adventure fitness and SCUBA camp for teens with type 1 diabetes. The camp began in Shelter Island, New York, when eight teens were chosen for SCUBA certification and fitness and meal planning training. Their classes completed, LaPierre and the campers flew to Maho Bay, St. John, American Virgin Islands, to dive in warm, tropical waters, practicing what they learned about managing diabetes as they made SCUBA dives in water up to 60 feet deep, hiked through tropical forests learning about the local flora and fauna, kayaked, and snorkeled. The teens also participated in an ongoing study to determine safety protocols for diving with diabetes.

LaPierre, director of programs with the Barton Center for Diabetes Education, Inc., North Oxford, Mass., was the driving force behind the Dream Big™ adventure fitness camp program. The camp was made possible by the Ascensia Dream Fund, which awarded LaPierre and the Barton Center a grant of $300,000 to make her dream come true. Barton is the largest independent camping and educational program in the country dedicated to children who live with diabetes and the people who care for them. Some 1,500 children and their families participate in programs annually at the Clara Barton birthplace resident camp and other camps and programs in New York, Connecticut, and Massachusetts.

To participate in the Dream Big™ program, teens were invited to submit an essay about why they wanted to SCUBA dive. Potential campers also had to pass a physical exam to be selected. Eight lucky teens were selected and began their training. The teens, as LaPierre says, had to “dive deep” within themselves and test their personal limits. Self-monitoring of blood glucose was a key component of the program, as was the use of insulin pumps. “I want to show young people with diabetes that through active self-management, including diligent monitoring and proper diet and exercise, they can control their life and achieve anything.”

LaPierre should know. Living with type 1 diabetes has not stopped her from living an active life or choosing a career path dedicated to adventurous outdoor activities. “I want kids to realize that they are capable of achieving things on their own,” she says.

The program is also an opportunity for parents to learn that their children are capable of taking care of themselves and their diabetes. “Parents tend to treat their kids with diabetes like they are in a cocoon,” LaPierre says. “That’s why parents were not allowed to attend the adventure camp. They learn that their kids can survive without them, and kids learn to do things new ways.” Parents were able to log on to an interactive website that provided daily pictures of camp activities, and could send one-way emails to campers.

LaPierre’s dream of an adventure camp for kids with diabetes began forming years ago, after she successfully completed an Outward Bound wilderness survival skills program. “That trip changed my life,” she says. “It was incredibly empowering to learn how to survive, especially with diabetes.”

A few years later, a friend took LaPierre for a SCUBA dive. She loved it and dreamed of becoming a certified diver. When the Dream Big™ adventure camp started to become a reality, LaPierre decided to add a SCUBA component. LaPierre became a certified SCUBA diver alongside her Dream Big™ adventure campers.

Each adventure camper was paired on dives with a certified diver and diabetes camp counselor. A doctor, Thomas Albushies, MD, and a nurse, Sue Bates, closely monitored the teens, logging blood glucose readings and being available for any questions or concerns.

With active self-management, says LaPierre, including diligent monitoring, proper diet and exercise, “teens with diabetes can take control of their lives and achieve their dreams, no matter how big or small.”

Diabetes and Diving

Insulin-dependent diabetes has traditionally been identified as a contraindication to SCUBA diving, and people with diabetes have been denied the opportunity to take dive training classes. However, a survey conducted by the Divers Alert Network (DAN), an organization that provides emergency services to divers and is a clearing house for diving medical information, has found that some divers with insulin-dependent diabetes are diving anyway.

Because divers with diabetes want to dive, DAN and other medical groups are developing guidelines to make the activity as safe as possible. The major risk is having a hypoglycemic episode underwater, during which a diver could lose consciousness and endanger themselves as well as their diving buddy.

Colleen McCarthy LaPierre and the Dream Big™ kids helped contribute to protocols being developed for divers with diabetes by wearing special dive computers during their Caribbean trip. The computers tracked their time spent underwater, and this information will help researchers understand how being underwater impacts blood sugars and contributes to data on decompression illness, a condition resulting from staying too deep too long.

Using protocols developed by Dr. George Burghen, Chief of Endocrinology and Metabolism at the University of Tennessee, and Stephen Prosterman, dive supervisor for the University of Virgin Islands, St. Thomas, the Dream Big™ divers checked their blood glucose levels four times before diving: one hour pre-dive, 30 minutes pre-dive, and immediately pre-dive. They then measured their blood sugar post- dive. The divers also carried instaglucose packs underwater.

Dr. Burghen recently reported that 32 divers making 146 dives had no instances of symptomatic hypoglycemia. German researchers, using the same guidelines, reported that seven divers they studied also had no instances of hypoglycemia. The data collected may change policies, allowing people with diabetes the opportunity to obtain dive training and certification.

For more information on diving and diabetes, visit www.diversalertnetwork.org

Youth and Diabetes

About 206,000 Americans under 20 years of age have diabetes.

Type 1 Diabetes in Youth
Type 1 diabetes is an auto-immune disorder that develops when the body’s own immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.
• Approximately one in every 400 to 500 children and adolescents has type 1 diabetes.
• The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood.
• Type 1 diabetes generally occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys.
• Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10% chance of developing the disease by age 50.
• The identical twin of a person with type 1 diabetes has a 25–50% higher chance of developing type 1 diabetes than a child in an unaffected family.
• There is a higher incidence of type 1 diabetes in Caucasians than in other racial groups.
• The symptoms of type 1 diabetes can mimic the flu in children.

Type 2 Diabetes in Youth
Type 2 diabetes is a metabolic disorder resulting from the body’s inability to make enough or properly use insulin. A growing number of children and adolescents are developing type 2 diabetes—a form of diabetes that is generally diagnosed among adults. Type 2 diabetes commonly occurs in children who are:
• Overweight. As many as 80% of youth may be overweight at the time of diagnosis.
• Older than 10 years of age and are in middle to late puberty; but cases of type 2 diabetes in children as young as four years old have been documented.
• Have a family history of type 2 diabetes.
• A member of a certain racial/ethnic group (African American, Hispanic/Latino, and Native American descent).