I have a child who was recently placed in my care due to medical neglect by the family. Because of her poor eating habits, I cannot get her to stop eating/binging then denying/lying that she ate anything. Prior to living with me, she had been hospitalized several times in diabetic ketoacidosis (DKA). I am at a complete loss on what to do to help her and, quite frankly, it scares me. She has never been denied food and was allowed to eat anything and as much of it as she wanted. Any suggestions on what to do would be helpful. Her current doctor does not seem that concerned since I am always there to bring her levels down, but I feel that she has to get the eating under control

This sounds like something that we have called diabulimia. This is a type of eating disorder, in those with diabetes, that is quite similar to bulimia and a version of anorexia nervosa. Almost always, there are severe psychologic issues and, in my experience, most of the time sexual or physical trauma, but certainly severe psychosocial distress. So, the issue is first to recognize that this is occurring and to provide as strict supervision as is possible at home and at school where food and snacks are concerned. Omitted insulin and falsified blood glucose monitoring (either not done or fabricated results) are part of this complex syndrome. Also, psychological assistance including something called eye movement desensitization and reprocessing (EMDR) is often a key to addressing these issues and that means getting a therapist who understands the PTSD nature of such underlying issues and can bring these to the surface and provide some counseling and assistance in therapy. This is all the more complicated because the diabetes lays on top of the PTSD areas and there is enormous overlap. The risks of DKA, if not properly supervised by adults, is incredibly high because of omitted insulin. Furthermore, another aspect of care involves adults actually giving the insulin instead of just asking if it is done. You should address these concerns with your diabetes team and also with your psychological team perchance with a joint meeting with all of you together.

SB