From Dallas, Texas, USA:
My 14 year old daughter was diagnosed four months ago. I am very concerned because she seems to be too involved with her diabetes.
At first I thought that it was great that she didn't even hesitate with her first shot, or fingerprick. She read everything she could, and, only a month after diagnosis, her hemoglobin A1c was already down to 8.5% from 13%! She completely took control of her meals and injections, sometimes even remembering them when I forgot. However, lately she has been maintaining a steady blood sugar level of 120 mg/dl [6.7 mmol/L] or below. Most of her readings are below 100 mg/dl [5.6 mmol/L]. She will usually test 10-12 times a day, although some days she has tested as many as 20 times! She wants to wake up at various times during the night to test her sugar so she knows what it is. Her theory is that she doesn't know what it is doing between 9 pm and 6 am so once a night she will test it. One night, she will check at 10 pm, the next at 11pm until she has all of the hours figured out.
I think this is excessive. She gets nervous and upset if her blood sugar is over 140 mg/dl [7.8 mmol/L]. Her last hemoglobin A1c was 5.1%. Even though she maintains good blood sugar, she will eat whatever she wants too. One month out of the hospital she sat down and did the math to figure out her insulin to food ratio and started to eat whatever she wanted (still at the designated times) without checking with the doctor. She switched her own self from an exchange diet to carbohydrate counting, again without consulting the doctor.
Humalog would change her blood sugar immediately after realizing that her lunch was causing her to go high and adjusting morning NPH wouldn't help. She started taking Humalog with lunch.
I'm not sure that she is doing the right things even though her numbers are good, and I need to find out how to get her to talk to the doctor more often. Her doctors don't seem to think there is a problem, but I do. They don't know how much she changes things! Plus, she goes low sometimes 2 or 3 times a day! She catches the low blood sugars right away and treats them, but it still makes me nervous. She says that she would rather have a few lows than have long term complications. I'd rather have her having no lows and running just a little higher, but she won't adjust her schedule to run higher. She wants to maintain blood sugars of somebody without diabetes. I think that she is overreacting.
I talked to the doctor about this too, and she said that since it wasn't controlling her life too much (she still is going out on the weekends, sleepovers, parties, etc.) that it was all fine, but I don't think she is right. She needs so many test strips I can hardly find the money. What can I do to stop this out-of-control behavior? Whenever I try to talk to her she screams at me that she is just trying to control this. What is your opinion, what can I do?
Your daughter needs help. She is beginning down a very dangerous path, where she can easily become burned out by the demands of her diabetes plan, move toward an eating disorder by the way she's manipulating insulin with her food, or suffer from the cognitive impairment that can come from frequent low blood sugars. Please let your diabetes team know what is going on. They need to work with her because she is working under beliefs about diabetes that are not true. Also, ask them to refer you to a mental health professional who is expert at working with teens with diabetes. You will have to be part of her therapy, whether she likes that or not. You can not let her to continue to engage in behavior that is medically dangerous. Please act immediately in getting her the help she needs.
[Editor's comment: Your daughter seems to be doing a great job controlling her diabetes. All the things she has learned are commendable. However, in agreement with Jill, your daughter has become obsessive-compulsive about her diabetes management and needs a mental health professional to help her find a delicate balance between controlling her diabetes and being overly obsessive. SS]
Original posting 18 Feb 2001
Posted to Behavior
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