My 11 year old daughter, who was diagnosed with type 1 diabetes about two and a half years ago, was doing pretty well until about a year ago when she started her period, and her life has been pretty miserable since. There seems to be no control of blood glucose, and she is chronically ill. with stomach pain and headaches. A week before she starts her period she is pretty much “non-functional” meaning she just can’t seem to get out of bed.

She has high blood sugar that doesn’t come down with insulin, she has urine ketones and has started developing DKA [diabetic ketoacidosis] around this time. Her endocrinologist put her on birth-control pills to help regulate her period, but this does not seem to help. I work in a hospital and my fellow workers (nurses, doctors and others) as well as her doctors tell me that her life will pretty much be like this until she gets through puberty. In your opinion, is this true? Will she be plagued with this for the next few years and possibly the rest of her life?

I shared your e-mail with our medical social worker, and both of us wondered if the underlying problem here is that your daughter is feeling that she isn’t getting enough support with her diabetes. Let me hasten to add that what she feels may bear no relation to what you are actually doing.

In an established center we would ask the medical social worker to try to disentangle what is going wrong, but in individual practises, this is not easy. In practical terms what may be happening is that your daughter is being left to do most of her testing and giving of insulin on her own and is from time to time not giving the full dose. It is important to explore these possibilities and to look on it as a largely subconscious cry for help and to do it in a way that is entirely without confrontation. You might start by saying that the doctor thought it would be good idea for you to take over all injections and testing for a time ‘to give her a rest’.

In brief, I suspect that this is not an organic problem, but an example of a very common need for counselling in a girl at a vulnerable age, I also think that in the right hands it can be put right.

DOB