My daughter is 13 years old and has been a diabetic since age seven. She has learned to manipulate her insulin so that she loses weight, if she thinks she needs to. She has been in DKA about four to six times since she was diagnosed, and the doctor told her if it happened again, she would die. Do you have any advice on how to get her to be more compliant? Would a pump help? She knows the effects can be fatal. She also knows that she can lose limbs over this.

Your daughter’s behavior is life-threatening, just as her physician told you. This is not a problem that an insulin pump would help. It is very likely, based on what you’ve said, that your daughter has a very serious eating disorder, and she is using the insulin as her primary means of weight control. This is not an uncommon event for teenagers with diabetes. However, the consequences can be fatal. Therefore, you will need to take over all responsibility for her diabetes care while she gets the psychiatric help that she needs to treat her eating disorder. Please be sure that you are the one who checks her blood sugars and administers her insulin (being hospitalized in DKA so many times proves that she is currently incapable of being responsible for her own health care). Also, be sure that she gets the psychiatric treatment that she needs to save her health and perhaps her life. Do not hesitate to get her this help if she protests it – her behavior is letting you know that she is not showing good judgment right now, and that she needs someone else to take over and make the decisions necessary to help her.

JWB