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Question:

From Austin, Texas, USA:

My 9 year old daughter was diagnosed almost two years ago. Basically our problem is her not eating. Every single meal/snack time is a major struggle. No exaggeration! It will literally take her 45 minutes to eat 9 grams protein (for example: 1/3 cup cottage cheese) and 1 cup milk. Needless to say, meals are horrible. Lots of crying, screaming, etc. I am at my wits end! She is in therapy (and the therapist is also at a loss as to how to handle this). She is ADD, bipolar (being medicated with Ritalin, Welbutrin and Depakote [prescription medications for these disorders]). But these eating problems existed long before the ADD and bipolar disorder showed up. She "doesn't like" having diabetes but instead of accepting the fact that she has it and her dealing with it the best she can, she fights it to the fullest extent. Her every waking moment is consumed with her fighting this illness. She has her quarterly appointment with her endocrine doctor today. They have been aware of the struggles but nobody really knows what to do. School district psychologist, therapist and psychiatrist all say, "back off, ignore her eating problems and eventually she will take responsibility for her own decisions." Easier said than done! It is nearly impossible to put her to bed when she refuses to eat her egg and milk - or to send her to school with only a cup of milk in her system (as I had to do this morning).

Her schedule is as follows:

Shot (27 units 70/30) - 6:30 A.M.;
60 grams carbs breakfast 7:00 A.M.;
15 grams carbs/9 grams protein - 9:30 A.M.;
60 to 75 grams carbs - lunch noon;
15 grams carbs/9 grams protein - 2:30 P.M.;
15 grams carbs - 3:30 P.M.;
Shot - 9 units 70/30 6:00 P.M.;
60 grams carbs - 6:30 P.M.;
15 grams carbs/9 grams protein - 8:00 P.M.

I am at the point where I am ready to have the Endo cut her food intake so far back that she is starving all the time. I know it sounds cruel but I am very concerned about the food control turning into an eating disorder.

Can anyone help me? Can anyone give me suggestions? We are desperate!

Answer:

I can tell you are quite frustrated and diabetes can present unique frustrations for parents and their children. Here are some suggestions. Take what is of value to you in your own situation.

  1. Has anyone checked your child to see if she is growing properly and maintaining her growth percentiles?

  2. Could your child have undiagnosed food intolerances? This would explain the aversion to cottage cheese, lactose, etc.

  3. Is it possible that the battle with you over food is symptomatic of struggles unrelated to the diabetes?

  4. Have you considered Diabetes Camp this summer for your child? This experience might lessen the sense of isolation your child may be experiencing.

  5. Has an occupational therapist checked your child for "tactile defensive behavior"?

  6. It is probably not the ideal course to have the MD cut back on your child's calories in an attempt to keep her hungry.

If any of these suggestions is of help, I would be very glad.

CMB

[Editor's comment: I would also like to add a comment about her insulin program. Two shots of premixed 70/30 insulin seem to be an inappropriate choice for a child with unpredictable eating behaviors. Talk to your daughter's endocrinologist about switching to a program using lispro insulin [Humalog®] when she eats, together with longer-lasting insulins like NPH or Ultralente, to smooth out the blood sugar control. WWQ]

Original posting 4 May 1998
Posted to Meal Planning, Food and Diet and Behavior

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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