October 16, 2003
Behavior
Question from Gaithersburg, Maryland, USA:
My 15 year old so, diagnosed with type 1 diabetes approximately three and a half years ago, is currently on basal/bolus therapy which is very successful, when he is diligent about covering his snacks/meals with a bolus. However, he has become far too lax about doing this, assuring me that he will “correct later, ” only to forget and then end up with extremely high glucose levels. He has actually become ill on two occasions within the last six months, with vomiting, stomach pains and small to moderate ketones. While I was able to pull him out of these episodes with Humalog and fluids, I worry about the long-term effects they will have.
His last hemoglobin A1c was 11%, and his endocrinologist, while concerned, seems to believe that this is an adolescent problem he will grow out of and that it is not abnormal, particularly with teenaged boys. So, she tells my son to bolus for his snacks/meals more thoroughly, he tells her he will, and then proceeds with his lax approach.
As his mother, I am obviously frustrated and very scared. He will not allow me to test him or to give him his shots (except for Lantus) and refuses to go on the pump, so we are at loggerheads over this. What can I do to get him to follow his prescribed therapy and regimen and get tight(er) control?
Answer:
If, indeed, your son is lax about giving himself bolus coverage he would not be a good insulin pump candidate. Since he doesn’t want a pump, that seems okay. However, he is pushing limits by avoiding his bolus shots.
At his age, your son feels a bit immortal and thinks that we adults overreact. However, since I watched a 15 year old die from such behavior, I take it seriously and so should you. If he is not going to comply then you must step in and risk being “the bad guy”. You must tell him that if he won’t give his shots, you will. Even if that means coming by his school to do it. No bargaining on this! As a motivator, I recommend no drivers license or driving at all unless he controls his diabetes. This usually gets compliance for teen boys. If all else fails, grab a good therapist familiar with diabetes and the psychosocial issues faced by teens and begin counseling.
CMB
