I am seeking advice regarding my three-year-old son with type 1 diabetes. Diagnosed seven months ago, he is still resisting getting insulin injections. We were hoping he would adjust and accept getting his injections twice a day. He is resisting and “stalling” or refusing to eat because he does not want insulin. We have tried insulin before food and insulin after he eats and the result is the same; he either physically and/or emotionally resists getting his insulin injections. On many occasions he has said, “I want the garbage man to take the insulin away!” Please let me know if you have any suggestions or strategies that may help my son accept the fact that he has to have insulin.

Resisting insulin injections is fairly common for preschoolers. However, it is non-negotiable. So, the challenge is how to make getting the injections to occur in as little time as possible. It is important to complete the injections as quickly as possible for two equally important reasons. First, we want the maximum amount of a child’s time to be focused on being a child (not someone with diabetes) and second, we want to be sure that children are not (by accident) learning that they can get a parent’s undivided attention in negotiating and pleading by refusing to get the shots. That said, how does a parent get these tasks done quickly? There are a few strategies, including setting a timer and having the child “beat the clock” to earn stickers/points, etc. and then getting tons of praise for beating the clock. Another is to have a picture of a person (like a gingerbread man outline) and then have the child put an “X” on either an arm, leg, abdomen or bottom to indicate where he wants the injection. Then, the child needs to put an “x” on the next spot, until there’s an “x” on each spot that’s an option for the injections to ensure rotation of the sites, and give the child a sense of control over the injections. Finally, some parents find that one adult needs to hold the child while another adult gives the injection. If this occurs, it’s vital that there is no discussion or negotiation or pleading during this time – that the injection time is done quickly and quietly so that the child can resume normal activities as soon as possible. This can give the message that shots are “business,” not be negotiated, but that this business needs to be completed as quickly as possible.

JWB