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Question:

From Botetourt, Virginia, USA:

I'm a 16 year old girl and a type 1 diabetic. I have had diabetes for about six years now and I still refuse to take control of it. At first, for about two years, I stayed in real tight control, which was my honeymoon stage, according to my doctor. I tried the pump out for about two years, but I was uncomfortable having something attached to me all the time. I also had a seizure in my sleep while I was on the pump so taking insulin before I go to bed in another fear of mine. My doctor has me on Lantus in the mornings and before I go to bed and then NovoLog for my sliding scale before I eat. Taking a shot a couple times a day isn't that big of deal for me. I just refuse to take my blood sugar and I really can't explain why. Part of me is scared that it will be high or I know it will be high and I just don't want to get into trouble with my parents. They get so mad at me when my sugar is just a little high and they keep saying that I do this because of my weight.

I have been in DKA (diabetic ketoacidosis) three times now where I've been hospitalized. Each time, the doctors have said that they were surprised I could function like I was the way my blood work came back. My blood sugars can get to as low as in the 30's (mg/dl) [around 1.4 mmol/L] before I start to get shaky and can stay high for weeks without me feeling any different. I know what the side effects are from letting my sugars run high, but I still have trouble staying focused on keeping my sugar normal. I would give anything to get an A1c back that's not above 8.0 and they have been slowly coming down over the last year but I still have problems. I had weight issues about two years ago and that was my reason for letting my sugars run high. Even now that I've accepted my weight, 145 pounds at 5 feet, 4 inches, my parents always go back to that event.

Do you have any suggestions for keeping myself on tasks? I don't like talking to professionals about this for the fact that they make me feel stupid and under them. I have done so much research on diabetes that I could probably educate a newly diagnosed diabetic, as well as their own doctor. I've been on medication for depression before but my mom always takes it from me and says it's not worth her money. I want to move out, but I can't because of diabetes which makes me hate this even more. I can't afford it (insulin, needles, test strips, etc..) on my own because I'm on my parents' insurance. What should I do?

Answer:

There are a lot of mixed messages here! You say you would give "anything" to get in better and control and a lower A1c, yet you refuse to check your glucose and you say you "don't know why." You sound angry and depressed, but you are being undermined and not allowed to take an antidepressant. You don't want to talk to the professionals to help you, but clearly you want help. And you NEED help. I know you need help with your medical condition (and I hope my comments that follow will be somewhat helpful); you may indeed need mental health professional help, too. If your parents are not supportive of that, then engage the assistance of a trusted clergyman, adult relative, neighbor, teacher, etc to talk to your parents about your depression and anger on your behalf. Help is out there! Many communities have mental health clinic to help serve those with limited resources. If you have a medical college in your state or a neighboring state near your city, there typically are resources there also.

Not uncommonly, young people don't want to check glucose readings for fear of the answer that they think they will see. They are afraid of the truth. They begin to look at the glucose readings on the meter as if it were a "report card" and, if you get anything other than a normal target glucose, you think you just got an 'F.' Nobody likes getting bad news. But, the glucose readings are NOT report cards. They are simply numbers to help guide you to help you decide how to intervene: your sugar is low, then eat something. Your sugar is high? Then, check for ketones. I typically ask my patients to check for ketones if the blood glucose value is more than 240 mg/dl; some centers ask you to check ketones when the glucose is more than 300. High glucose with ketones is almost always a reason to take extra insulin. High glucose without ketones may mean extra insulin, but it may also mean that perhaps you shouldn't have that snack you planned or maybe you should drink some extra water and take a little walk around the block first.

The glucose readings also offer you the opportunity to look for patterns. Looking for patterns then helps you and your doctor adjust the insulin and meals. You likely know that different types of insulin start to work at different times and that they last different lengths of time. If you can detect a pattern that you are typically high or low or normal at specific times of the day, you can make smarter decisions as to which insulin may need an adjustment.

Yes, sometimes testing the glucose level hurts. You can adjust the tension on the finger poker/lancet device so as to make a smaller or less deep poke. Ask your diabetes team for one of the newer glucose meters that allows you to check glucose from a site different from a fingerstick, if you are not already doing that. Newer meters can give an answer as soon as 5 seconds for some meters so the "I don't have time to check" excuse doesn't ride with me.

You sound smart. You sound like you really know the right thing and you sound like you want and need help. You CAN take control. But you do need the help of others.

DS

Additional comments from Dr. Jill Weissberg-Benchell:

You are very wise to realize that right now, managing your diabetes responsibilities, managing your weight, and managing your depression all by yourself is not working very well. You clearly have a great deal of knowledge about all of these issues, but knowing what to do does not always result in doing what you know. There are things that are getting in the way for you, such as your worries about other people's reactions to the numbers on your blood sugar meter. However, even though there are things getting in the way, you have managed to improve your A1c recently. That shows that you can be very successful in spite of the barriers in your way. You should feel so very proud of that!

I would recommend that you find one person in your life that can become your diabetes team member. That could be a close friend, a teacher, a diabetes nurse, a physician, a religious leader, or anyone else you know that you feel you can trust. Ask them to help you set small goals, such as checking your blood sugar numbers once per day and to help encourage you to do that every day no matter what that number is. You want this person to be your cheerleader and to be encouraging of every small step you take. Each step will lead you closer to your goal.

I also recommend that you search out an adolescent health program in your community. Often, the care is free and confidential. They may have a counselor there that can help you manage all of the emotional aspects of living with a chronic illness, even if they don't know diabetes as well as you do. You can't have too many people on your side and helping you meet the goals you set.

JWB

DTQ-20040605162702
Original posting 17 Jun 2004
Posted to Behavior and Hyperglycemia and DKA

  
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Last Updated: Tuesday April 06, 2010 15:09:58
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