October 28, 2005
Behavior, Mental Health
Question from Pittsfield, Massachusetts, USA:
My son has had diabetes since he was five. He has had a lot of anger over having diabetes, which has gotten worse over time. I have tried to talk to him about it, as have his doctors. I have taken him to therapy, etc., to no avail. Now, he is really rebelling. He isn’t taking his shots like he is supposed to, skipping them, lying about doing them, not doing the proper amounts, fighting with me about letting me see how much he is doing, etc. He isn’t writing down his blood sugars, either. His appetite is very low. He doesn’t seem to want to eat anything. The few things he does want to eat aren’t good for him. His endocrinologist wanted me to take him to therapy. I did, but he walked out.
The therapist was very concerned and said he wanted him signed into a mental facility against his will. I really don’t want to go this route. It seems very extreme. This place is not close to me. I’m afraid that once he goes in, I’ll have a hard time getting him out, etc. I really don’t want to do this. Yet, his health is at risk. He has gone into diabetic shock several times. The last one was very hard. He didn’t seem to come out of it for over a half hour and had to be given Valium to calm down to be transported to the Emergency Room. I feel like there was some brain damage. I don’t know if that is where some of this newer anger is coming from.
I’m very worried. I don’t know where else to turn. He won’t go to any support groups. I did send him to a diabetic camp near Boston this summer for two weeks. I thought it would help, but it didn’t seem to get through to him. I’d appreciate any help you could give me.
Answer:
Your son is engaging in extremely dangerous behavior by not taking his insulin. This can be life-threatening and you have even seen such danger when he has been in shock. Therefore, his decisions and judgment are so poor that he can no longer have the ability to make his own decisions. You must take over in order to keep him safe. Once he is appropriately treated (whether it is for depression, anger, rebellion, or something else) and he is able to make safe decisions, then he can resume responsibility for his own self-care. He clearly is not able to do that right now.
Please contact a mental health professional with expertise in teens with chronic illnesses. You may wish to contact your diabetes team, your pediatrician, or even the Joslin Diabetes Center in Boston for recommendations or referrals. It is possible that your son will require inpatient hospitalization, but, without a comprehensive evaluation, that is hard to predict. The whole goal is to keep him safe, even that decision makes him angry at first.
In the meantime, do not allow your son to have any access to or any responsibility for his diabetes care. You must check his blood sugars and give him his insulin. That’s the only way to know that he is actually safe and receiving his necessary care. This is going to be extremely difficult, but it is your son’s life that you are saving.
JTL
[Editor’s comment: Cumberland Hospital in New Kent, Virginia is the only facility we know of for treating teens with diabetes and behavioral problems.
BH]
