A 13 year old female who has had type�1 diabetes for three years is now refusing blood draws. She does her blood sugars at home, and they are in the 300 mg/dl [16.7 mmol/L] range. She refused to come to her last doctor’s appointment that specifically was to address the need for certain labs. Her mother came alone. Do you have any suggestions as to:

Why she is now refusing lab draws (past three months)?
Methods to encourage her cooperation.
Educational material on taking charge of her diabetes?

There are many reasons why this young lady may be struggling with her diabetes. The most important thing for her right now is for her family to be clear that at the age of 13, she does not get to choose whether or not she attends clinic or receives the necessary medical care to keep her healthy. This choice is her parents, as the individuals legally and morally responsible for her health and safety. Therefore, her parents must get her to the clinic (whether she agrees or not), and be sure she receives the necessary medical care. If she remains adamant that she will not participate in the necessary medical treatment, then the parents must seek emergency psychiatric help, and her diabetes team may be helpful with a referral.

JWB

[Editor’s comment: I agree — it is not appropriate for this young lady’s parent to attend doctor appointments without her, and essential to look at her side of things. This young lady is in serious need. of counselling to explore the reasons she is unwilling to have her blood drawn and attend doctor appointments. Education alone at this point will not do much to solve the problem. Often, the problem is really the fault of health care providers and parents who place value judgements on high numbers (blood sugar levels and HbA1c results). This lady may be being “blamed” and or “chastised” for poor control. It is important for her to be able to discuss her management difficulties in a non-threatening environment and to work with a team, specialized in the care of teens with diabetes, in order to develop a treatment plan that not only improves control, but self-esteem as well. I suggest that she be referred to such a team as soon as feasible.

SS]