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July 5, 1999


Question from New Jersey, USA:

I am a school nurse, and I have a 15 year old severely noncompliant student who manipulates his diabetes. He is completely out of control at home and in school. We are concerned for his safety and well being. The family and school would like to find a residential setting /school in which to place this student. Can you make a few recommendations?


As far as I know, there are no boarding schools for children with diabetes.

As a professional counselor, I do not look at “diabetes out of control” in a child as a reason to send the child away. It does trigger my curiosity as to exactly what is going on in the child’s larger life: at home, in the community, among his peers, etc.

In my own experience with patients, out of control blood sugars often signal a plea for someone to step in and listen. This is true for adults as well as children. You must forgive me but I absolutely cringe at the word non-compliant. It suggests a level of willful neglect that I have trouble wrapping my mind around. More times than not, there is an emotional core for the behavior and someone has to be brave enough to explore that patiently with the person. It isn’t an easy fix and it is hard to do, but it is worth it.

I recall meeting a patient who threw a Kleenex box at me when we met. She was so angry and her blood sugars were way out of control. But, I simply kept coming back. She yelled, “I hope this place burns down with you in it!” But I kept coming back.

Eventually, this “non-compliant and non-adherent” young lady disclosed her rage about having diabetes, her fears of complications, and her low self esteem. I followed her for 8 years into her young adulthood and her marriage and the birth of her first child. We became friends and it only happened because I didn’t blow her off and kept wanting to know why she was reckless with her diabetes.

I know this is a long reply and I know you may not hear what you hoped for, but it is from my heart and from my experience. Going someplace else is not the answer: the diabetes goes right along with the person who has it.

A very respected endocrinologist I know said it best; he said, “Diabetes has as much to do with the heart and the soul as the blood sugar levels.” He was right.