The grandson of my deceased best friend has type 1 diabetes. His parents have him on an insulin pump. They care for his health, but can be “lazy” when it comes to some things. They think the pump can be regulated to allow his life (and eating) to be like everyone else’s. His sister recently celebrated a birthday at a national doughnut chain. He was allowed to attend and to eat the same as everyone else did. They figure they will control his blood sugars with the pump later. He eats doughnuts on a regular basis. The only concession they have made to his eating is that he drinks diet soda instead of regular. I keep thinking this has to be hard on his body to get these massive doses of sugar. Please advise me so that I might pass this on to them. The mother claims to have attended classes to learn how to use the pump, but I am thinking that she needs to take some basic diabetes classes. They live in another city but I am sure there is something available.

The situations you described can be concerning. While it is important for children with diabetes to experience as much of childhood as possible, there are certain modifications which may need to be made. An occasional party is acceptable as long as the basics of diabetes management are considered (insulin, fluids, activity). One way to assess whether a lifestyle is affecting a child’s health is to determine if certain measures are near the targets for that child: A1c, blood glucose variations, blood lipids, growth (including height and weight, BMI), emotional development, family functioning. If these are within target, the child and his family have landed on a lifestyle which is working.

Thanks for your interest and concern for this family.

BS
Additional comments from Dr. Jill Weissberg-Benchell:
It is very kind of you to worry about this child and his health. Families who use an insulin pump receive fairly extensive training and education about how to use this device. One of the goals of an insulin pump is to allow the person with diabetes the flexibility in quantity and content of food as well as timing of food. It is quite likely that the family covered the high carbohydrate content of the party food with the appropriate amount of insulin, just as a person without diabetes does so when their pancreas covers the food they eat with insulin. As long as this child is being seen by a diabetes team regularly, and as long as this child�s A1c is in the developmentally appropriate target range, it is unlikely that you need to worry. Diabetes technology today has certainly improved the lives of many people living with this difficult disease.

JWB