April 7, 2005
Behavior, Mental Health
Question from Whiting, New Jersey, USA:
My son was diagnosed two years ago. He is now 13 years old. His onset was precipitated by HSP that was treated with high doses of prednisone. Over the course of the first year, his numbers dropped and he was taking hardly any insulin. Last March, he had severe hypoglycemia with seizures. In consultation with his endocrinologist, we stopped the insulin injections. His numbers were good for two weeks and, at that time, we were told he probably wasn’t diabetic, that his pancreas had recovered from the insult of the prednisone. We continued to monitor his blood sugars and, three months later, they began to climb. We changed doctors, to have one closer to home. The new doctor felt he had just been in honeymoon.
Since the re-diagnosis in August, my son has been very angry. His behavior in school has been horrible. In November, he had another hypoglycemic event, and in the course of treatment, a heart condition was discovered. He has an extra nerve path in his heart that causes an arrhythmia. In January, he threatened suicide and was very aggressive toward me. I took him to a crisis unit and he was hospitalized for five days. Yesterday, he had issues with a teacher and said he wanted to burn the school, which earned him four days in school suspension (and he only goes half a day because the psychiatrist doesn’t feel he’s ready for full-time since his hospitalization) and another trip to crisis. They felt he wasn’t a danger to himself or others and released him.
He’s been seeing a psychiatrist since January and is on Prozac. He’s been seeing a LPC (counselor) since last March and has been going to a social skills group once a week since November.
No one seems to really have a handle on the connection between the anger, depression, and diabetes. Could you expand on doctor’s response to another parent that “It may depend very likely on the non-acceptance phase of the different four or fives phases of the psychological crisis that an adolescent has to pass, after the initial diagnosis, towards the active full adjustment to the disease.” (See this question.) What are those phases? As his parent, is there anything I can do to help him through those phases?
My area doesn’t seem to have many child psychiatrists and I haven’t had any luck finding anyone who counsels child with diabetes. My endocrinologist has recently suggested someone and I will give them a call. The local support groups are more geared towards caregivers. He is registered for Camp Nejeda this summer.
Answer:
Teens and families all adjust to the diagnosis of diabetes in different ways and at a different pace. Teens and parents can go through different phases of grief that may include feelings of shock, anger, denial, and acceptance, but, as I said, everyone is different in how they adjust to a new diagnosis of diabetes.
There is a link between depression and diabetes. Individuals with diabetes have about a two to three times higher risk of being depressed than individuals without diabetes. If your son’s blood sugars are high, he may be more moody or irritable and he may be very angry about his medical problems. However, the behavior that you are describing is not a typical reaction to adjusting to a new diagnosis of diabetes. I am very worried about your child’s safety as well as your safety because you said that he has been aggressive to you. In addition, I am very concerned about the comment he made about wanting to burn down the school. I am glad you are working with a counselor and a psychiatrist and they need to be aware of those things that you wrote. He should continue to follow-up with his psychiatrist and counselor regularly. In addition, if you have any safety concerns you should call 911 or take him to the Emergency Room for a safety assessment.
I am not familiar with the phases of which my colleague spoke.
DB
Additional comments from Dr. Jill Weissberg-Benchell:
Your son’s emotional distress and behavioral difficulties may have become worse with the stress of living with a chronic illness. However, diabetes does not cause you to engage in physically aggressive or violent behaviors (like burning a school down). It may be that your son needs to be re-admitted to a psychiatric inpatient unit. He may, instead, need to be placed in a day-treatment program where he receives intensive therapeutic services during the day, including school, until he is stable enough to re-enter his own school full-time. If you are not sure you have adequate psychiatric care for your son, please contact your pediatrician and your local community mental health centers as well as your insurance company for other referrals.
JWB
