My 13-year-old son has had type 1 diabetes since the age of four. He is currently going through puberty. His diabetes is very hard to control and he keeps running very high, over 300 mg/dl [16.7 mmol/L], and has ketones almost daily. He’s been in the hospital twice in three weeks. He gets dehydrated very quickly. When he is in the hospital and on an I.V., his numbers seem to be very good and normal but as soon as he’s released, in a few days, he starts having the same problem. It seems like the insulin is not working when he eats. We do everything that the doctor tells us and the endocrinologist is constantly adjusting his medication. We count carbohydrates, measure out food, give insulin 15 minutes before meals, and test two hours after meals. My son does not eat any concentrated sugars. The endocrinologist finally said today that she had another patient in the past with the same problem and she had to have a home health aide come once a week to the home to get fluids through I.V. Is this something common? It is really getting frustrating for my son and me. He’s missing a lot of school. If you know of any other solutions please let us know. He is also scheduled this week to have an introduction to the pump at a local hospital because he will be going on one very soon.

The scenario you describe, with an adolescent with diabetes getting out of glycemic control is, unfortunately, way too common. But, experience tells us that it is usually not a manifestation of the diabetes itself; instead, it is usually a reflection of puberty and the emotional changes that accompany that.

You say that you are doing all the things the doctors have requested. Are you simply telling your child what he should do or are YOU actually performing the glucose readings, the carbohydrate counting with the insulin injections, etc? Teens try in so many ways to display their independence. They have very little in their lives to really “be the boss of.” Your son has had diabetes since an early age and has always been required to be dependent on other’s for advice. Now, perhaps, he is showing some independence – and bad judgment – by making bad activity or food decisions and perhaps even missing or mis-dosing his insulin. If he does well in the structured hospital setting, but does poorly at home, that almost clinches the diagnosis for some.

Not only may a home health aide be helpful, but I would strongly urge psychological counseling. Your diabetes doctor can probably guide you to a professional with experience with children with chronic diseases.

Finally, I will add that, in my experience, children in this situation, who are failing to succeed with insulin by multiple daily injections, almost always fail on insulin pumps. Before you spend thousands on an insulin pump, I think you should get his glycemic control much, much better. Maybe you can use getting a pump as an incentive for his getting in better control.

DS