We have a friend whose son (6th grade) was taken to the hospital in a diabetic coma about 7 months ago. He was taken by his father and all of the information (diet, exchanges, etc.) has since been kept by his father who refuses to give it to him or his mother.
My grandfather gave me an exchange book to look at but I was wondering if you have a diet that would go along with that. I have know idea how many calories a 6th grader needs.
Also, do you have any advise on how to handle a mother who refuses to regulate what her son eats or when he takes his insulin? She has left all of this up to him and I have seen his sugar levels go over 400 and have known him to go up to 48 hours without taking any insulin.
There are really two problems that you raise in relation to your friend's 11 year old son. The first relates to his care and particularly his diet, the second to the problems raised by the animosity between father and mother.
This boy, if reasonably possible, would be best cared for in a situation where there is a team that includes not only a physician but also a nurse educator, a nutritionist and a medical social worker. At this age, current nutrition practice is first of all to assess his normal diet, if necessary subjecting it to a computer analysis. If it turns out to be adequate then the next steps are to smooth out carbohydrate intake with snacks and to help the family grasp the need for a consistent intake from day to day; but with variation in the menu. The exchange system has been a big help with this though nowadays the talk is of "carb counts." The ADA publishes an Exchange List Book which can be a great help. It is not good practice with children to use set diet sheets, because the total calories assigned may be inappropriate. In view of what you say about the mother's attitude, it would help if you could accompany them to the nutritionist.
The relationship between mother and father sounds like an obstinately bitter one which contributed to the boy's admission in coma. The first step, presumably for the mother, would be to examine the court documents on the custody to see whether medical information was to be shared or not. This may or may not have been specified depending on when the separation was effected. The mother could petition the court to specify sharing if this has not already been done. It might possibly be easier to establish a separate pattern of care for the period when she has her son. The doctors would almost certainly collaborate even if the parents did not. The mother might also petition the court to appoint a guardian ad litem to assess the child's position and this guardian would have authority to insist on mediation with the hope that it would induce cooperation in the care of the boy if not a mitigation of hostility between mother and father.
Finally, I am sure that the child himself must need help in coping with this difficult situation. An experienced social worker in a diabetic team could initiate this; but he might also need help from a clinical psychologist, again someone with a wide experience of childhood problems.
Original posting 2 Nov 96
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