My daughter has had several seizures and confused states due to her diabetes and this is starting to stress me out! It seems like it might be happening a little more. She is getting a little heavy. She skips meals and she is getting a little more defiant. She doesn’t like to discuss her diabetes at all. We have tried to talk her into going to a camp, getting a pen pal, doing a diabetes walk, anything, to show her she is normal but she shuts us down. This is the only thing she is so defiant about. We go to Vanderbilt University to Dr. Nancy Najjar, who acts like it is just a phase. Do you have a dietician who can help us develop a better diet? If I have to, I will fly her there to see whoever can help us.

It sounds like your daughter is really struggling with the burden of diabetes. Her seizures are, of course, the most frightening. However, skipping meals is also concerning. You say that she is on an insulin pump, but it may be that she is giving herself insulin when she does not need it (or giving herself more insulin than she actually needs) and that these decisions are leading to frightening and dangerous low blood sugars.

Please contact your diabetes team and/or your daughter’s pediatrician for referrals to a mental health professional with expertise in working with children who have a chronic illness. The concerns that you raise are very serious and warrant more than a consultation with a dietitian (although that would be a necessary and important part of your daughter’s care). It may be that she cannot be responsible for an insulin pump right now (it is such a heavy burden to manage a pump), especially if she may be making errors on how much insulin to bolus. It may be that you will need to return to injections, and that you will need to administer all insulin until she is safer.

Please discuss these issues with your diabetes team again and also with your pediatrician. Please find a therapist that can help your daughter and your family cope with the day to day burden of diabetes.

JWB