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December 20, 2006

Behavior, School and Daycare

Question from Illinois, USA:

My son is currently on Lantus and Humalog. For the last six months, he has been in denial about his diabetes. His last A1c was 13.5. His schoolwork is also suffering, so I called the school for some help. He has been talking to the school counselor and things have been steadily improving until I received a call from DCFS stating "medical neglect." I'm sure it was the counselor who called but can't confirm this. Now, the school is forcing him to eat lunch even though he doesn't want to. He has breakfast at home and then waits to eat again after school. I know he should be eating lunch, but he does not want to take a shot at school. I am trying to get him on the right path. I have read other stories on this web site about teenagers with high A1cs and I am at a loss over what to do with this issue. Can the school or the state force him to eat lunch when he doesn't want to?

Answer:

I am glad that you are asking for help. It sounds like things have gotten out of control. You said that your son’s last A1c was 13.5 and that his schoolwork has been suffering. Both of these issues are concerning. With an A1c of 13.5%, your son is most likely missing insulin and/or is under dosed with insulin. Have you discussed this A1c with his diabetes health care team? Do you know if he is on an adequate dose of insulin? If so, is he in charge of all of his diabetes management tasks? If he is in charge of his shots and blood sugar checks, I would encourage you to try and get back involved with his diabetes management and start giving him all of his shots. Teens can get burned out from having diabetes and they usually benefit from more parental/adult involvement. It is also important that you know what your son’s blood sugar numbers are by either going through his meter or actually checking his blood sugar yourself. Sometimes, teens stop checking their blood sugar and parents just assume that they are still checking and sometimes teens tell their parents that their blood sugar is in range when it isn’t. So, it is important that you know if he is checking blood sugars.

In terms of your son not eating lunch at school – if it is because he doesn’t want to get another shot, have you discussed this with his diabetes health care team? Some of our patients who are on Lantus also take some NPH in the morning to cover their school lunch so that they do not need a shot when they eat lunch in school. Maybe this would be an option for your son.

I don’t know the legality of whether a school can force your child to eat, but I am curious if your child has a diabetes medical management plan or 504 plan? A 504 plan is a legal document that the school needs to follow. If your son does not have a 504 plan, I would encourage you to put one in place with the help of your son’s diabetes health care team, to avoid this type of problem.

You also said your son’s schoolwork has suffered. This may be because his blood sugars are so high it is hard for him to concentrate. I also think it is important to have him assessed for depression because one sign of depression in teens is that things start to fall apart with their schoolwork. Also, individuals with diabetes are at a higher risk of being depressed. If your son has found meeting with the school counselor has been helpful, I wonder if he would like to meet with a counselor outside of the school. You could ask your son’s health care team if they know a counselor (psychologist or social worker) that specializes in diabetes.

Finally, you also mentioned that DCFS is now involved. I would encourage you to have the social worker that you are working with talk to your child’s medical team to make sure that he or she has a good understanding about type 1 diabetes in adolescents. I have had to teach most of the department of social services workers that I have been in contact with about diabetes.

DB