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Question:

From Cleveland, Ohio, USA:

Our 12 year old son has had type 1 diabetes for two and a half years, and although he is very active with sports, is not overweight, and we watch his carb intake, he has too many high readings (400 mg/dl [22.2 mmol/L]). He is followed by his pediatrician and endocrinologist and is on an established Humalog and NPH insulin program with morning and evening injections. He is often very irritable and has great difficulty waking up in the morning and getting to school. He has not yet accepted that he has diabetes even though we visit a counselor together.

Tender love and infrequent tough love have not helped his mind set. We don't know what else to do and need help for our son. Before he was hit with this, he was very motivated, always happy and loved school. He has many friends, is popular, and is active in sports, scouting, church and other activities, but school has been a problem. He is bright, articulate, and curious, but school attendance has become a constant battle. Also, the fact that I have been unemployed has not helped matters. Thank you for any advice you could give us for our son.

Answer:

My first thought is that your son might really benefit from a session with a registered dietitian. His early morning "crabbiness" might mean an adjustment is needed in his meal plan. Does he wake up with low sugars? Also, the stress of managing diabetes can cause higher than normal readings throughout the day. Any stress can impact blood glucose readings.

From your letter, it sounds as if you are actively involved with your son's diabetes management. Perhaps he is rebelling against such deep involvement by a parent. Does he ever see his counselor alone? He may not risk confiding in a counselor about his food intake or his feelings if you are present. His anger about diabetes is a normal part of adjustment, and he needs the freedom to just be mad in a safe zone. At the age of 12, it is impossible for you to monitor every bite he eats or what choices he makes. So I wonder if he is acting out with food when he is not in your sight.

CMB

Additional comments from Dr. David Schwartz:

I'd add that perhaps the "counseling" sessions need to be with a professional who certainly has experience in dealing with children with chronic illness, especially diabetes.

In that same vein, they should ask their own diabetes team if they have support sessions for teens with diabetes.

I'd think that this young, articulate, bright, athletic person would bloom if he went to a diabetes summer camp.

DS

[Editor's comment: Perhaps the problem is with your son's insulin regimen. The program he is currently on is very limited in terms of the flexibility it allows. You might inquire about using a basal/bolus treatment plan with Lantus once daily and Humalog or NovoLog at mealtimes depending the amount of carb he wants to eat and the premeal blood sugar. This would allow your son a great deal more freedom and be more conducive to a teen's lifestyle. SS]

DTQ-20030908101307
Original posting 11 Sep 2003
Posted to Behavior

  
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Last Updated: Tuesday April 06, 2010 15:09:50
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