November 10, 1999
Question from Canada:
My daughter is 14 and has had type 1 diabetes for 6 years now. She has a diabetic team that she sees every three months. The last two appointments she has gone to reluctantly and ends up crying when meeting with the doctor. She feels she can do “nothing right” since he is always fine tuning things for her. I’ve explained that this is his job.
She has now begun to test only on occasion and has missed giving herself a needle in the morning after breakfast. Her three month blood scores are 117. I am concerned that she may be experiencing depression centered around the diabetes issues. The only sign is really the crying when she has to see the specialist and on occasion when I try to talk about her lack of control (she eats all the wrong things and too much). Her doctor is aware and feels that we just keep adjusting as usual. If her ketones become too high we will have to hospitalize her and that could be a wake up call to her. Should I be concerned about the ‘depression’? Should I take another tact than the one suggested? How can I help her get back in control? (She won’t do camps or become part of a support group.)
Your daughter may be experiencing “diabetes burn-out”, where she is tired of the demanding daily regimen required for diabetes care. It may be very helpful to offer your daughter a break from caring for her own diabetes tasks, and for you to take full responsibility for her regimen. Sometimes teens need this break for a day or two, sometimes for a few weeks. Often, with diabetes burn-out, people perceive other’s (parents, physicians, etc.) attempts at improving blood sugar control as criticism. Ask your daughter if that may be why she is so distressed when she comes home from the doctors. Also, ask your diabetes team if there is a mental health practitioner that works with the team (psychologist, social worker, etc.). If your daughter is not testing blood sugars regularly and if she is purposefully making poor food choices, she is letting you know that she is overwhelmed by her diabetes. She needs to talk with a professional about ways to feel less burned-out.