January 8, 2008
Behavior, Meal Planning, Food and Diet
Question from Fort Dodge, Iowa, USA:
My 13-year-old son was diagnosed with type 1 at 14 months of age. Since then, we have had many ups and downs with respect to control of his blood sugars. Last year, I decided to start locking up the snacks in the house, in a special cupboard, because my son was waking in the middle of the night and eating snacks. After 11 months of success, I discovered that he was getting up and eating other things in the house (Lipton side dishes, ramen noodles, leftovers, etc.). At the time, he was testing his blood sugars and administering the correct dosage of NovoLog. Then, one night, he decided to pick the lock to the locked cupboard and binged on a lot of snacks (eight cereal bars). This night, he decided to not do an insulin dosage. Out of desperation, I contacted his therapist, whom he sees on a weekly basis, explained the situation and asked her advice. I then sat down with my son that afternoon and explained to him that I wasn’t going to lock the cupboard anymore and if he wanted something to eat, he just had to test himself and give himself the correct dosage of NovoLog. Well, needless to say, he still gets up in the middle of the night and binge eats, but, now, doesn’t test himself or give an insulin dosage of any kind. His morning blood sugar readings, of course, are over 200 mg/dl [11.1 mmol/L] on a regular basis. I have had SEVERAL conversations as to the results/side effects of hyperglycemia and at our three month check-up last week with his endocrinologist, he was just told that he needed to start taking care of himself. Can you tell me of anything else that I could be doing at this time? Any and all advice would be greatly appreciated.
Answer:
It is very likely that your son is eating because he is hungry, not because he is choosing to defy you or choosing to have poor blood sugar control. Locking up food only lets him know that you do not trust him, and that, somehow, food is to be rationed. Adolescent boys going through puberty eat a great deal of food and they eat it very often. Please see a dietitian who can help you look at why you feel food should be restricted and who can help you and your son work out a strategy around food that allows him to eat what he needs to grow and be healthy while giving the correct amount of insulin to cover his food.
JWB
Additional comments from Dr. Larry Deeb:
I will only speak as the physician. In the context of a clinic visit, I really do not have the time to fix this. I’m glad you are seeing someone. You are lucky to be able to do so.
I see it more often than you might think. I understand it, too. Forbidden is difficult for any of us, kids with diabetes, too. I think you have done the right thing now by not locking it up. That said, I also see the frustration of giving permission to eat and then not taking the insulin for the carbohydrates. I would think the usual consequences for behavior would apply here.
LD
