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February 5, 2001

Behavior

Question from Wisconsin, USA:

My 12 year old daughter has had diabetes for five years. Lately, she does not want to do her insulin or check her blood sugar. Every day it is a battle. She has mood swings which I believe are do to the blood sugars going up and down so much. I cannot get her Hemoglobin A1c below 12%. Is there someone out there she can talk to or help the whole family out?

Answer:

There are several possibilities as to why your daughter is having difficulty right now:

Your daughter is at an age when she is already in or approaching puberty. During this developmental stage, hormonal surges wreak havoc with blood glucose control and mood swings.
Your daughter may be tired of self-management, and may need a “vacation”. This is not unusual for children in this age group. She may not be checking blood sugars because she knows they’re high and does not want to blamed for “bad” control. See if see she is willing to let you take over her injections and blood sugar checks for a while. That might make a difference in control.
It is also possible that your daughter’s current treatment plan does not fit teenage lifestyle. Children this age want to be more spontaneous, not having to stick to a rigid schedule and meal plan. If she is currently on a structured regimen which pretty much dictates when she gets up in the morning, eats her meals, etc., she might do better on a more flexible program utilizing multiple daily injections or an insulin pump. Such a treatment plan would her to be more like her peers.

These are the most common reasons for the problem you describe. It may be some or none of them. It is time to sit with your daughter and her diabetes team (including a mental health professional) to sort some of these things out. It is extremely important to not place blame on her for the inadequate control she currently has. Rather, this needs to be approached from a problem-solving viewpoint so that a new treatment plan can be devised that will not only improve control, but meet your daughter’s needs as well.

SS