What do you do with a 15-year-old, stubborn as a mule, son who’s had diabetes since he was one year old, who continually cheats and sneaks snacks and foods even though he knows he can get a shot for it? We’ve talked to his endocrinologist about this several times over the past few years and he still does it.

He’s also very depressed and doesn’t want to go back to his therapist. He says that unless he’s going to make him no be diabetic, there’s no sense in him going. I explain it to him that he can help you deal with living with your diabetes better, but he just doesn’t want to hear it. My son just wants to live his life as a normal kid does, eat anything he wants, whenever he wants. I keep trying to tell him that even if he weren’t diabetic, I wouldn’t let him sit there and eat nine Oreo cookies, but he thinks I’m being restrictive with his diet. He likes to eat 90 grams of carbohydrates right before he goes to bed. I keep telling him that it’s not right to do that, but he doesn’t want to listen to reason! What should I do?

Currently, my son is 112 pounds. He gets 10 units of Humalog and 12 or 13 units of NPH inn the morning. If he needs a shot for lunch, it’s usually one and half or two units. Then, for dinner, he gets four or five units of Humalog, depending on what his blood sugar is, plus 17 units of NPH before bedtime. Previously, he tried pumping, but it didn’t work out.

It sounds like you are so worried about your son. It’s tough to watch our children feel so defeated by diabetes. I would encourage you to go with your son to a diabetes clinic appointment, where you meet with all of the members of the team on that same day. This will be a long day, but it will be worth the time and energy. Getting everyone on the team (nurse educator, dietitian, physician, etc.) to be on the same page about how to help your son cope more effectively with this diabetes will be an important first step.

In addition, if your son is depressed, his depression is preventing him from engaging in more healthy behaviors and preventing him from making more adaptive decisions. Therefore, his depression must be treated. If the current person you are working with is not a good match for your son, please find another person. Ask your diabetes team and your son’s pediatrician for referrals. Also, your local ADA chapter may be able to help you find people in your area with expertise in diabetes.

JWB
Additional comments from Dr. David Schwartz:

You might want to consider having a contract with your son, taking him out of the loop and placing ALL diabetes checks, glucose checks, insulin dosing, meal-planning, etc. in the HANDS OF A PARENT with consequences to BOTH if there is failure.

Therapy for his noted depression and his seemingly obvious adjustment disorder (with or without concurrent oppositional defiance disorder) must be dealt with by a qualified mental health care professional. If you have the means OR your insurance will pony up, you might seek out help at the Cumberland Hospital for Children & Adolescents in New Kent, Virginia.

DS