My son is 12 and was diagnosed eight years ago. His sugar numbers are usually very high (anywhere from 400 mg/dl [22.2 mmol/L] and up). Our endocrinologist determined that it is stress related and we are now seeing a therapist. So far no help. Any suggestions?

I think that the story you give about your son certainly could be a cry for more support and attention in caring for his diabetes, and it could also be a manifestation of depression. I have always felt that the best kind of person to disentangle these issues is the Medical Social Worker associated with the diabetes team, certainly someone familiar with diabetes, with this age group, and with the family.

If it has not already been tried, I would urge that one of the parents take over all responsibility for measuring blood sugars and for insulin injections for a time. It makes sense too to start with new insulin bottles and to make them inaccessible to your son. I well remember another older teenager who was surreptitiously diluting the insulin! This move should be presented, not as an exercise in supervision, but as a way for all the family to try to help get the blood sugars back to a more normal range.

Sometimes it takes hospitalisation to make these points, but I am sure everyone wants to avoid that. This is quite a common problem, and it is important to solve it before it goes the length of inducing acidosis. In the end, of course, if this does prove to be the answer, your son has to be reassured that he is not alone in having to take responsibility for his diabetes.

DOB