I am working in a child care center. Five months ago, we got a 14 year old boy who has had diabetes for two years. His father is an alcoholic, and his mother has severe depressive symptoms. He eats all he wants, and he is often with his friends very late in the evenings and does not eat for several hours. He is rejecting the rules and norms in the care centre.

We have disagreements on the child’s case. The psychiatric doctor met with the child several times, and he does not think that the child needs psychiatric care and his problems are more social and somatic ones. Would you kindly tell me if the psychiatrist is correct or he just trying to avoid taking care of the child because of his tight schedule and budget?

There is no way for me to know what the psychiatrist’s reasons are for not providing this young man psychiatric services. In addition, there is no way for me to state what services this young man needs without actually meeting him. However, you are clearly very concerned about him, and it seems that there is quite a lot to worry about. Have you talked to his parents about your concerns? Have you asked them to get involved in family counseling? Have you asked this young man if he is interested in counseling? What does his school think? Are they worried about him too?

The most practical thing you can do for this young man is to coordinate with his diabetes team and his school to be sure he gets a morning insulin shot and a late afternoon/early evening shot. If you can be responsible for administering his insulin twice a day, and testing his blood sugars twice a day, then at least you know his basic diabetes needs will be met.

JWB