DIABETIC DYSCONTROL: A SYNDROME OF MISBEGOTTEN CHILDREN IN A METABOLIC NIGHTMARE

Abstract

Diabetic dyscontrol is defined as the persistence of erratic blood glucose levels in the adolescent with insulin-dependent diabetes mellitus who demonstrates proven knowledge of management. It results in multiple recurrent life-threatening episodes of ketoacidosis causing extensive familial disruption, stagnation of education, social isolation, and fragmentation of medical care. A program for treating children with diabetic dyscontrol is described. The patient is hospitalized for an extended period (3-12 months) while a total reeducation process occurs. The focus of treatment is on uncovering the underlying factors responsible for the loss of control and to alter the patient/family relationship so that effective reintroduction into society may occur. A team of professionals consisting of physicians, nurses, psychologists, social workers, nutritionists, and recreational specialists address the specific needs of the patient, using a variety of therapeutic modalities. A series of graduated home passes challenge the patient by reinserting him/her into the community to which he/she may return. Following discharge, the patient is seen by members of the treatment team to provide ongoing support, education, and medical surveillance at regularly scheduled intervals. The success of the program is related to the ability to correctly identify sources of conflict in the patient-family dyad, and to break the cycle of inappropriate and harmful interactions.