A year ago, I married a woman who has a 14 year old son diagnosed with diabetes about seven years ago, and I’m trying to be understanding and learn as much about diabetes as I can. We tried to allow him to test and inject on his own, but through checking his test kit every once in a while, we’ve found that he records lower numbers than the actual reading. My wife says that we cannot discipline him for his deception. When we discover the inaccuracies, we point out that he’s not fooling anyone and that indeed he’s only hurting himself.

First of all, I don’t understand his rationale for the lies, especially since I told him that we would be checking his kit every week. He still records the wrong numbers. My wife has done a wonderful job of helping me to understand this disease and the emotional effects that it has on those who have to endure it, but I feel like I need a “support group” of some kind to teach me what type of discipline is truly appropriate for these types of actions. I am only trying to help him. My major concern is: if we don’t teach him to manage his diabetes on his own, what happens in four short years when he’s on his own?

In my practice, I’ve run across several young people who alter their blood sugar readings. Generally, it is a result of seeing blood sugar values as either “good” or “bad” — and wanting the good results to be on record.

Since this young man has had diabetes long before you entered the picture, I wonder where he got the idea that only sugars within ideal range are acceptable? A good doctor can see through this strategy by using the hemoglobin A1c test to get an average of sugars for 90 days. If the numbers don’t fit — a kid’s faking it!

Rather than look at this as a matter of discipline, I would encourage a frank and truthful conversation about the issue. You may need to take over the testing and injections for a time for your own comfort level. Sadly, I did have a patient who faked her records for several months and died following an episode of DKA [diabetic ketoacidosis]. We did not know until we ran a computer scan of her meter after her death which showed very high readings that contradicted her own records. Her parents were crushed.

Your wife and you must be united on this matter and make it a safety issue and not a moral lapse. Driving a car, going on trips, college, and other rites of passage cannot be navigated safely by a young person who will not keep tabs on his/her blood sugars. You are right — now is the time to get things on track.

CMB

[Editor’s comment: I would suggest asking your son’s diabetes team for a referral to a mental health specialist, experienced in the care of teens with diabetes, for some individual and family counselling to help resolve this issue.

SS]