Any ideas?

General
1

So I want to preface this with a statement of I know there is a similar post out there right now but I do not want to steal from the other thread. I am looking for some input into this situation. 

The background, my friend Laurie has a 20 year old son who was diagnosed with type one diabetes at 14 years of age. In the beginning he was handling things well. However, for the past few years he has not been doing so hot. First of all, she is convinced that her son is suffering from depression, which I agree with. Might be suffering from diabulimia (jury out on that one from me), but in the end he is not taking care of himself.

Two years ago, he really stopped taking care of himself, not taking insulin, and was very unhealthy. He lost so much weight (hence Laurie's thoughts of Diabulimia). To help him cope with things Laurie did what she could, tried to setup meetings with counselors and the like. Which he did not do. He was not happy in school , but so bright, she had him test out of school by taking the High School equivalency tests. Which he aced. So he was able to work and stay home. He started smoking pot and got busted. Even though he was still on Parole he wanted to go to school in California. So Laurie and her husband did what they could to get him out there and he did a year out there. Not very happy, but decent grades...

He came back home this summer and decided he wanted to go up to Vermont as it was at least closed. He needed a car, so Laurie bribed him, if he kept his grades up and also went to the Doctor and took better care of himself, her and her husband would spring for a car. The bribe was because he again was not taking his insulin. In the fall before he went up to school he "needed" insulin, but he never found a new endo. for adults. He called his old ped. endo. and was able to get a one month supply of insulin.

When he got up to school my friend helped him find an Endo. up there to take care of him. He went to one appointment as far as Laurie has been able to find out and got a prescription for syringes and nothing else. He was supposed to go back two weeks later once the blood work came in. But never did. This is all Laurie has been able to get from the Endo office as he is an "adult". So she has been mad worried about her son again.

He came home over break, still thin and haggard, Laurie did not try to talk to him about his care and control because it turns into a huge fight. Now the other day she finally got his report card for the fall semester 1 B and 3 F's. While she is irritated about the grades, she is more concerned for her sons health and well being. She is convinced he is depressed which is why he doesn't take care of himself. I truly think the bad grades are from his extra curricular activities that got him in trouble back here.

Anyway, she decided she needs to really do something, because she is wasting money and worried about her son. She called his endo's office and got as much info from the receptionist as she could. Probably more than she should have, but she being a concerned mother most likely swayed the receptionist to help her out. She was able to get an appointment on Friday to go meet with the Nurse Practitioner for a good period of time to try and get things sorted out with her son.

Her plan is to head up early Friday morning with her husband and meet the son for lunch. (She let him know they were coming for that, not sure if he ever called her back though). After lunch she plans on basically dragging him to the Endo's office and trying to knock some sense into him. Now she asked me my opinion of the entire thing. I mean, yes I feel he is depressed, but I am not sure this is the best way to handle things. I did warn her that she must know that in ambushing her son like this, he might be mad at her for a long time. They used to fight all the time about his diabetes even after trips to the hospital for DKA in High School. I mean, I would be angry about this and I am not having the problems he does have.

How would you handle the situation? Do you think this is right? Any suggestions?

The one thing she plans on asking her son to do is to sign a release form so she can talk to his doctor's about his health care and also see a counselor. I suggested to contact the JDRF chapter up there for names of people who might be able to help, but again he is very evasive of anything that relates to the D-word.

This is way beyond me and because I am so close to both having the illness and wanting to help Laurie I can't feel this out properly. Thanks.

2

Brian,

It's like you are describing my life with my daughter, only difference being she is younger. My prayers are with him and Laurie. Even at the age of 20, she is still concerned about her son's health and well being. I think my daughter is depressed too. I know life is stressful, and that can factor in, but I also think that some of it is because her numbers are so high all the time. She just seems miserable about anything and everything. I just joined today, but this seems like the place to start.

Good luck.

3

If their son does not welcome discussions about diabetes, what about school or other topics?  They might suggest he speak with his college's services about dropping his grades from the previous semester to help keep him on track.  Looking into depression and uncontrolled diabetes as a means for a retroactive drop can soften the blow (while not recovering tuition), and might require proof such as an hba1c reading or a meeting with a therapist (which his parents seem to want anyway).  Looking into requesting a leave of absence so that he could take a semester or so off from school without losing his ability to come back might be helpful too, if he used the time effectively.  By framing the conversation as a cooperative approach to keep his progress toward degree intact instead of a confrontation about diabetes, it might be more productive.  I worry about the use of ultimatums, as he might end up rejecting them altogether regardless of the consequences.

4

I agree and that is part of my concern. I see the why she wants to do this and in a sense support her. By making demands or ultimatums, when he is not willing to accept life as is can make things worse. I mean I just get annoyed when my mom asks me about my sugar if I am tired. It annoys me, because in my mind I am fine and don't feel like talking about this. For him, who is in denial, once the word is brought up he goes right into shut down mode and doesn't care. In the past she has tried to research clinics and such who deal with counseling and therapy, but the only places who dealt with the mixture of depression and possible diabulimia even with insurance which barely would cover anything would cost them about $30,000. So she pushed that idea to the side. She would do it, but again there is getting him to go. And not wasting the money.

5

Wow, what a terrible situation! Unlike a teenager who is likely going through a "developmental" rebellion, he is an adult. I agree that she should find a formal time to sit down and have an "official" discussion about her concerns, what he thinks his plans are, etc. Obviously she can threaten to cut off their funding for his school, but I agree that it could make him rebel more. Are there other T1's at his school he could talk to? Instead of a threat, could they try bribe? (e.g., x type of control and we will do y...) I wish I could think of better suggestions!

6

Since he is an adult there really isn't anything his mom can do.  Sometimes the person has to hit rock bottom to realize they need/want help.  If he is a threat to himself she can always go to court and ask for a court order to have him committed. 

7

My son has had type 1 for almost 10 years.  Up until about a year ago, he seemed to be doing great.  However, about a year ago, he and I started fighting non-stop about testing, eating, etc.  I didn't realize how controlling I had been since he was diagnosed!  I had been in total charge of keeping his logs, making sure he tested, ate properly, going into every Dr. visit every 3-4 months and doing all the talking for him!  For all those years.  Then, finally my husband, and others told me to back off him and let him start taking care of himself.  So I did.  For months, things calmed down, we fought less, he said he was taking care of himself and I believed him.  Then we went to a Dr. visit and I was blindsighted!  I sat there and didn't say a word while we went through the usual questions from the nurses.  Then, after downloading his testing meters, the Doctor came in the room, looked at my son and "why are you only testing 1-2 times a day?"  I was floored!  I felt like the worst mom!  And, to make matters worse, his A1C came back over 10 for the first time ever.  My son looked at me, but the doctor immediately stepped in and said, "don't look at mom, YOU should know better, this is YOUR responsibility!"  That was a huge turning point for us.  I never said one word the entire office visit, I didn't have to - the doctor talked, the nurse talked, all the while I sat there pretending to read a magazine.  They did not yell at him, they were just very blunt with him about how much weight he had lost, pointed out loss of muscle mass, blurry vision, etc.  They explained what would happen if he kept it up, then they supplied him with a 3-month plan to follow.  When we left, I wanted to scream all the way home, and I am sure my son expected it.  But something had come over me in that moment when the doctor had taken over.  I was scared to death for my son, yet I also felt alittle weight lifted off me when the doctor and nurse stepped in and acted like I wasn't even in the room.  For so long, I felt like we were going to the doctor for a report on how I WAS DOING in caring for him.  I never even gave my son a chance to slowly learn and take responsibility for his own care. 

So I did NOT yell in the car, in fact I didn't even bring up the topic until my son did.  He said, "Sorry mom".  I told him he did not need to apologize to ME.  This was not about ME.  I said you just need to focus on you and do what the doctor says.  We talked a little more about it, then I wanted to change the subject.  We went to lunch, we talked about school, and we laughed for the first time in a long time.  Within 6 months his A1C was down to 7 - the lowest ever!  He was so proud he did it himself.  Now, I am in no way saying everything is perfect.  We still fight about usual teenage boy stuff.  But I am working real hard to steer clear of fights over whether or not he is taking care of himself.  I keep a close watch - but at a distance. At Dr. visits, he and the doctor talk.  I only ask brief questions if I have any and keep mine to a minimum.  The whole dynamic in our home has changed.

Now I know my son is younger than your friend, who is an adult.  However, we have friends who went through the same thing with their son who was in college.  They tried to be patient and hope their son would finally snap out of it.  Unfortunately, it took a few serious hospitalizations for their son to finally start taking of himself.  He is back in college, but at a local college.  He lives on his own and pays own rent from getting a job.  They pay for his tuition. 

I feel for both your friend and mother.  I still have to fight the urge to question my son constantly.  And I can't imagine what it would be like if he was acting like your friend.  If he is not physically healthy, he can't be mentally healthy.  I'm sure he is having a hard time thinking clearly.  And, for the mother, it is hard enough watching your child suffer from this disease - but there is also an added pressure that people are looking at him getting sicker and blaming the parent for not stepping in and taking care of him.  That feeling, for most of us parents, never goes away.  So, I feel for her.  But it sounds like she might have to stop what has not worked and try putting more of the responsibility into her son's and his doctor hands.  It might take the son experiencing a serious hospitalization before he changes.  At least he would be assessed medically to see if he is also experiencing depression as well, which could be standing in the way of him being able to care for himself. 

I wish you, your friend, and his mom the best.  I hope this helps in any small way.  Unfortunately there are no real right or wrong answers. 

8

Specialists for his particular issues may be rare and expensive, but his college likely has individuals who are much cheaper who can help him protect his gpa.  At this point since he won't listen to family for diabetes advice he may listen to college advice (it seems the concern over tuition is a source of stress).  His university will likely want him to see a counselor for a depression screening, and will want an hba1c reading as soon as possible to consider how this may have influenced him last semester.  As he would then be aware of the university academic drop policy, to be able to use this in the future he would need to keep up to date hba1c (with possible conditionals), and stay in touch with a counselor, as after the fact paperwork would likely not be allowed again.  In an indirect fashion, the original goals may be accomplished.