I am a nurse consultant for Department of Children and Family Services. We have a seventeen year old ward who is a brittle diabetic and is continually on the run. The problem are his behaviors — he is oppositional defiant. We have gone the rounds of counseling and inpatient facilities most recently being the University, and to no avail. He is running constantly. He will check himself into the hospital for insulin; he is usually dehydrated. We have tried residential facilities, but he also runs. He has had multiple inpatient stays in mental health facilities and is quickly discharged as he is not of risk for mental health issues. The same is true of the medical facilities in relation to his insulin. We are out of ideas. What about the pump? Peer groups have not worked. Do you have ideas about a support group for this type of child?

Unfortunately this is a common situation with any large diabetes clinical team. Not much that can be offered except for what you have already tried. Perhaps getting some of his friends to assist in support would help remind him to take his insulin. My take on such situation is that getting attention from the medical establishment is one of the ways that he gains some self-control. At this age, it is unlikely any family would be supportive or consistent enough to get him to take insulin. An insulin pump would only work if he would actually wear it and actuate the pump — this would be a very expensive experiment so before I would try this I might give him a loaner and see what happens rather than waste more than $6000. It would also be important to explore the reasons for his not taking insulin — if he has no money, then he also would not have money for catheters or insulin via a pump.

SB
Additional comments from Dr. Jill Weissberg-Benchell:

A support group will not help. This young man is in the custody of the state, so for some reason, his family was not able to care for him. Any child who is a ward of the state will have mental health issues. Living with diabetes also has an emotional impact on an individual. It sounds as if his diabetes is well-controlled when he is in a controlled, structured environment where others make sure he gets all of his shots. It also sounds as if his behaviors improve when in a psychiatric inpatient facility that is highly structured and controlled. Once he is not in such a structured setting, his behavior and his health deteriorate.

JWB
Additional comments from Stephanie Schwartz, diabetes nurse specialist:

An insulin pump is certainly not the answer for this young man. The major problem here appears to be his psychiatric disorder.

SS