I am looking for a place for my son at age 16 for him to get his diabetes under control; a place where there are people all the time who specialize in diabetes, not a regular hospital that the nurses aren’t always working with these children. Is there anyplace in the U.S. that this happens? I feel that this is what he needs. Not a brief stay to tell me that he only likes to eat, and his blood levels are good there and not enough education. His last A1C was 12.3!

I’m afraid that the type of hospital stay you are seeking no longer exists in the United States because of the nonsense of managed care. However, with a hemoglobin A1c of 12% this likely represents a major crisis medically and emotionally. The only time we see such enormously out of control values is in people not taking their insulin or massively overeating for long periods of time. This almost always represents very severe psychosocial problems and the best advice that I could offer is to work closely with your diabetes team members to identify these problems and seek specific remedies.

We have had some success in older teenagers with such problems when parents actually assume all of the care responsibilities: adults draw up and actually administer all doses of insulin, obtain all blood glucose readings 3-5 times each day and supervise all food intake. If this absolutely cannot be done then hospitalization may be required in an emergency situation involving psychiatrists, psychologists as well as all members of the diabetes team and the family involved. I would urge you to discuss very specific treatment options with the diabetes team working with you and your son.

SB