I have a nine year old with type 1. She has had diabetes since she was 20 months old. She has been binge eating for about three years. We have sent her to be seen by two counselors already, none of whom have been helpful. We have had to lock up as much food as possible. There are some foods we can’t. She takes advantage of this. There has not been hardly more than one day in between her binges. She has been admitted into the hospital in DKA about six or more times already because of the eating. She even does not stop at home. Anywhere she goes, she will find a way to get into food.

I don’t know what else to do. I have sent her to counselors. She has a higher carbohydrate to insulin ratio. I have spoken with her diabetes team. They were no help. They look at me every appointment and ask me why her blood sugars are so high and want to know why I can’t control my child. We can’t if she does this in the middle of the night. Then, they also say I need to tell her to not do it. She is supposed to stop just like that. If you could, please give me any advice on where else to turn. I am so worried about her health. She is going to really harm herself with this eating.

You have asked a difficult question. Unfortunately, I do not think there is a simple answer to your question. Food can easily become a control issue, particularly for children with diabetes. It is not uncommon for kids with diabetes to want more food, especially treats, if they feel restricted with their meal plan. Have you met with a nutritionist that is knowledgeable about pediatric diabetes? Can you incorporate some of the foods that your daughter feels restricted from into her meal plan, in moderation, and then cover these foods with insulin? Maybe the nutritionist can also come up with a list of essentially carbohydrate free foods that your daughter is allowed to eat whenever she wants without any restrictions, for example vegetables, pickles, sugar free jello, etc. If your daughter feels less restricted with her meal plan, and in more control of what she eats, I hope you will feel comfortable removing the locks from the cabinets.

I know you said that you have tried working with two counselors and it did not help, but I would encourage you to find a new counselor (psychologist or social worker) that you do think is helpful. Maybe you could ask your diabetes health care team if they know any counselors that are knowledgeable about diabetes to whom they can refer you. I know it is a rare specialty, so a counselor that specializes in eating disorders may be helpful as well, and your child’s pediatrician may be able to refer you to someone with this specialty.

You also didn’t mention whether you have any other children. I like to encourage families to have similar guidelines about food for all of the children in the family, regardless of whether they have diabetes, because a healthy meal plan for someone with diabetes is the same for someone without diabetes. I also try to take some of the focus off of food and talk about the importance of activity or exercise, which families can do together as well.

DB