My daughter has had type 1 diabetes since she was nine, and her blood count is always high. She does her insulin twice a day, and we try to keep to a set time, but sometimes we forget so now I set my alarm clock to the set time. I check her urine every day and night. Sometimes, she admits that she had sweets, but sometime she swears that she never had any.

The problem got so bad that now she is on a child protection order for neglect. The worst thing is that they put her on this order, but nothing has changed, and she still has high blood sugars. Please give us some advice as to how to get her blood count low.

I’m afraid that your story is not at all unusual, but the answer is not straightforward. You don’t give your daughter’s age but I guess that she is approaching or going through puberty. This alone can cause problems with diabetes because of the hormones involved, and the emotional and psychological aspects make things more difficult.

Almost all children with diabetes will eat sweets in quantities which at times are unwise, but it is the frequency of this behaviour that is important. If you look at it from your daughter’s perspective, she is being asked to make herself different from her peer group — something that teenagers find almost impossible. However, there is no doubt that consistent neglect of her diabetes will bring trouble later and possibly also sooner with a likelihood of acute and severe illness if she catches ‘flu’ or a throat infection.

I don’t know how poor your daughter’s control is, but child protection procedures are usually only invoked when things are at a dangerous level. I suggest that you and your daughter should ask her diabetes team for support which may include involving a psychologist. All the factors have to be considered including her insulin regimen which may not be the most appropriate. Diet is usually a major issue and the skills and persuasion of a paediatric dietitian should be used. Sometimes the team will be able to arrange to see young people alone (e.g., after school), to get them to take more responsibility for their care. Finally, it is a known fact that many teenagers omit insulin — often as much as 50% of the time. Armed with this knowledge, you should be in a better position to avoid an acute crisis.

KJR

[Editor’s comment: I totally agree with Dr Robertson and have a few additional thoughts:

If your daughter is currently giving her own injections, take over for while and see what happens.
You state that you are currently using urine testing to monitor. I urge you to get a blood glucose meter and check levels frequently throughout the day to see what’s going on.
As Dr Robertson has suggested, set an appointment with a pediatric diabetes team. Let them know your concerns and help you and your daughter get the tools you need to improve control.
SS]