I’m very concerned about my 14-year-old cousin who has diabetes. She is overweight, but neither she nor her parents seem to care. Her diabetes is very unstable. Twice in the last year and a half, her blood sugar has gone up due to uncontrolled eating of sweets and other junk food. One of her parents actually encourages her to consume sweets and other junk. He behaves as she is a normal child, which is something that he supports vigorously especially in presence of the child and other relatives.

My family and I are very worried about this child. Several times we have been able to talk with her, but her attitude is at least reckless. We also suggested to the parents to meet a psychologist, to help them all understand the situation and be helpful to their child. They actually visited one once, but the father laughed at the specialist after the session was over and, of course, did not follow any of his instructions.

We haven’t talked to her doctor, as she visits him with her parents and we wonder if it would be wise to talk to him about the parents’ behaviour. We know that the doctor has told them that by Easter, she must weigh 10 kg (22 pounds) less, but she is still overweight and does not pay any attention, mostly because she has full support of her father.

She also has hypermetropia since she was born. I do not know if her diabetes affects this or vice versa.

Please tell me what can we do, as relatives, to help her realize how serious things can get and how to persuade the father, through legal means, to act more responsible. Perhaps we are the ones being oversensitive, but I would like to have a professional opinion.

It sounds like you are a very caring cousin. I know you said you have tried talking to your young cousin about what she is eating, but I would suggest that you try talking to her parents instead about your concerns. It sounds like your cousin is just eating like the rest of her family so it would be difficult for her to change her eating habits unless her family, particularly her parents, want to change. I wonder if your cousin and her parents would consider meeting with a nutritionist to discuss healthy eating for the whole family and how your patient’s food intake should be covered with insulin. I know a lot of children with diabetes and adults with diabetes struggle with all the advice they get about their food choices (a.k.a. the “food police”), so my advice would be to refrain from making comments about what your cousin is eating. I know you are concerned about your cousin, but you may want to try a different approach and try to focus on how encourage your cousin to exercise more and be more active. When I am working with overweight children and teens, I like to focus on fun ways that they can get more activity versus just discussing their food intake. Maybe you and your cousin could go for a hike, or a walk along the water, or go swimming, or just go walking around a shopping mall. There is also a video game that you can buy in this country called DDR (Dance, Dance, Revolution) that involves dancing around on a pad while trying to mimic the steps and dance moves listed on the screen. Finally, I know you said you would like to speak to your cousin’s doctor, but it appears that the doctor may already be aware of your concerns if he/she has already discussed a weight loss goal. I do not know about the confidentiality laws in your country, but as health care providers in this country, we can only talk to a child’s parents or guardians, or any other health care provider involved in the child’s care, unless there is an emergency, or unless the parent or guardian gives us permission. That is why I think it is best to just talk to your cousin’s parents and work on finding creative ways to be more active with your cousin.

DB