From Salamanca, New York, USA:
My daughter is 11 and there is no one in her school area that has diabetes. She feels alone and is getting really depressed about her condition. Her sugars are uncontrolled, the 61 to 450 mg/dl [3.4 to 25.0 mmol/L] range, and she is eating in between meals without proper coverage. I feel so guilty about how upset she already is that I am having trouble "enforcing" what she eats and when. I know her health depends on it, but she already deals with so much. Please, can you advise me in how to set rules and enforce them without making her hate me or herself anymore than she already does?
It is very important that you and your daughter talk about her feelings with her diabetes team. They will have lots of ideas on how to help her manage her sad feelings and feelings of isolation. The large variation in her blood sugars may very well be a part of why she is not feeling well. Please discuss this and discuss strategies to minimize the variation in her blood sugars with your diabetes team.
It may also be helpful for you to talk to her pediatrician, as her physician may also have a referral list of psychologists and social workers who can help your daughter learn ways to cope with her feelings.
As you already mentioned, her ability to cope with the demands of the diabetes regimen requires your consistent support as well. She may feel better if you take over her injections and blood sugar checks, so that she has less to do. She will also benefit from a discussion between the two of you on ways she can graze less. Why is she feeling so driven to eat when it is not the optimal time to eat? Is she willing to eat foods during those times that will not affect her blood sugars? This issue around food choices and food timing should be discussed with a dietician.
Finally, you may enjoy the book The Ten Keys to Helping Your Child Grow Up With Diabetes by Timothy Wysocki, published through the ADA.
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