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November 11, 2007

Behavior

Question from Chicago, Illinois:

I am a dietitian and have an 11-year-old son on an insulin pump. For the past three months, he has been very resistant to check blood sugars and put carbohydrates in his pump when he eats. We have NEVER restricted anything he eats, but when he asks if he can have anything, I always ask him to check his blood sugar. Usually, his responses have been, "Then I don't want the snack." It has gotten so bad that now he only eats at meals. His quantities have decreased and, for the second time at his bimonthly visit, he has lost weight and has gained no increase in height. His nurse feels that he may have some sort of eating disorder relating to not accepting his diabetes yet (he's had it since age three). We have an appointment for him to see a psychologist. Have any of you ever experienced this? Do you have any other suggestions? He hasn't been making himself throw up or anything like that, but has limited his own intake.

Answer:

It’s wonderful that you have already made an appointment for your son to see a psychologist. Regardless of what the underlying reason is for not checking blood sugars and not taking insulin when he eats (or not eating to avoid insulin), he is struggling with the emotional burden of the daily demands of diabetes. Developing a relationship with a counselor who understands diabetes will be very helpful.

Sometimes, children burn-out from the demands of diabetes and just get plain old sick and tired of doing the things that no one else their age needs to do. Sometimes, they have moments when they do everything “right” and have unexplainable blood sugar numbers. Sometimes they do the “wrong” things and their numbers are fine. This can also lead to a sense of helplessness. These would be issues to explore with your son.

Often, children respond very well to having their parents take over the diabetes regimen for a few weeks. Parents check blood sugars. Parents change infusion sites. Parents set basal rates. Parents administer insulin at meals and snacks. Sometimes just being relieved of the burden for a few weeks helps children renew their energy to tackle the diabetes regimen again.

JWB