My 19 year old younger sister, who has had type 1 diabetes since she was 13, has been hospitalized three times in the past year (all within months apart) for not taking her insulin. It seems to me that she is in denial or is upset about something, but she won’t tell anyone what is going on. She is currently in the ICU, and I am really concerned about her. Is there anything I can do to help her? I have suggested that perhaps she needs to talk to a counselor or psychiatrist, but she doesn’t seem to think so. However, I am scared that if she keeps doing this to herself, she will not make it the next time it happens. I just need some information or suggestions on what I can do to help her understand how important she is.

I can tell how very worried you are about your sister. Generally speaking, multiple hospitalizations for out of control diabetes signal a need for psychological assistance. You are absolutely right to urge her to seek help. Are your parents also sharing your opinion? If the whole family is in agreement, the chances are better that your sister will comply. Does your sister’s diabetes team have a therapist? If not, there certainly are therapists skilled in dealing with chronic disease and the emotional complications that come with diabetes.

Your sister can die the next time she ignores her diabetes. I have seen it happen, and it is heartbreaking. Get your family together and take a stand and then stick to it. Either she voluntarily gets help or you will get it for her. If all else fails, in some states you can petition a magistrate to have her placed in a psychiatric facility for evaluation since she could be considered a “danger to herself”. This is a serious step and a last resort.

CMB

[Editor’s comment: It’s not clear from your letter if your sister’s physicians are aware that she’s omitting insulin. If they don’t know, someone (you or your parents) need to let the doctors know!

WWQ]