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February 13, 2000

Social Issues: Community Resources

Question from New York, USA:

I have a 15 year old daughter, who has been a Type 1 diabetic since age 6. She is not dealing with her diabetes -- her blood sugars are generally over 250 to 350. We have tried therapy; she sees both a psychologist and psychiatrist; family counseling with a diabetes educator and the situation has not improved. I was told that there are treatment centers for adolescents who are out of control. They are residential, and give both medical and psychological support. We would like information about any programs that would help our daughter. She attends private school, and the faculty feels that getting her diabetes under control is most important. We have tried, explaining that the high sugars can affect her concentration, and therefore, her ability to study. We live in the metropolitan New York area. We would consider anyplace that has a program geared for adolescents, even if it's not in our general area. I was told about Cumberland Hospital in Virginia, but I have not been able to get information on the program. I have been involved with the JDF for the past 10 years. I have chaired the charity gala's, auction committee, and am on the Board. I hope that you can help me find a way to help my daughter learn to live with her disease. She is about 60 pounds overweight.

Answer:

It sounds like your daughter and your family are both having a hard time and also doing the right things to deal with the problem. Usually when blood sugars are constantly high and the adolescent has gained a lot of weight, too much emphasis has been placed on getting the high blood sugars down with extra insulin. This extra insulin will then increase the child’s appetite even more and a vicious cycle will start with giving extra insulin to get the blood sugar down — eating more — gaining weight, and becoming relatively resistant to insulin due to the weight. Usually what needs to be done is to slowly lower the insulin dose and try to match the food and exercise to a dose that slowly has her lose weight (say 1-2 pounds a month). If her blood sugars are high and she is not spilling ketones and not sick, you may be better off not covering with extra insulin but encouraging exercise if possible, or cutting the next meal or snack by 1 carb (if she is willing). Of course, this is easier said than done and if there are other emotional issues (either unrelated to diabetes or secondary to the stress of diabetes), the emotional issues may interfere with accomplishing these goals.

In my experience, sending a teenager to a residential facility away from home is not usually a good long term answer as the teenager may do well in the sheltered setting of the residential facility, but doesn’t learn to cope with the real life stresses of home.

It is important for you to work closely with a physician, psychiatrist or psychologist, dietitian, and if possible even an exercise physiologist to help guide your daughter and your family.

TGL