My 13 year old son has had diabetes for three years. He has been treating with pump for over a year. This year he has been irresponsible with his diabetes as well as school work and family responsibilities. He has discovered that high blood sugar will cause his school nurse to call his parents and demand he be picked up immediately. His nurse has attempted to have him bolus and retest and every time it has been ineffective. When he returns home he improves control of diabetes and happily continues his day. We all feel manipulated by him. I have had type 1 diabetes for over 20 years and am familiar with care and treatment and have been in excellent control. However, I have been unable to make my son comply with expectations. I feel his future health is in jeopardy and believe he controls this family with the continued drama. Please help.

Young teenagers often have a very difficult time coping with the incredible demands of daily diabetes care when they also have to cope with the demands of school, friends, family and the physical changes their body is going through at this time of development. It sounds like your son is struggling with these issues as well. His behaviors around his diabetes care state that he is currently unable to balance all of the demands in his life on his own. Although it would be easier if he came directly to you to ask for help, it is likely that his actions are asking for that help.

I would recommend that you sit down with him at a time when there are no other demands and ask him how you might be able to help him. Perhaps you should be responsible for checking his basal rate every morning before he goes to school and perhaps you can also give him his bolus from breakfast so that he gets to school with the appropriate insulin on-board.

Is it possible that there’s something going on in school (either academically or involving his classmates) that he wants to avoid?

You can also teach his nurse how to give him an extra bolus so that if he arrives at the nurses’ office with a high blood sugar number, she can help him bring it down so he can stay in school.

Finally, I strongly recommend that you contact your diabetes team to see if they have a psychologist or other mental health professional that they refer to who has expertise in working with teenagers with diabetes. That individual may have many very helpful ideas on how to decrease the burden of diabetes for your son and for your family.

JWB