My eight year old son was diagnosed with type 1 diabetes about three months ago, and now he has started not eating and will not eat at times. I find it hard to get him to eat his bedtime snack in order to take his bedtime insulin. Is this normal?

A change in eating patterns is not uncommon after a child has been diagnosed with type�1 diabetes. Often, in the weeks before the diagnosis is made, the child has lost weight — sometimes several pounds! Then with treatment, there often is a voracious appetite as the child tends to “catch back up” to the weight that he is supposed to be. Insulin doses tend to need to be relatively higher during this time. However, as the child begins to enter the honeymoon, the weight gain tends to level off and the doses of insulin often are able to be decreased somewhat.

Perhaps all that needs to be done now is to have your son’s meal plan re-assessed by his dietitian. He may no longer need as much food for the “catch-up”, and he simply is truly “fuller”, but a bedtime snack is usually very important, so please don’t stop it without input from his dietitian or physician. It might just need to be modified to include less carbs or more protein, or his diabetes team may want to change the timing of his bedtime insulin dose to be closer to dinner. There are lots of options: talk with your son’s team.

DS

[Editor’s comment: While the most likely thing that is going on is what Dr. Schwartz has already stated, there is another possibility to explore. Sometimes children this age have difficulty adjusting to diabetes and its treatment plan. Children this age can also sometimes blame parents for causing the diabetes, and this type of behavior is a way of getting back at them. In other words, there are a number of thoughts and feelings about getting diabetes that children your son’s age often have difficulty expressing. Once again, the answer is to visit with his diabetes team to sort out all the issues. It is important to involve even an eight year old in treatment planning of any sort.

SS]