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December 22, 2003

Behavior

Question from Charlotte, North Carolina, USA:

My 14-year-old son (dx at age 13) does not check his blood sugar regularly. He has had no problems. He can count carbs in his head. He remembers to bolus, I think. On his last doctor visit everything was fine. Everything and everyone says he should check his blood sugar 4 plus times a day. I'm lucky if he checks his blood sugar once a week. He says he knows when he is low or high. The doctor said to take him to a counselor. Been there done that. Should I be worried? What can I do?

Answer:

The most important thing a person living with diabetes can do to improve their physical health is to check blood sugars frequently. Checking once per week is dangerous. It is actually life-threatening if you are using an insulin pump. If he will not check blood sugars, he can not safely be using an insulin pump. He needs to return to shots.

How is it that your son still has the responsibility for checking his blood sugars and blousing his insulin if he has clearly shown he is not able to meet this responsibility right now? He might be able to carb-count, but that does not mean he can manage the overwhelmingly difficult demands of a daily diabetes regimen. Think about it this way: even if he knew how to start the car and manage the gas and brake pedals, you would not allow him to assume responsibility at 14 for driving. Similarly, he can not assume responsibility for his diabetes care.

There are many reasons why a 14-year-old can not manage the daily demands of a diabetes regimen. He may feel burned-out by the burden. He may hate the intrusiveness of the boluses and blood sugar checks. He may be feeling depressed. He may not wish to allow any of his friends to know he has diabetes. Whatever the reasons for his inability to assume responsibility for his diabetes care, these need to be discussed in a warm and understanding environment. Perhaps his diabetes team can recommend some strategies for how to approach this with your son. Although you say you’ve tried counseling, it may be that you either did not meet with someone your son was able to feel comfortable with and/or you did not meet with someone who had expertise in working with people who live with a chronic illness.

Right now, the most important thing you can do for your son is to assume all responsibility for his blood sugar checks and his insulin administration. When he feels ready to try his hand at taking some of this responsibility back, he will need to do so slowly and with very, very close monitoring and supervision. His health is at stake.

JWB