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October 21, 2002

Behavior

Question from Denver, Colorado, USA:

I recently took care of my 16 year old niece (height: 5 feet 2 inches weight: 145 pounds), who has type 1 diabetes, for several weeks and was horrified the amounts and types of food she ate. She goes to the hospital a lot with blood sugars over 800 mg/dl [44.4 mmol/L]. Is there anything that could give her information about how important it is to get a grip on her eating behavior? My father passed away at age 50 due to brittle diabetes after losing his eyes and legs. He was a binge eater like my niece and did not take care of himself. I had gestational diabetes four times and have raised my kids in a very low carb lifestyle. We have very little desire for junk foods and all five of us are thin. Her mom (my sister) does not have diabetes yet but weighs over 250 pounds and constantly sneaks high sugar carbs also. My niece kept sneaking off from us to buy "Coke" and "fries", always saying that she was "low", even though we snack constantly on healthy foods. I bought four times the amount of bread we would go through and watched her put jelly on four pieces in a sitting. She sneaked away at malls, walked to 7/11 to buy a doughnut, and we were all shocked that she would eat and sneak that kind of food. We drink unsweetened juice or team but I caught her sneaking sugar in the juices constantly, while downing a pitcher in half a day. She claims that I caught her sneak and binge so much because we never went to McDonald's or had treats in the house. She also says that her doctors say not to keep her from those things or she'll feel deprived and need more. (Her doctors tell her juice is healthy, but she drinks gallons and no water). Our family thinks very little about food. It's never on our minds. We knew my niece would need more carbs, but I feel she's killing herself fast. She has very low low self esteem about her weight. She wouldn't do any physical activities because she always said she was too" low". So she watched TV or surfs the Internet 24 hours a day. My daughters saw her put insulin on her strips to alter her sugar test and justify stopping for pie or cake! Is there any literature I can read and pass on? She's very receptive to my opinions, but she's been stuffing on Cokes and Oreos since her mom gave her that stuff as a toddler.

Answer:

You have a difficult task since you are not this teen’s mom. However, you are correct to be concerned. It is likely that her diabetes is totally out of control since her eating is totally out of control. Perhaps she has bulimia nervosa, a type of eating disorder which involves overeating. Perhaps she has some other psychological problem.

If she is often in the hospital without of control diabetes, it is also likely that she omits taking her insulin on occasion and runs into DKA [diabetic ketoacidosis]. We call this diabulimia, another form of eating disorder that involves omitted insulin plus binge eating.

Short terms risks from all of this dangerous behavior is out of control glucose levels, constant thirst, hunger, feeling poorly, lack of energy etc. Long term risks are all those associated with very high blood glucose: retinopathy, nephropathy, neuropathy, etc.

Talking to your niece in a non-judgmental fashion and letting her know that you are worried about what all this means would be helpful. Talking to your niece’s mom would also be helpful. Whether or not your niece or your niece’s mom can listen to your advice is difficult to know. Perhaps you could attend one of your niece’s diabetes clinic visits yourself and discuss this with her physicians.

SB