January 7, 2011
Behavior, Hyperglycemia and DKA
Question from Sutton, Alaska, USA:
My son has been a type 1 diabetic for a little over 10 years. His behavior is getting out of control. In the beginning, I dealt with sneaking foods from school, church, friends, etc. Now we are way beyond that. He attended a great diabetic camp this last summer where I really thought he learned so much about his condition and he did, but he also learned how to manipulate things more. He and I moved home with family because, as a single mother, it is more than hard to raise a child alone but also throw in a diabetic child with other serious medical conditions. He has high blood pressure, epilepsy and a rare bleeding disorder. So, basically, he has been doing everything he can to get out of going to school. He knows that if his blood sugar is elevated and he has ketones he has to stay home and be monitored very closely. This year alone he has already had to be admitted due to DKA three times (2010 year). His team at Children’s has been wonderful. With him going on 14 years of age, I have been told that all adults have to oversee his care 100% again because he can’t be trusted. Examples: He tests and tells me his blood sugar is 119 mg/dl [6.6 mmol/L] when it really is 492 mg/dl [27.3 mmol/L]. He tells me he has no ketones and his ketones are large. He hates being a diabetic (in his words) and he wants to be like all the other kids (normal). I have told him he is like all the other kids, just that he has to take shots and each and every child has something, whether it be allergies, asthma, etc. This is draining me emotionally because, on one hand, I am told he needs to be given some responsibility for his diabetes care, but then you give an inch and he takes a mile. Now here we are back at square one with mom, grandma, aunts, uncles, school nurse, etc. having to do everything because he can’t be trusted. Do I seek psychological help? I am at my wits’ end and honestly I feel like this is out of my hands. He has been sick so many times now and he knows what he is doing to himself and it doesn’t stop him. He wants me to homeschool him again, but I just can’t. I can’t do it because I am not capable of teaching him the things he needs to know even with the curriculum. He needs the routine, the schedule, and he needs to be around other children. What is your advice? Where do I, or we as a family, go from here? I’m just tired and I don’t know what to do any more.
Answer:
You and your son have been through so much. Raising a child is such hard work. Raising a child as a single parent is harder. Raising a child as a single parent when that child has at least three chronic illnesses: wow! Please do seek the support of a psychologist. You probably already know this, but there is no easy solution to the challenges that you all face. The work will be hard but rewarding and will require a commitment from you, your son, and other family members as well. Contact your son�s diabetes team as well as his pediatrician to get referral recommendations for good psychologists who work with children and teens that have chronic illnesses. In the meantime, I agree with the advice you’ve been given: all diabetes care tasks should be done by an adult. It is currently too dangerous for him to be in charge of his own care, as evidenced by his DKA admissions. Part of the goals of the work you will do with the psychologist will be to help him become more independent in his own care over time, but he is clearly not capable of doing that now.
JWB
