My 16-year-old son says that it is not fair to punish him for being rude when his blood sugar is high. Is there a number (300s mg/dl [16.7 to 22.1 mmol/L]? 400s mg/dl [22.2 to 26.3 mmol/L]?) beyond which he truly cannot control his anger? I know that ultimately he is responsible because his blood sugar gets that high because he does not test, bolus adequately, ensure there is insulin in his pump before he leaves for school, etc.. I understand that he feels lousy and is irritable when his blood sugar is high, but it seems to me that it is reasonable to expect him not to curse at people or throw things, etc. even then.

When blood sugars are high, you feel grumpy and irritable and unwell. That is not an excuse for misbehavior.

It may be helpful to take a different tact and prevent the high numbers in the first place. Perhaps you can bring your son’s meter to him each morning, already set-up, and then, once he checks his blood sugars, you can thank him for checking. Then, once you see the number, you can ask him if the number requires an action (e.g., insulin or food). Doing the same exact thing at dinnertime and bedtime will insure at least three blood sugar checks per day and increase the likelihood of appropriate insulin dosing. In addition, it is important that you check his pump every morning to insure there’s insulin, as he is currently not capable of accepting that responsibility and you cannot send him off to school without insulin. Finally, it may help him if you send him a text message at lunch that says, “bolus,” on a daily basis.

JWB