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November 29, 2018

Behavior, Hyperglycemia and DKA

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Question from Hurst, Texas, USA:

I am a school nurse and have had a relationship with a diabetic 5th grader since he was in Kindergarten. Mom, Dad and the doctor have all talked with him about this issue, but mom has found evidence in his room that he is still sneaking food and hiding the bags in his room. Most recently, mom found a 2 pound bag of Skittles under his bed, half empty. She had to give him 12 units of insulin that night to get his blood sugar back down to normal and he still lied and said he only “ate a few.” Do you have any words of wisdom or websites for me to help educate him without scaring him to death about blindness or other complications and damage he could be doing to his body?

I have already suggested to mom that she may need to lock up the food. However, this does not help all the time since he goes to other peoples’ houses on occasion, etc. I hope to make a lasting impression on him that he is damaging his body and to teach him to love his body. Any suggestions you have would be most helpful.

Answer:

First, I’d like to say how lucky this young person is to have you in his life. Children thrive when adults really care about them.

There are a few things I’d encourage you to consider. First, fifth graders are typically going through huge growth spurts and are constantly hungry. So, I’d try to explore this with the diabetes team (nurse, doctor, dietitian) to figure out a way to provide either more quantity of food at each meal and snack or more frequent meals (of course, covering each meal with insulin). When a child is no longer hungry, they are less likely to eat food outside of an adult’s vision. Locking up food is a punitive measure and there’s just no reason for it, as children with diabetes can eat as much as anyone else and also can eat the same kinds of foods as anyone else including sweets. The key is to cover what’s consumed with insulin. So, again, working closely with the diabetes team to figure out how to increase intake with foods that keep the child full and well-nourished will be important. Second, using threats about future harm never works to change behavior, frightens and angers the child, and ruins whatever trusting relationship you had. If these strategies are not successful, then there are likely more issues going on in the family than you are aware of, and it would be quite helpful to enlist the support of a psychologist or other mental health professional with expertise in diabetes.

JWB